What is Peyronie's disease? Causes, symptoms, and an overview of treatment options. Peyronie's disease in men - what is dangerous, how to treat it Peyronie's disease ICb code 10

Clinical symptoms of Peyronie's disease occur in 0.39-2% of cases, but this prevalence is only a statistical equivalent of seeking medical attention for this disease. The true prevalence of Peyronie's disease is much higher - 3-4% of cases in the general male population. 64% of men who suffer from Peyronie's disease are in the age group from 40 to 59 years, with a general occurrence in a fairly large age population - from 18 to 80 years. In men under the age of 20, Peyronie's disease occurs in 0.6-1.5% of cases.

Causes of Peyronie's disease

The causes of Peyronie's disease remain not fully understood.

The most widespread theory of the occurrence of Peyronie's disease as a result of chronic traumatization of the cavernous bodies of the penis during coitus. According to the post-traumatic theory, inflammatory mediators in the area of ​​microtrauma of the albuginea disrupt the reparative process by changing the ratio of elastic and collagen fibers in the penis. Peyronie's disease is often combined with Dupuytren's contracture and other local forms of fibromatoses, which makes it possible to characterize this disease as a local manifestation of systemic collagenosis.

There is also an autoimmune theory for the development of Peyronie's disease. According to this theory, Peyronie's disease begins with inflammation of the albuginea of ​​the cavernous bodies of the penis, accompanied by lymphocytic and plasmacytic infiltration. The infiltrate, as a rule, does not have clear boundaries. In the future, the formation of a site of fibrosis and calcification occurs in this zone. Since during erection the extensibility of the albuginea in the plaque area is sharply limited, there is a varying degree of curvature of the penis.

As a rule, the process of plaque formation and stabilization of the disease occurs 6-18 months after its onset.

Involvement in the process of Bucca's fascia, perforating vessels and dorsal arteries of the penis leads to a violation of the mechanism of vein occlusion and arterial insufficiency of the penis.

Peyronie's disease symptoms

The symptoms of Peyronie's disease are as follows:

• erectile deformity of the penis;
• the formation of a palpable plaque or "bumps" on the penis

Exist Various types clinical course of Peyronie's disease.

Symptoms of Peyronie's disease may be absent and manifest only by the presence of "neoplasms" of the penis, which can be detected by palpation. In the clinical course of Peyronie's disease, there may be severe pain and deformity of the penis during erection. In some cases, especially with the circular nature of the lesion, there is a significant shortening of the penis, and sometimes Peyronie's disease is clinically manifested only by erectile disorders.

During Peyronie's disease, an "acute" phase and a stabilization phase are distinguished, which lasts from 6 to 12 months. Complications that develop in the natural course of Peyronie's disease include erectile dysfunction and shortening of the penis.

Diagnosis of Peyronie's disease

Diagnosis of Peyronne's disease, as a rule, is not difficult and is based on the anamnesis, the man's complaints and physical examination (palpation of the penis). Rarely, Peyronie's disease disguises itself as penile carcinoma, leukemic infiltration, lymphogranuloma, lesions in late syphilis. More often, Peyronie's disease has to be differentiated from lymphangitis and thrombosis of the superficial veins of the penis.

Examination of a patient with Peyronie's disease, along with general clinical methods, involves:

• assessment of the degree of erectile deformity (photography, injection tests or tests with phosphodiester type 5 inhibitors);
• assessment of the anthropometric characteristics of the penis in a relaxed state and in a state of erection;
• study of penile hemodynamics (pharmacodopplerography, nocturnal penile tumescence).

It is advisable to conduct sexological testing.

Ultrasound of the penis is widely used in the diagnosis of Peyronie's disease. Unfortunately, plaque identification with a detailed structure is possible only in 39% of cases, due to its polymorphism and multilevel growth pattern.

Diagnosis example

• Peyronie's disease, stabilization phase, erectile deformity.
• Peyronie's disease, stabilization phase, erectile constriction deformity, erectile dysfunction.

Peyronie's disease treatment

There is no etiotropic treatment for Peyronie's disease. Usually, drug treatment and physiotherapy methods are used in the acute inflammatory phase of Peyronie's disease. The goal of conservative treatment is to relieve pain, limit and reduce the area of ​​inflammation and accelerate the resorption of infiltrates.

All methods of conservative treatment are aimed at stabilizing the pathological process. For conservative treatment, oral medications: vitamin E, tamoxifen, colchicine, carnitine, various NSAIDs.

For local injection of drugs into the plaque, hyaluronidase (lidase), collagenase, verapamil, interferons are used.

In most cases, combined treatment of Peyronie's disease is carried out using various methods of physiotherapy (electrophoresis, exposure to laser radiation or ultrasonic waves). Treatment of Peyronie's disease is carried out continuously or in fractional courses for 6 months. Data regarding the effectiveness of pharmacotherapy and physiotherapy treatments for Peyronie's disease are very mixed, due to the lack of a standardized approach to assessing the final results.

