Penile deviation – colloquially called penile curvature – (lat. coles scoliosis) refers to a deformation of the penis of varying degrees.
Note: Slight bending of the flaccid or erect penis can occur naturally.
A distinction is made between congenital (congenital) penile curvatures (ICD-10-GM Q55.6: Other congenital malformations of the penis) and acquired penile curvatures:
- Congenital penile curvatures resulting from 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 in the process
Congenital (congenital) penile curvature affects approximately 2-4% of all men worldwide.
The prevalence (disease frequency) of acquired penile curvature is 3-7%, depending on the age of the man.
Frequency peaks of induratio penis plastica: 30-39 years (1.5%), 40-59 years (3%), 60-69 years (4%) and over 70 years (6.5%).
Course and prognosis: Induratio penis plastica IPP) has a biphasic course. An active phase is distinguished from a stable phase. In the active phase, painful erections occur and there is increasing penile deviation (curvature of the penis). In the stable phase, there is stable penile deviation with no pain. Penile deviation is often accompanied by penile shortening. There is usually spontaneous improvement of pain within 6 months. As the disease progresses, erectile dysfunction (ED; erectile dysfunction) becomes increasingly apparent.In about 90% of men, the disease stops after 3 years. There is no chronic disease of induratio penis plastica.In less than 10% of cases, late recurrence (recurrence of the disease) occurs even after 5 to 10 years.Spontaneous regression of the disease is possible, but occurs only in about 15% of all cases.
Start of therapy: as early as possible, i.e. during the active inflammatory phase. Nowadays, the therapy of IPP is multimodal, i.e. the therapy concept consists of a drug therapy including supplements (dietary supplements: e.g. antioxidants and L-arginine), mechanical penis modeling (targeted penis stretching and bending exercises), if necessary also the use of penis stretching devices and vacuum therapy as well as extracorporeal shock wave therapy (ESWT). Surgical procedures should only be used in cases of severe functional impairment, i.e. severe penile curvature with significant problems with cohabitation (intercourse). Before surgical intervention, it must be ensured that there is a disease arrest of about 6-12 months.
Comorbidities (concomitant diseases): In about 30-40% of patients with induratio penis plastica (IPP) there is also Dupuytren’s disease (disease of the palmar aponeurosis of the hand (tendinous structures of the palm); mostly the 3rd-4th fingers are affected, which sometimes show considerable bending) and in about 2-5% of cases there are similar changes on the sole of the foot (Mobus Ledderhose). Common to IPS and the two comorbidities mentioned are genetic alterations on chromosome 7 (WNT2 locus) and a microdeletion on chromosome 3.
