Rigi10™ Malleable Penile Prosthesis
Also Known As
Penile fibrosis, Induratio penis plastica, plastic induration of the penis, penile curvature, PD.⁶˒⁹
Definition
Peyronie’s disease (PD) is an acquired connective tissue disorder characterized by the formation of fibrous scar tissue, or plaques, within the tunica albuginea, the normally elastic sheath surrounding the corpora cavernosa of the penis.¹⁻³ This plaque development leads to a localized loss of elasticity, causing penile deformity, which can manifest as curvature, indentation (e.g., hourglass shape), or shortening of the penis, particularly noticeable during erection.²˒⁴ The condition is considered a disorder of wound healing, where an initial injury or repetitive microtrauma to the penis is thought to trigger an abnormal fibrotic response.⁵˒⁶ While the penis is flaccid, these plaques can often be felt as firm lumps or bands under the skin.⁷ The primary purpose of understanding and diagnosing Peyronie’s disease is to address the associated symptoms, which can include painful erections, difficulty with sexual intercourse, erectile dysfunction, and significant psychological distress for both the patient and their partner.⁴˒⁸
Clinical Context
Peyronie’s disease is typically encountered in adult men, most commonly presenting in their sixth decade of life, though it can occur at any age.⁶ Clinically, it is characterized by the development of a fibrous plaque in the tunica albuginea, which can lead to penile pain (especially during the acute inflammatory phase), curvature or other deformities during erection, and erectile dysfunction.²˒⁴ The pain associated with Peyronie’s disease often subsides over time, typically within 1 to 2 years, but the curvature and plaque usually persist or may worsen.²
Patient selection for treatment depends on several factors, including the phase of the disease (acute or chronic/stable), the severity of the curvature, the presence and degree of pain, the impact on sexual function, and the patient’s overall health and preferences.⁵ The acute phase, which can last for several months up to 1-2 years, is often characterized by penile pain and evolving deformity.²˒⁵ The chronic or stable phase begins when the pain has resolved, and the penile deformity has remained unchanged for at least 3-6 months.⁵
Surgical intervention is generally reserved for men with stable disease (typically for at least 3-12 months with no change in deformity) who have significant curvature that impairs sexual function and who have adequate erectile function, either naturally or with medical assistance.⁵˒⁶ Surgical procedures include tunical plication (shortening the side of the penis opposite the plaque), plaque incision or excision with grafting (lengthening the shorter side of the penis affected by the plaque), and implantation of a penile prosthesis, which may be combined with plaque-releasing maneuvers.⁶ The choice of surgical procedure depends on factors such as the degree of curvature, penile length, and the presence of erectile dysfunction.⁶ Expected outcomes vary depending on the treatment modality. Non-surgical treatments, such as oral medications, intralesional injections (e.g., collagenase clostridium histolyticum, interferon), and mechanical traction therapy, aim to reduce pain, decrease plaque size, and improve penile curvature, but success rates can be variable.⁵˒⁶ Surgical treatments generally have higher success rates in correcting curvature but carry risks such as penile shortening, recurrent curvature, numbness, and erectile dysfunction.⁶