Surgical treatment of Peyronie's disease

Curvature of the penis, which prevents or hinders sexual intercourse, erectile dysfunction (impotence), shortening of the penis are indications for surgical treatment of Peyronie's disease. Surgical treatment deviations of the penis consists in shortening the "convex" part of the cavernous bodies (Nesbit's operation, plication techniques), lengthening the "concave" part of the cavernous bodies of the penis (patchwork corporoplasty), or phalloendoprosthetics.

In 1965, R. Nesbit introduced into practice a simple method for correcting the deviation of the corpora cavernosa in congenital erectile deformity, and since 1979 this surgical technique has been widely used in Peyronie's disease. Currently, this method is widely used in the USA and many European countries both in the classical version and in modification, and many urologists consider it as the standard for correcting deformities in Peyronie's disease. The essence of the Nesbit operation is to cut out an elliptical flap from the albuginea on the side opposite to the maximum curvature. The defect of the albuginea is sutured with non-absorbable sutures.

Modifications of the classical Nesbit operation differ in the number of resected areas of the albuginea, options for creating an intraoperative artificial erection, and a combination with various options corporoplasty, in particular with plication techniques or in combination with plaque dissection and the application of a synthetic flap.

An example of a modification of the Nesbit operation is the Mikulich operation, known in Europe as the Yachia operation. The essence of this modification is to perform longitudinal incisions in the zone of maximum curvature of the penis, followed by horizontal stitching of the wound.

The effectiveness of the Nesbit operation and its modifications (according to the criterion of deformity correction) ranges from 75 to 96%. The disadvantages of the operation include a high risk of damage to the urethra and neurovascular bundle with the development of erectile dysfunction (impotence) (8-23%) and loss of sensitivity of the glans penis (12%). Shortening of the penis is noted in 14-98% of cases.

An alternative to the Nesbit operation is plication of the albuginea of ​​the penis. The essence of this type of corporoplasty is invagination of the albuginea without opening the corpora cavernosa in the zone of maximum deviation. During the operation, non-absorbable suture material is used. Differences in the methods of plication relate to the options for creating duplications of the albuginea, their number and marking the levels of overlap.

The efficiency of plication corporoplasty is very variable and ranges from 52 to 94%. The disadvantages of this type of surgery include shortening of the penis (41-90%), recurrence of deformity (5-91%) and the formation of painful seals, granulomas that can be palpated under the skin of the penis.

Indications for plication corporoplasty:

• deformation angle not more than 45°;
• absence of "small penis" syndrome:
• no hourglass deformity.

Plication corporoplasty can be performed both with preserved erectile function and with erectile disorders in the stage of compensation and subcompensation, provided that phosphodiesterase type 5 inhibitors are effective. The Nesbit operation is indicated only with preserved erectile function at the clinical and subclinical levels.

Indications for patchwork corporoplasty ("lengthening" techniques):

• deformation angle over 45°;
• syndrome "small penis":
• change in the shape of the organ (deformation with narrowing).

A prerequisite for patchwork corporoplasty is intact erectile function.

Flap corporoplasty can be performed both with incision and excision of the plaque, followed by replacement of the defect with natural or synthetic material. The question of the optimal plastic material remains open. When patchwork corporoplasty is used:

• autografts - venous wall of the great saphenous vein of the thigh or dorsal vein, skin, vaginal membrane of the testicle, vascularized flap of the preputial sac: o allografts - cadaveric pericardium (Tutoplasi), dura mater;
• xenografts - submucosal layer of the small intestine of animals (SIS);
• synthetic materials Gortex, Silastic, Dexon.

The efficiency of flap plasty (in terms of deviation correction) is very variable and ranges from 75 to 96% when using an autovenous graft. 70-75% when using a skin flap. 41% - freeze-dried flap from the dura mater, 58% - from the vaginal testicular membrane. The main complication of flap corporoplasty is erectile dysfunction, which occurs in 12-40% of cases.

Experimental studies have confirmed the advantages of using a venous flap compared to skin and synthetic ones. The operation using a flap of the great saphenous vein was proposed by T. Lue and G. Brock in 1993 and is currently widely used.

The indication for the implantation of penile prostheses with simultaneous correction of deformity in Peyronie's disease is a widespread lesion of the penis and erectile dysfunction (impotence) in the decompensation stage, which is not amenable to therapy with phosphodiesterase-5 inhibitors. The choice of penile prosthesis depends on the degree of deformity and the choice of the patient. It is customary to regard the “success” of phalloendoprosthetics with a residual curvature less than or equal to 15. In the case of a more pronounced residual deformity, either manual modeling according to Wilson S. and Delk J. is performed, or plaques are dissected with (without) subsequent flap corporoplasty.

Peyronie's disease (ICD code 48.6) is diagnosed when foci of fibrosis are detected in the albuginea of ​​the penis (fibroplastic induration). These formations cause deformation of the organ, which manifests itself during an erection. In a number of sources, the pathology is known under the name "penile fibromatosis". The disease is rare, it is fixed mainly in men of the age category from 35 to 70 years. It almost never occurs in boys. Peyronie's disease not only distorts appearance penis, but is also accompanied by pain during erection, depriving a man of intimate life.

