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Congenital curvature Peyronies disease and penile fracture

INSTITUTE for the STUDY of ÚROLOGIC DISEASES CENTRE FOR SEXUAL AND REPRODUCTIVE HEALTH CONGENITAL CURVATURE PEYRONIE'S DISEASE &PENILE FRACTURE Source: Hatzimouratidis K et al: Eur Urol 2012; 62:543-52 Levine L and Burnett A: J Sex Med 2013; 10:230-44 TYPES OF PENILE CURVATURES ACQUIRED CURVATURE (Peyronie's disease) SCAR CONGENITAL CURVATURE (born with curvature) Curvatures -of different severity, deviation angle and direction- appear only during erection rendering sexual intercourse difficult or impossible Curvatures are anatomical -structural alterations in the tunica albuginea, which is the part of penis covering the 2 corpora cavernosa CONGENITAL PENILE CURVATURE It is a rare condition CONSEQUENCES that does not affect quality of erection There are major psychological consequences, as it concerns young men who avoid having a sexual life exactly because of their aesthetic problem DIAGNOSIS History and self-photography of erect penis TREATMENT Exclusively surgical treatment (plastic repair) PEYRONIE'S DISEASE - PENILE FRACTURE ETIOLOGY CAUSE MECHANISM The penis bends, resulting in either partial (Peyronie's disease) or total rupture (fracture) of tunica albuginea Injury during sexual intercourse ONLY 20-30% of patients remember it A. Failure of penis to insert the vagina B. Abrupt and violent movements during sexual intercourse or masturbation CHARACTERISTIC FEATURES It usually occurs after the 5th decade What can be observed in the penis (only when erect) In Rare 3-9% spontaneous cure of men 3-13% (10-180°) Curvature Pain during erection is the first symptom in Erectile disorder in Rotation 50% Reduction of length (usually 1-3cm) 35-40% Progression of the disease with increase of penile Deformity e.g. hourglass- like indentation) curvature or rotation in 30-50% of patients (within 12 months) Characteristic in the final stage is the palpable hard plaque formation inside the penis RISK FACTORS PSYCHOLOGICAL EFFECTS Dupuytren's disease (collagen disease) Agitation- anxiety about potential progression (fear for cancer) Diabetes Mellitus Emotional problems (his and his partner's) Hypertension Dyslipidaemia Dysthymia- Depression (1 out of 2 men) Smoking Low testosterone Medical history DIAGNOSIS Sexual history Patient self- photography of erect penis Physical examination Penile U/s (ultrasound) Penile Triplex with drug-induced erection TREATMENT Pharmacotherapy IS INEFFECTIVE Surgery PROVIDES THE SOLUTION, in case impairment is stabilized for >3 MONTHS Penile Traction Devices and Vacuum Erection Device MAY HELP PARTIALLY REDUCE CURVATURE THERE ARE 3 SURGICAL ЛА OPTIONS: 1.Excision or plication of tunica albuginea - procedures that do not usually affect penile function 2. 1.Placement of grafts within tunica albuginea - this procedure though often leads to relapse and may impair erectile function 1.Placement of penile prosthesis, if patient has erectile dysfunction that does not respond to pharmacotherapy 3. TUNICA ALBUGINEA PENILE FRACTURE Full rupture of tunica albuginea, which is rarely accompanied by urethral injury CAUSED BY CHARACTERISED BY CHARACTERISED BY a cracking sound and sudden sharp pain a cracking sound and sudden sharp pain Injury of the erect penis during sexual intercourse (usually with partner on top) or during masturbation (rare cases) EMERGENCY Conservative treatment is usually accompanied in Within the first 6 to 8 hours it must be treated surgically 50-80% Immediate surgical treatment protects erectile function by erectile dysfunction with or without penile curvature Visit Www.imop.gr and get informed on SEXUAL PROBLEMS and their solutions INSTITUTE for the STUDY of ÚROLOGIC DISEASES www.facebook.com/imop.gr You Tbe youtube.com/imopgr E www.twitter.com/imop.gr gplus.to/imop in linkedin.com/in/imop.gr GREEK INFOGRAPHICS

Congenital curvature Peyronies disease and penile fracture

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