What is the origin of Peyronie’s disease?
Recent studies agree that Peyronie’s disease occurs as a result of trauma to the penis (in 37% of cases). In the absence of a real trauma, it could be a repetition of micro-traumas that trigger the onset of disease in patients that are likely genetically predisposed. Indeed patients with Dupuytren’s contracture, in particular, are more inclined to develop Peyronie’s disease (Dupuytren’s Association – Peyronie’s disease was found in 10-15% of cases). Other gene alteration pathologies responsible for collagen degradation were also found. There are other risk factors, such as diabetes, smoking, high blood pressure, taking beta-blockers or rheumatoid arthritis, as well as history of trauma to the penis or urological procedures (catheterisation, resection, intracavernous injections following a radical prostatectomy, etc.).
Peyronie’s disease, therefore, corresponds to abnormal healing of the tunica albuginea of ??the corpora cavernosa. In other words, trauma (or micro-trauma) to the penis causes a break in the microvascularisation of the penis. The bleeding of the tunica albuginea that follows will induce an inflammatory response necessary for any healing. Thus, inflammatory cells (mast cells, polynuclear neutrophils and macrophages) arrive at the bleeding site to allow healing of this “wound” by secreting various substances. The immune response causes the creation of a fibrous plaque composed of dense collagenous connective tissues with rigid elastic fibres (see illustration). Thus, the normal tissue architecture that makes up the tunica albuginea is destroyed locally by this inflammation and the tunica albuginea now bears a “scar”: this is the fibrotic plaque (or fibrous scar nodule), which is found by ultrasound and can sometimes be felt.