Peyronie's disease manifests itself with the following symptoms:

• the appearance of seals (plaques) and fibrin bands under the skin of the penis, a decrease in its turgor (elasticity);
• pain during erection, aggravated during frictions. The symptom is caused by the pressure of the seals on the blood-filled cavernous bodies;
• gradually increasing degree of deformation of the erect member. There are three types of curvature: dorsal (up), ventral (down), lateral (sideways).

In the acute form of Peyronie's disease, pain and a pronounced change in the shape of the penis occur already at the initial stage, which lasts from 6 to 18 months, then the pain subsides and the chronic phase begins.

In most cases, the pathology develops slowly. For a long time, the only symptom is barely palpable single or multiple seals under the skin of the penis. Dull pain may come and go periodically. As the disease develops, the intensity of pain symptoms increases, the curvature of the penis during erection can reach 60-90 degrees.

Complications

Although Peyronie's disease is not fraught with the development of life-threatening complications, but without diagnosis and treatment, this pathology makes intimate life impossible. Infertility, termination of relationships, severe depression and neurosis - this is an incomplete list of negative consequences.

From the moment of the birth of the plaque to the completion of its formation, it takes about a year and a half. The disease tends to progress. Spontaneously pathology is resolved only in 13% of cases. A big mistake is trying to self-medicate with medications, physical effects or injections. This can lead to new seals, hematomas, suppuration, stricture (narrowing) of the urethral canal.

Reasons for development

Injury to the trunk of the penis leads to ruptures and displacement of collagen fibers, damage to blood vessels, and the formation of hematomas. Normally, tissue regeneration occurs without consequences, but in some cases, fibroblast cells are activated, producing fibrin in large quantities. Gradually, the inflamed area is replaced by scar tissue, which eventually matures, calcifies and becomes hard (osteogenic degeneration).

Injuries are considered the most common cause the onset of the disease. In 70% of patients with Peyronie's disease, damage to the penis occurred during sexual intercourse when the partner is on top.

A significant part of specialists in the field of urology tends to the autoimmune origin of the disease, believing that the cause of scarring is an attack of one's own immunity on the tissues of the albuginea. Such a pathology is not systemic, like lupus or arthritis.

The disease state is manifested by the appearance of extraneous sclerotized plaques in the erectile (protein) tissue, leading to the bending of the penis during potency. Patients with sexual ailment usually have several foci of connective tissue growth, however, the bending of the crooked penis is observed predominantly upward, although bending slightly to the right and left is also possible. Changes are often diagnosed in patients older than 50 years, but the detection of curvature is possible at an earlier age.

Reference! Alternative names for Peyronie's disease are penile fibromatosis and van Buren's disease.

Why is it so called?

The development of a foreign tissue fragment was discovered by the French surgeon Francois Peyronie in the first half of the 18th century.
The discovery made it possible to name the disease in honor of an outstanding doctor, who also determined the dependence of the direction taken by the penis during an erection on the location of the “tumor” in the penis.

Curvature in the presence of plaque in right side also leads to a deviation of the direction in this direction(to the lesion). Therapy in those days was limited only to mercury rubbing and mineral compresses, which occasionally brought benefits.

Already in the 18th century, Peyronie associated a high risk of developing the disease after suffering a sexually transmitted disease.

Does it pose a threat to the life of a man?

The curvature of the male penis does not belong to the group of diseases that can bring a threat to life, however, the displacement significantly worsens the quality of life of a man. Strong changes in the direction of the penis complicate sexual penetration and bring discomfort to the partner - as a result, the patient is forced to reduce the number of sexual contacts.

ICD-10 disease code

According to ICD-10, this disease has a numerical designation N48.6, which belongs to the group of urological diseases, which also includes balanitis and plastic induration of the penis.

Percent chance of developing the disease in childhood

Incorrect distribution of the cavernous and albuminous membranes during the formation of the fetus leads to the occurrence of congenital Peyronie's disease. Pathology is observed in six children per 1000 born boys (0.6%), although earlier (40 years ago) this ratio was only 2 children (0.2%) who had a curvature of the penis to the number of births described above.

Prerequisites for the disease

Doctors attribute the abnormal development of the fetus due to the influence of the careless behavior of the mother - smoking, hormone therapy or stress during the period up to 15 weeks of pregnancy. Peyronie's disease often develops in babies who have been exposed to intrauterine infection.

Increased risk of developing with other congenital diseases:

• cryptorchidism;
• inguinal hernia;
• hydronephrosis.

The prerequisites for the development of the disease are also created in the presence of a hereditary factor that can affect several generations in a row. The problem of diagnosis in children lies in the appearance of stable erections only in adolescence, so the child or his parents may not immediately notice the curvature. The exception is significant lesions that are noticeable even when examining a member that is in a calm state.

In adolescence, active penis lengthening also begins., forcing the owner of the disease to quickly identify signs of abnormal development of the penis. If a child has a congenital deficiency of the skin of the penis, then the curvature is formed not due to the presence of a plaque, but to pathological stretching of the skin during an erection. This condition is not Peyronie's disease.

medical fact. The risk of acquiring congenital changes in the penis by the fetus increases with in vitro fertilization.

