[Clinical symptomatology and histopathological changes in Peyronie's disease: a comparative analysis]. / Induratio penis plastica: Vergleich der klinischen Symptomatik und der Plaque-Histopathologie.

ABSTRACT

PURPOSE: Our understanding of the etiology of Peyronie's disease (IPP) as well as the diagnostic and therapeutic approach is suboptimal. In order to improve this situation, we conducted a comparative retrospective analysis between the clinical symptoms of 50 patients with IPP and their histopathological results after radical plaque excision. PATIENTS AND METHODS: From 106 patients with IPP who consulted our clinic between 2002 and 2004, fifty were selected after clinical examination (sonography, Doppler sonography, DICC cavernosometry, X-ray) for surgery. The median age was 57.2 years. The plaque material was examined qualitatively and semi-quantitatively. Perivascular infiltrations and the type of the cells have been investigated immunhistochemically, and the structure of collagen was analysed by polarisation microscopy. RESULTS: In all 50 plaques, the tunica albuginea was fibrotic. In 41 cases the corpora cavernosa were infiltrated too. In 22 patients, the cavernosogram revealed venous leakage from the penile shaft. 32 plaques showed inflammatory infiltrations, 21 pathological vessels and 16 osseous metaplasia. In 13 plaques the fibrosis was stable and areactive. Mostly patients with metaplastic plaques or atypical vessels suffered from pain and erectile dysfunction. The results 6 months after plaque resection were best in painless patients who had that were plaques well marked off from the surrounding tissue (n = 13). Patients with aggressive fibroses of the corpora cavernosa (n = 5) and venous leakages from the penile shaft (n = 10) showed the worst results. CONCLUSION: A preoperative biopsy of IPP plaques could improve the quality of therapeutic decision. Painless patients with well marked and detectable plaques are suitable candidates for surgery. An operation is not the first-line option for patients with aggressive fibroses, venous leakages and painful indurations with fuzzy demarkation.