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Cavernosal Fibrosis

Erectile Dysfunction

Also Known As

Corporal fibrosis, Penile fibrosis (when specifically referring to the corpora cavernosa), Corpus cavernosum fibrosis, CCF (Cavernous Cavernosum Fibrosis).

Definition

Cavernosal fibrosis, also known as corporal fibrosis, is a pathological condition characterized by the excessive formation of fibrous connective tissue (scar tissue) within the corpora cavernosa of the penis.¹ It involves the overgrowth, hardening, and/or scarring of these erectile tissues, primarily due to an excess deposition of extracellular matrix components, particularly collagen.² This process leads to a loss of elasticity and smooth muscle content in the cavernosal tissue, impairing its ability to expand and engorge with blood, which is essential for achieving and maintaining an erection. Consequently, cavernosal fibrosis is a significant contributor to erectile dysfunction (ED).³ The condition can result from various etiological factors, including aging, diabetes mellitus, trauma to the penis, complications from priapism (prolonged erection), Peyronie’s disease, chronic inflammation, or as a consequence of certain medical interventions like the explantation of an infected penile prosthesis or chronic intracavernous injection of vasoactive drugs.⁴ The primary purpose of understanding and identifying cavernosal fibrosis is to diagnose and manage the underlying causes of ED and to develop targeted therapies to prevent or reverse the fibrotic changes, thereby restoring erectile function.⁵

Clinical Context

Cavernosal fibrosis is clinically relevant in the context of erectile dysfunction (ED) and penile deformities. It is often encountered in patients with a history of:
  • Priapism: Particularly refractory low-flow priapism, where prolonged erection leads to tissue hypoxia and subsequent fibrosis.³,⁴
  • Penile Trauma: Severe trauma to the penis can initiate a fibrotic healing process.³,⁴
  • Penile Prosthesis Complications: Explantation of an infected penile prosthesis is a common precursor to significant corporal fibrosis.³
  • Peyronie’s Disease: This condition is characterized by the formation of fibrous plaques in the tunica albuginea, but can also involve underlying cavernosal tissue.³,⁵
  • Chronic Intracavernous Injections: Long-term use of vasoactive drugs injected directly into the penis for ED treatment can induce fibrosis.³
  • Systemic Diseases: Conditions like diabetes mellitus and aging are associated with an increased risk of developing cavernosal fibrosis due to factors like oxidative stress and altered signaling pathways.¹,⁴ Hypertension and castration have also been cited as etiological factors.¹
  • Post-Radical Prostatectomy: Cavernosal nerve injury during radical prostatectomy can lead to cavernosal hypoxia and subsequent fibrosis.¹
Patient Selection Criteria: Patients presenting with ED, especially if it’s severe, progressive, or associated with penile pain, curvature, or shortening, should be evaluated for cavernosal fibrosis. Those with the risk factors mentioned above are particularly susceptible. Diagnosis may involve patient history, physical examination, and imaging studies like penile Doppler ultrasound or MRI to assess blood flow and tissue characteristics.
Surgical Procedures: In cases of severe cavernosal fibrosis leading to ED unresponsive to conservative treatments, surgical intervention may be necessary. The primary surgical approach is often the implantation of a penile prosthesis. However, the presence of significant fibrosis makes this procedure more challenging, potentially requiring specialized techniques such as corporal excavation, scar tissue resection, and grafting to create adequate space for the implant and to restore penile length or correct deformities.³
Expected Outcomes: The expected outcome of treating cavernosal fibrosis depends on its severity and the chosen intervention. Conservative treatments in early or mild cases, such as phosphodiesterase-5 inhibitors (PDE5is) or pentoxifylline, aim to halt or reverse the fibrotic process and improve erectile function, though their efficacy in established, severe fibrosis is limited.³ For severe cases, penile prosthesis implantation can restore sexual function, but the presence of fibrosis can impact the complexity of the surgery, recovery, and final penile size.³ Recovery from prosthesis surgery typically involves a period of healing and adjustment, with success rates for achieving intercourse being generally high, although complications like infection, erosion, or mechanical failure can occur.

Scientific Citation

[1] ScienceDirect. Penile fibrosis - an overview. Available at: https://www.sciencedirect.com/topics/medicine-and-dentistry/penile-fibrosis (Accessed: May 14, 2025) .

[2] ScienceDirect. Penile fibrosis - an overview. Available at: https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/penile-fibrosis (Accessed: May 14, 2025) .

[3] Egydio PH, Kuehhas FE. Treatments for fibrosis of the corpora cavernosa. Arab J Urol. 2013 Jul;11(3):294-8. doi: 10.1016/j.aju.2013.05.004. Epub 2013 Jul 9. PMID: 26558095; PMCID: PMC4443017.

[4] Cho MC, Song WH, Paick J-S. Suppression of Cavernosal Fibrosis in a Rat Model. Sex Med Rev 2018;6:572–582. (Cited in ScienceDirect overview)

[5] Mayo Clinic. Peyronie disease - Symptoms and causes. Available at: https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468 (Accessed: May 14, 2025) . (Note: While about Peyronie's, it describes fibrous scar tissue formation relevant to understanding fibrosis).

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