What are the symptoms and manifestations of a crooked penis?

After the appearance of a patch of connective tissue within a year, the body can eliminate it naturally, but if this does not happen, then it remains for life. Every year the patient's condition worsens due to an increase in the angle of curvature of the penis.

Signs of Peyronie's disease:

• sensation of a seal under the skin;
• pain during friction;
• reduction in the length of the penis;
• decrease in potency.

The last negative consequence is diagnosed due to the gradual compression of the growths of the vessels that feed the penis. Lacking the flow of fluid, the crooked penis remains soft, leading to the inability to maintain full sexual activity.

Attention! The chronic fibrotic stage develops immediately after the acute stage of the course of the disease, in which there are severe pains in the penis.

Possible reasons

The mechanisms of development of changes in the tissues of the penis are diverse - from autoimmune to mechanical. Usually they are connected: after traumatizing the penis, the body begins to perceive certain tissues as unwanted and begins to “attack” them. The desire to engage in rough sex often leads to microtrauma that can create a focus for the formation of fibrotic changes. Especially a penis fracture is dangerous, which forms gross damage due to hemorrhage.

Urologists also highlight a high probability of influence medicines a group of beta-blockers used to correct cardiovascular ailments, as well as hypertensive drugs used for hypotension. It is also possible to acquire an ailment due to the deliberate creation of excessive pressure on the genitals, an example is the use of devices, weights and extenders to increase the length of the penis.

Individuals with gout, atherosclerosis and diabetes are more likely to have Peyronie's disease.

Complications when refusing medical intervention

In the initial stage, the plaque is actively growing, so it retains the semblance of flexible cartilage, during the transition to the chronic stage, it is gradually saturated with calcium, so it quickly becomes hard.

In advanced cases, on palpation, it resembles a bone - resorption of such a fragment is impossible, therefore, only surgical removal of the growth is indicated. The presence of dense foreign body capable of equally creating a curvature up to 90 degrees.

Other threats:

• impotence;
• depression;
• infertility;
• blockage of blood vessels.

Destructive transformation leads to a slow displacement of the opening of the urethra, which shifts towards the focal lesion, mainly in the region of the coronary sulcus.

In such men, the ejaculation does not occur directly, but to the side, which creates inconvenience during the finalization of sexual intercourse without a condom. By creating tension in the tissues of the penis, the disease also leads to dysplasia of the foreskin - "hood syndrome" - and the creation of tingling in the hole and adjacent areas of the mucosa.

The narrowing of the lumen of the vessels leads to the inability to correct a weak erection with stimulants: blood flow even in this state remains limited. The most dangerous condition involves necrosis of the tissues of the penis, caused by malnutrition of the cells for a long time.

Important! The presence of only one plaque often does not lead to penis curvature.

Overview of treatment options

The choice of an effective method of correction depends on the stage of the disease, determined by laboratory tests - ultrasound, MRI or CT of the penis. It is easy to diagnose the presence of seals with the help of palpation.

1. surface impact. Rubbings are used at the initial stage of the disease and are often associated with folk recipes (baths with sage, the use of ointments with horse chestnut). Sometimes even leeches are used, but official medicine recognizes such methods as ineffective.
2. Oral intake. Conservative treatment includes the use of vitamin E (strengthens immunity and reduces pain), Tamoxifen (inhibits the development of scar tissue), Colchicine (relieves inflammation).
3. Minimally invasive intervention. The introduction of a solution that promotes tissue dissolution includes injections of Lidase, Hydrocortisone. Lidocaine injections are given to relieve pain, and interferon-based drugs are used to strengthen immunity. Verapamil is used to prevent calcium buildup in plaque (effective for men with an angle of curvature up to 30 degrees). In European countries, injections with the enzyme collagenase are also increasingly used.
4. Physiotherapy. Tissue resorption is facilitated by electrophoresis sessions with Chemotrypsin and Lidocaine. Ultrasound is also used, which increases the likelihood of destruction of destructive tissue.
5. Surgical correction. Straightening with a scalpel is carried out with the ineffectiveness of other methods and stabilization of the disease (transition to the fibrotic stage). Perhaps 3 options for the surgeon - complete removal of protein tissue, lengthening (straightening of the plaque) and endoprosthesis replacement of the penis.

Endoprosthetics is performed by replacing the pathological site with an implant if the patient has a weakening or lack of erection.

The operative method of straightening is contraindicated in the presence of balanoposthitis, orchitis, urethritis and other inflammatory diseases of the urogenital area.

Useful video

Watch an interesting video about Peyronie's disease:

Conclusion

Curvature of the penis is an unpleasant condition that is recommended to be treated immediately after detection. Delay leads to an increase in the inclination of the penis and the development of destructive changes in the fibrous tissue, which becomes more and more difficult to eliminate over time.

Despite this nuance, the prognosis of treatment is favorable, since during surgical intervention, the restoration of the correct geometry of the penis is diagnosed in more than 95% of cases.

