Penile Curvature (Penile Deviation): Causes

Pathogenesis (development of disease)

A distinction is made between congenital (congenital) penile curvatures and acquired penile curvatures:

  • Congenital penile curvatures as a result of genetic maldevelopment of the penis are usually discovered in the newborn.
  • Examples of acquired penile curvatures:
    • Induratio penis plastica (IPP, Latin induratio “hardening”, synonym: Peyronie’s disease; ICD-10 GM N48. 6: Induratio penis plastica): areal proliferation of connective tissue (plaques), mainly present on the dorsum of the penis, with an increasing hardening of the penile shaft; disease of the corpus cavernosum: scar tissue (coarse plaques), especially in the area of the tunica albuginea (connective tissue sheath around the corpora cavernosa), leads to abnormal penile curvature with retractions and pain during erection.
    • Penile fracture/penile rupture (more correct would be penile rupture): tearing of the corpus cavernosum or tunica albuginea; penile rupture can occur when the penis is erect and is kinked.

The pathomechanism of induratio penis plastica is not yet considered conclusive. The trauma leads to a separation of the outer longitudinal and inner circular layer of the tunica albuginea, as a result, a fibrotic inflammatory reaction (plaques) develops after hemorrhage. Fibrinogen deposits and dense collagenous connective tissue with little elastin can be detected in the plaques. The microtraumas are usually accompanied by audible and palpable cracking sounds. This is referred to as a latent penile fracture (penile fracture).

An inflammatory stage of induratio plastica is distinguished: here, nodules and indurations (plaques) still feel relatively soft. After about 6-12 months, this stage changes into a stable post-inflammatory, often calcified stage: here, the penile curvatures or bends appear. This is accompanied by calcification in the connective tissue, cartilage or ossification (penile bones).

Etiology (causes) of induratio penis plastica (IPP)

Biographic causes.

Genetic predisposition:

  • Genetic alterations on chromosome 7 (WNT2 locus) and a microdeletion on chromosome 3 (occurring in both IPP and Dupuytren’s disease).

Behavioral causes

  • Consumption of stimulants
    • Tobacco (smoking)

Causes related to disease

  • Diabetes mellitus
  • Penile fracture (penile fracture)