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Peyronie's disease is a connective tissue disorder involving the peyronie's disease and viagra growth of fibrous plaques 3 in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and peyronie's disease and viagra shortening. 4 5 6 7, a variety of treatments have been used, but none have been especially effective. It is estimated to affect about 10 of men. 2, the condition becomes more common with age. 2, contents, signs and symptoms edit, example of penis deformation from side. A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature. The disease may cause pain; hardened, big, cord-like lesions (scar tissue known as "plaques or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (cita). Citation needed, although the popular conception of Peyronie's disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though it is unclear whether some men report satisfactory or unsatisfactory intercourse in spite of the disorder. It can affect men of any race and age. The disorder is confined to the penis, although a substantial number of men with Peyronie's exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including. Dupuytren's contracture of the hand. An increased incidence in genetically related males suggests a genetic component. 8, the underlying cause of Peyronie's disease is not well understood, but is thought to be caused by trauma or injury to the penis usually through sexual intercourse or physical activity, although many patients are often unaware of any traumatic event or injury. 9, diagnosis edit This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease. The top image shows normal anatomy whereas the bottom image shows scar tissue on the tunica albuginea (penis). The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing). A urologist may be able to diagnose the disease and suggest treatment. An ultrasound can provide conclusive evidence of Peyronie's disease, ruling out congenital curvature or other disorders. 10 Treatment edit Without treatment, about 1213 of patients will spontaneously improve over time, 4050 will get worse and the rest will be relatively stable. This is based on a survey of 97 men and therefore based on the subjective impression of the patients. No objective long-term natural history via continual evaluation of patients has been recorded to date. 11 Medication and supplements edit Many oral treatments have been studied, but results so far have been mixed. 12 Some consider the use of nonsurgical approaches to be "controversial". 13 Collagenase clostridium histolyticum (marketed as Xiaflex by Auxilium a drug originally approved by the FDA to treat Dupuytren's contracture, is now an FDA-approved injectable drug for treatment of Peyronie's disease. The drug is reported to work by breaking down the excess collagen in the penis that causes Peyronie's disease. 14 15 Vitamin E supplementation has been studied for decades, and some success has been reported in older trials, but those successes have not been reliably repeated in larger, peyronie's disease and viagra newer studies. 16 A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition. 17 Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba 18 pentoxifylline (acting through TGF1 inhibition 19 and Coenzyme Q10. 20 The efficacy of Interferon-alpha-2b in the early stages of the disease has been reported in recent publications, but it was found to be less effective in cases where calcification of the plaque had occurred in common with many treatments. Surgery edit Surgery, such as the "Nesbit operation" (which is named after Reed. Nesbit (18981979 an American urologist at University of Michigan 24 is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases. 25 Physical therapy and devices edit There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment, but there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult. 26 Counseling edit Peyronie's disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's disease to exhibit depression or withdrawal from their sexual partners. 27 See also edit References edit Freedberg, Irwin.; Fitzpatrick, Thomas. Fitzpatrick's dermatology in general medicine (6th.). New York: McGraw-Hill, Medical Pub.