Erection- an increase in the penis in volume with a sharp increase in its elasticity; due to stretching and filling with blood of the cavernous bodies during sexual arousal, which makes it possible to have sexual intercourse.

Code by international classification ICD-10 diseases:

• N48.4

Erectile dysfunction is the inability to have an erection or maintain it at a level sufficient to perform a normal sexual intercourse, lasting for at least 6 months. The disorder does not always accompany aging and may be absent in extreme old age. With age, the frequency and severity of ejaculations, the degree of sexual tension and the need for ejaculations decrease, and the ability to have an erection often remains. While maintaining morning erections and a good erection during masturbation, mental factors play a major role in the development of the disorder. With a persistent inability to erect under any circumstances, an organic cause is suggested. Erection disorders can be true and imaginary (dissatisfaction with erection, caused by its inconsistency with subjective and often false ideas about it) and be combined with ejaculation disorders.

Frequency- 52% of men aged 40 - 70 years. Only 10% of patients seek help from specialists.

Causes

Etiology. Functional disorders of the central nervous system. Organic lesions nervous system. Diseases of the genital organs with damage to their receptor apparatus (prostatitis, urethritis, colliculitis). Endocrine disorders (primary hypogonadism [due to direct damage to the testicles], secondary hypogonadism [due to damage to the pituitary gland, adrenal glands, thyroid gland], senile erectile dysfunction). Lesions of the penis (malformations [underdevelopment, short frenulum], injuries [fracture], fibroplastic induration of the penis [Van Buren's disease, Peyronie's disease] - thickening of the albuginea and septum of the penis with the formation of nodules or plates that are not soldered to the cavernous bodies hence the deformation of the penis during erection; chronic cavernitis, priapism). Somatic diseases (arterial hypertension, diabetes, ischemic heart disease, lipidemia, hypercholesterolemia, renal failure). Vascular lesions (Lerish syndrome). Drugs (for example, antihypertensive, b - blockers, antidepressants). Alcoholism, drug addiction.

Symptoms (signs)

Clinical picture

Patients complain of lack of erection during sexual arousal (falloplegia).

Less commonly observed deformation of the penis during erection, making sexual intercourse impossible.

Depending on the etiology, the following are possible: .. Neurotic disorders (anxious, phobic) .. Signs of endocrine disorders ... Female-type hair growth ... Gynecomastia ... Cryptorchidism or testicular atrophy ... Complaints characteristic of male menopause (irritability, tearfulness, hypochondriasis, headaches, etc.) .. Leriche's syndrome (obliterating atherosclerosis of the bifurcation of the aorta and arteries lower extremities): intermittent claudication; systolic murmur heard over the abdominal aorta; lack of pulsation of the femoral arteries. Neuropathy. Epiconus syndrome is a combination of symmetrical peripheral paresis (paralysis) of the feet with the absence of Achilles reflexes, dissociated sensory disturbances along the posterior surface of the thigh, lower leg, outer edge of the foot, and erectile dysfunction, caused by damage to the I and II sacral segments of the spinal cord.

DIAGNOSTICS

Collection of anamnesis. During the initial collection of anamnesis, it is necessary to create a trusting atmosphere. It is necessary to find out the patient's sexual relations in the present and the past, the emotional state, the onset and duration of erectile dysfunction, whether he sought help from a specialist in the past and what treatment he received. It is necessary to ask in detail about erotic and morning erections separately: the degree of penile rigidity, duration. Details of sexual arousal, ejaculation and orgasmic experiences must also be clarified. To objectify the data obtained and control the effectiveness of therapy, you can use one of the approved questionnaires, for example, the International Index for Erectile Function (IIEF).

It is necessary to answer 15 questions regarding the assessment of erectile function during the last 4 weeks; Each question can be scored with a maximum of 5 points.

1. How often did you have an erection in situations that usually cause sexual arousal (sexual intercourse, masturbation, watching erotic films, photos, etc.)? .. 0 - No sexual activity as such .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time .. 5 - Almost always or always

2. How often, when an erection occurred, was it sufficient to initiate sexual intercourse (insertion of the penis)? .. 0 - No sexual activity as such .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time .. 5 - Almost always or always

3. How often were you able to insert your penis during sexual intercourse? .. 0 - No sexual intimacy .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time. .5 - Almost always or always

4. How often did you maintain an erection after the insertion of the penis? .. 0 - No sexual intimacy .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time. .5 - Almost always or always

5. How difficult was it to maintain an erection throughout the entire intercourse? .. 0 - No sexual intimacy.. 1 - Extremely difficult.. 2 - Very difficult.. 3 - Difficult.. 4 - Not very difficult.. 5 - Not difficult.

