PROPOSAL - TRAUMA AS THE CAUSE OF THE PEYRONIES LESION

Purpose: We define the cause of the occurrence of Peyronie's disease. Materials and Methods: Clinical evaluation of a large number of patien ts with Peyronie's disease, while taking into account the pathological and biochemical findings of the penis in patients who have been treat ed by surgery, has led to an understanding of the relationship of the anatomical structure of the penis to its rigidity during erection, and how the effect of the stress imposed upon those structures during int ercourse is modified by the loss of compliance resulting from aging of the collagen composing those structures. Peyronie's disease occurs mo st frequently in middle-aged men, less frequently in older men and inf requently in younger men who have more elastic tissues. During erectio n, when full tumescence has occurred and the elastic tissues of the pe nis have reached the limit of their compliance, the strands of the sep tum give vertical rigidity to the penis. Bending the erect penis out o f column stresses the attachment of the septal strands to the tunica a lbuginea. Results: Plaques of Peyronie's disease are found where the s trands of the septum are attached in the dorsal or ventral aspect of t he penis. The pathological scar in the tunica albuginea of the corpora cavernosa in Peyronie's disease is characterized by excessive collage n accumulation, fibrin deposition and disordered elastic fibers in the plaque. Conclusions: We suggest that Peyronie's disease results from repetitive microvascular injury, with fibrin deposition and trapping i n the tissue space that is not adequately cleared during the normal re modeling and repair of the tear in the tunica. Fibroblast activation a nd proliferation, enhanced vessel permeability and generation of chemo tactic factors for leukocytes are stimulated by fibrin deposited in th e normal process of wound healing. However, in Peyronie's disease the lesion fails to resolve either due to an inability to clear the origin al stimulus or due to further deposition of fibrin subsequent to repea ted trauma. Collagen is also trapped and pathological fibrosis ensues.