6. During the last 4 weeks, how many times have you tried to have sexual intercourse? .. 0 - No attempts .. 1 - 1-2 attempts .. 2 - 3-4 attempts .. 3 - 5-6 attempts .. 4 - 7-10 attempts .. 5 - 11 attempts or more

7. How often were you satisfied with the quality of sexual intercourse? .. 0 - Didn't try .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time .. 5 - Almost always or always

8. How pleasant is sexual intercourse for you? .. 0 - No sexual intimacy .. 1 - No pleasurable sensations .. 2 - Minimal pleasurable .. 3 - Quite pleasurable .. 4 - Pleasant .. 5 - Very pleasurable

9. How often did intercourse or sexual stimulation end in ejaculation? .. 0 - No sexual stimulation or intercourse .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time.. 5 - Almost always or always

10. How often did you have an orgasm (or intimate sensation) during sexual stimulation or intercourse? .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time .. 5 - Almost always or always

11. How often did you experience sexual desire? .. 1 - Almost never or never .. 2 - Several times (less than half the time) .. 3 - Sometimes (about half the time) .. 4 - More than half the time .. 5 - Almost always or always

12. How would you rate the degree of your sexual desires? .. 1 - Very low or no desire for sexual satisfaction .. 2 - Low .. 3 - Moderate .. 4 - High .. 5 - Very high

13. How would you rate your sex life generally? .. 1 - Extremely unsatisfactory .. 2 - Fair .. 3 - Satisfactory in half of the cases .. 4 - Satisfactory .. 5 - Good

14. Are you satisfied with your sexual relationship with your partner? .. 1 - Not at all satisfied.. 2 - Not at all satisfied.. 3 - Yes and no.. 4 - Almost satisfied.. 5 - Completely satisfied.

15. How sure are you that in the future you will have an erection and that it will remain until the end of sexual intercourse? .. 1 - Not at all sure.. 2 - Not sure.. 3 - Not quite sure.. 4 - Almost completely sure.. 5 - Completely sure.

Scoring.. Scoring for erectile function - the sum of the answers to questions 1, 2, 3, 4, 5, 15 .. Scoring for assessing the ability to experience orgasm - the sum of the answers to questions 9 and 10 .. Scoring for assessing sexual desires - the sum of answers to questions 11 and 12 .. Scoring for satisfaction with sexual intercourse - the sum of answers to questions 6, 7 and 8 total score - the sum of the answers to all questions

Interpretation: minimum total score - 5, maximum total score - 75 .. Erectile function: 1-30; .. Ability to experience orgasm: 0-10; .. Sexual desire: 2-10; .. Sexual satisfaction: 0-15; .. General satisfaction with sexual life: 2-10.

Survey. In many patients, it is not possible to detect significant changes in the nervous, genitourinary and endocrine systems, as well as internal organs. Cortical erectile dysfunction. An adequate erection is disturbed earlier and more significantly, while a spontaneous erection is preserved. Spinal erectile dysfunction. Violations of both adequate and spontaneous erection, which occurred simultaneously and gradually progressing, are characteristic of a decrease in the excitability of the spinal reproductive centers or receptor devices. Endocrine dysfunction of erection: a pronounced decrease in sexual desire is characteristic. When examining a patient, one should pay attention to possible signs of chronic alcohol or drug use, examine the genitals, assess the neurological status, exclude vascular pathology and endocrine dysfunction.

Diagnostics

Laboratory research. KLA and OAM. Blood glucose and glucose tolerance test. Testosterone in blood plasma and urine (total and bound). LG. FSH. Prolactin. Serum lipids.

Special studies. Tracking nocturnal erections. Endourethral thermometry. Measurement of penile blood pressure. Rheofallography. Aortography and selective perineal angiography. Dynamic cavernography. neurological research. Psychological testing.

Treatment

TREATMENT

If a man with erectile dysfunction has a low concentration of testosterone, normal prostate size, normal PSA concentration and lipid profile, testosterone treatment can be started. 5 r / day .. Follow-up ... Annually assess the size of the prostate gland (using ultrasound) and determine the concentration of PSA ... If there is no recovery of erectile function within about 8 weeks, therapy is stopped and other causes of erectile dysfunction are looked for and ways to correct it.

Sildenafil is a phosphodiesterase inhibitor. This drug increases the concentration of cyclic guanosine monophosphate, which causes relaxation of the MMC. This drug is intended for oral administration in the form of tablets of 25, 50 and 100 mg, which are taken 1-2 hours before sexual intercourse. The initial dose is 50 mg. In elderly patients and with chronic renal failure or chronic liver failure, the initial dose is 25 mg. Exceeding the dose of 100 mg does not cause an additional effect. Sexual stimulation is necessary. The hypotensive effect of nitrates is potentiated by sildenafil. The use of sildenafil is contraindicated in patients taking nitrates. headache, "hot flashes", dyspeptic disorders, a feeling of nasal congestion and transient visual impairment.

Yohimbine hydrochloride is an oral drug with conflicting information about its effectiveness.

With a normal concentration of testosterone and no effect from sildenafil, the drugs of choice are Pg (for example, alprostadil), administered intracavernously. First, a trial injection is performed in the clinic (to check the effectiveness of the injection and select an adequate dose). When the first injection is effective, this technique is taught to the patient himself and, possibly, his partner. The patient is given written instructions explaining the injection technique and how to deal with prolonged erection (if it occurs). .5-1 ml (10-20 mcg). If necessary, the dose can be increased to 2 ml (40 mcg) ... P - p is injected into the erectile tissue of the penis (in its proximal third). The needle is directed from above and somewhat laterally, which avoids damage to the urethra ... You can use a special injection syringe - a pen in case of difficulty using a conventional needle .. Side effects ... Pain in the penis in every second man; in rare cases, it is very pronounced ... Prolonged erection (4-6 hours) in 5% of patients ... Prolonged erection more than 6 hours (requiring treatment) in 1% of patients.. Treatment of prolonged erection ... Exercise stress eg going up and down stairs... Cool shower... Aspiration of blood from the penis with a needle and syringe (100-200 ml)... An a-adrenergic agonist can be injected into the erectile tissue (for example, norepinephrine 0.02- 0.04 mg), if necessary, the introduction is repeated. Hospitalization is indicated in the event of any difficulties in treatment.

Intraurethral administration of alprostadil. Alprostadil gel is injected into urethra Using the applicator, the penis is gently massaged for approximately 10 minutes. This method of treatment is most suitable for impotence of psychogenic, neurogenic genesis or with minor arterial insufficiency of blood supply to the penis.

Treatment with local negative pressure (using a vacuum pump) is the method of choice for men who do not want to use drugs. Erections can be achieved to some extent in 90% of patients. However, not all men prefer these mechanical devices. Side effects - a feeling of numbness and pain in the penis, sometimes hematomas (contraindications for use in men are a violation of blood clotting or taking anticoagulant drugs).

In a certain contingent of patients, vascular operations are used. They are effective in young men with traumatic vascular lesions. In men with generalized atherosclerosis, the effect after surgery lasts only for a while. The results of operations on the veins are contradictory.

As a last resort (with the failure of all other methods of treatment), urologists use penile prostheses.

Synonym. Impotence. Disorder of sexual arousal in men

ICD-10. F52 Sexual dysfunction not due to organic disorders or diseases. N48.4 Organic impotence

Some urological diseases are peculiar only to men, because the structure genitourinary system they are very different from women. For example, Peyronie's disease occurs only in men and develops when the structure and function of the penis is disturbed.

Peyronie's disease

In medicine, Peyronie's disease is understood as a rare pathology characterized by the formation of fibrous plaques inside the cavernous body of the penis (according to the ICD-10 classification, it is included in the code N48.6). Due to fibroplastic degeneration, often constantly progressive, the penis is bent. Other names of the disease are penile fibromatosis, fibroplastic induration of the penis. Peyronie's disease was named after its researcher, the French surgeon F. Peyronie, who observed patients at the end of the 18th century. The predominant age of detection of pathology in men is 30-65 years, the prevalence is approximately 0.3-1%.

Pathology refers to collagenoses, implies violations in the structure of the connective tissue. With its development, elastic fibers are replaced by coarse fibrous cords.

Without an erection, plaques do not cause pain, but as the cavernous bodies fill with blood, very painful feelings arise. Erectile function gradually decreases, the ability to reproduce decreases. In the severe stage of the pathology, the ability to have sexual intercourse is completely absent.

The classification of Peyronie's disease is as follows:

1. According to etiology - the acquired form (the reasons lie in the influence of risk factors during life), the congenital form (the disease occurs from birth).
2. According to the type of course - an acute disease or a disease with no clear symptoms.
3. According to the type of deformation of the penis - dorsal (directed upwards), ventral (tilted down), lateral (deviated to one side).

On the video about Peyronie's disease:

Causes

Specialists cannot unambiguously indicate the causes of the pathology. Presumably, the pathogenesis of Peyronie's disease is as follows: against the background of constant trauma to the penis, microcracks form on its cavernous body. They heal without causing symptoms, but gradually become covered with small scars. Constant irritation and microtraumas lead to the inclusion of the inflammatory process, which causes the activation of the work of fibroblast cells. The tissue of the penis is replaced by plaques of connective fibers that are hard, rough, immobile. The configuration of the organ changes, it becomes curved.

According to the theory, some factors can affect the occurrence of Peyronie's disease in men:

• Diabetes;
• Hypertension;
• and disorders of fat metabolism;
• Smoking;
• Alcoholism;
• penis injury;
• Regular traumatic sexual contacts;
• Gout;
• Lack of calcium, vitamin E;
• Long-term treatment with drugs for impotence;
• Abnormally short urethra.

In half of the patients, Dupuytren's contracture is detected - fibrous degeneration of the palmar aponeurosis, leading to impaired movement of the palm and fingers. This confirms the presence of deviations from the production of collagen in the body. Also, Peyronie's disease is characterized by hereditary transmission.

The photo shows what Peyronie's disease looks like.

Symptoms

Usually the first phase of the pathology, when there is an active replacement of the cavernous bodies with fibrous plaques, lasts 6-18 months. Pain during this period does not occur, there may also be no outwardly obvious changes. A man is in no hurry to see a doctor, so Peyronie's disease moves to the next stage - the stage of clinical manifestations.

The patient begins to notice a number of symptoms that are constantly growing:

• Sore erection, pain and severe discomfort during intercourse.
• Decreased erection quality - the penis does not reach the required size, does not harden sufficiently.
• Visually noticeable curvature of the penis, often on one side, as well as a decrease in its length.
• The acquisition of an irregular shape by an organ - like an hourglass, the neck of a bottle.
• The presence of palpable plaques under the skin of the organ (up to 1-3 cm in diameter).
• Often - stretching of the skin in a place over large plaques.

In the absence of treatment, complications of Peyronie's disease can be infertility and impotence, depression, pain during intercourse. It is impossible to delay treatment - after identifying any of these symptoms, you should consult a doctor!

Diagnostics

Usually, a urologist can suggest a diagnosis already during the first visit - after examination, palpation of the organ. An artificially produced erection with the help of vacuum devices only confirms the assumptions - there is pain, a clearly visible curvature, a protruding plaque.

1. penis ultrasound. Reflects seals on the body, as well as circulatory disorders.
2. Radiography. Clearly shows fibrous plaques composed of tough, rough tissue.
3. MRI. The most accurate technique helps to differentiate Peyronie's disease from other pathologies in doubtful cases.
4. Cavernosography. Helps to obtain data on the state of the spongy and cavernous bodies of the penis.

It is necessary to differentiate Peyronie's disease with penile cancer, the consequences of syphilis, and tuberculosis.

Treatment

At the initial stage, you can get by with expectant tactics, coupled with the appointment of drug therapy, without surgery. During the year, the patient is under dynamic observation by a urologist, undergoes examinations in order to detect the rapid development of the disease in time. If progression continues, plan surgery. In a third of cases, there is a regression of the pathology after taking the necessary medications. Many patients are helped by the use of an extender - a device for lengthening and straightening the penis.

Conservative therapy

Such treatment is reduced to taking and local administration of drugs at home, preventing inflammation from developing and fibrous tissue from forming. Medication is also needed, which involves taking medications that normalize metabolism, the level of vitamins in the body, and the process of collagen production. Courses usually last 1-3 months, after which they make a control examination, and after a break, a new course is prescribed.

The most common drugs and therapies for Peyronie's disease:

1. Vitamin E and calcium preparations to eliminate their deficiency.
2. Non-steroidal anti-inflammatory drugs (Ibuprofen, Ketonal) to reduce the inflammatory response and pain.
3. Glucocorticosteroids (Prednisolone) and cytostatics (Cyclophosphamide) to stop uncontrolled cell division.
4. Injections into the cavernous bodies with lidase, collagenase to optimize cell division. The drugs penetrate into the problem area and minimize fibrinogenesis - the formation of fibrous plaques.
5. Electrophoresis with interferon preparations, trypsin, lidase to reduce inflammation and activity of collagen cells.

Folk remedies

Delay seeing a doctor and practicing treatment folk remedies strictly prohibited - it will not stop the progression of the disease. But, coupled with traditional treatment under the supervision of a doctor, it is quite possible to use homemade recipes (to improve metabolism and saturate the body with the necessary vitamins).

For example, you can prepare a collection of equal parts of burdock root, oregano herb, primrose, initial letter, sage, toadflax. Brew 2 tablespoons of the collection overnight in a thermos in 2 cups of boiling water. In the morning, start treatment - drink 100 ml four times a day. Course - 21 days.

Surgical intervention

Surgery will be indicated for patients with an already formed plaque, with a curvature of the penis of more than 45 degrees, as well as with serious violations of the quality of sexual life.

There are several types of surgery that may be recommended for this disease:

1. Operation Nesbit. Allows you to straighten the curvature of the penis, remove plaques, seals. Correction of the defect is possible by imposing folds on the opposite side of the organ, while the penis loses some of its size. With a significant curvature, the membrane of the penis is excised in the form of an ellipse, and on the opposite side, sutures are made with a non-absorbable material.
2. plastic surgery. After excision of the plaque, the defect is hidden by suturing flaps from the testicle, other areas of the skin, as well as from the saphenous veins, bovine pericardium. So you can fix the problem without shortening the length of the organ.
3. Falloprosthetics. For men who already have severe erectile dysfunction, implantation of special prostheses is indicated.

Carefully! On the video, the surgical treatment of Peyronie's disease (click to open)

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shock wave therapy

The technique of shock wave therapy involves the destruction of plaques with waves of low intensity. As a result of the course of treatment, it becomes soft, pain and inflammation go away, the penis is aligned in shape. Erectile disorders are often completely eliminated. Usually 5-8 treatments are enough for a cure, but at an advanced stage, shock wave therapy will not replace surgery.

Prevention

To prevent acquired forms of Peyronie's disease, it is necessary:

• Lead a healthy lifestyle, do not abuse alcohol, do not smoke.
• Avoid traumatic sexual intercourse and other cases of damage to the penis.
• Eat right, prevent beriberi.
• Maintain normal blood pressure and lipid metabolism.
• Early detection and control of diabetes mellitus.
• Do not self-medicate urological problems.

Treatment of Peyronie's disease with shock wave therapy:

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