Peyronie’s Disease (PD) is an acquired condition where fibrous scar tissue, known as a plaque, forms within the penis. This plaque causes a lack of elasticity in the penile tissues, often leading to a noticeable bend or deformity during an erection. While PD is primarily recognized for its impact on sexual function and penile curvature, the physical changes it causes can also affect urinary function. The resulting lower urinary tract symptoms are a recognized complication linked directly to the scar tissue and the mechanics of urination.
Understanding the Scar Tissue Formation
The core of Peyronie’s Disease involves the formation of a dense, inelastic plaque within the tunica albuginea. This is the tough, fibrous sheath that encases the two spongy cylinders responsible for erection, called the corpora cavernosa. Normally, the tunica albuginea is flexible, allowing the penis to expand and straighten as it fills with blood.
The plaque itself is composed of disorganized collagen and fibrin, representing an abnormal wound-healing response. This scar tissue does not stretch like the healthy tissue, which directly causes the penile deformity and determines the direction and severity of the curvature.
The Mechanism Linking Peyronie’s to Urinary Changes
The mechanism connecting the Peyronie’s plaque to urinary changes involves external pressure and mechanical obstruction. The urethra, the tube that carries urine from the bladder, runs through the corpus spongiosum, situated directly beneath the corpora cavernosa. When the fibrous plaque develops, especially on the underside of the penis (ventral aspect), it forms in close proximity to the urethra.
Ventral plaques can exert significant external compression on the urethra. This pressure effectively narrows the channel through which urine must pass, similar to a pinched hose. Plaques that wrap around the shaft, causing an “hourglass” or “waisting” deformity, can also constrict the urethra from multiple sides.
This compression reduces the internal diameter of the urethra, creating an obstruction to urine flow. This mechanical narrowing forces the bladder to work harder to push urine through the constricted passage. Over time, this obstruction leads to various lower urinary tract symptoms (LUTS). In severe cases, the chronic scarring can lead to the formation of a urethral stricture, which is a permanent area of narrowing within the urethral wall itself.
Common Urinary Symptoms Experienced
The mechanical obstruction caused by the Peyronie’s plaque results in a specific set of Lower Urinary Tract Symptoms (LUTS). These are classified as voiding symptoms, reflecting the difficulty in emptying the bladder. The most common complaints are a weakened or slow urinary stream, a direct consequence of the narrowed urethral channel. Patients may also experience:
- Urinary hesitancy, which is difficulty initiating the flow of urine.
- Straining during urination due to the effort required to push urine past the obstruction.
- Incomplete bladder emptying, causing a feeling that the bladder is not fully drained.
- Increased urinary frequency during the day and nocturia (waking up at night to urinate).
Options for Managing Urinary Discomfort
Managing the urinary discomfort associated with Peyronie’s Disease involves addressing the mechanical obstruction and alleviating the resulting symptoms. A urologist evaluates the symptoms to differentiate between PD-related issues and other common causes of LUTS, such as an enlarged prostate. If symptoms are mild, observation and lifestyle modifications, such as managing fluid intake, may be suggested.
For more bothersome symptoms, pharmacological interventions typically used for LUTS can be employed. Alpha-blockers are a class of medication that relaxes the smooth muscles in the bladder neck and prostate. While they do not directly treat the Peyronie’s plaque, this muscle relaxation can decrease resistance and improve the flow of urine. Phosphodiesterase type 5 (PDE5) inhibitors, commonly used for erectile dysfunction, have also shown some benefit in improving LUTS.
If the plaque has caused a severe urethral stricture, or if symptoms do not respond to medical management, surgical intervention may be necessary. This could involve procedures like a urethral dilation or a urethroplasty to surgically repair or reconstruct the narrowed segment of the urethra. Patients must consult with a urologist experienced in PD to create a comprehensive treatment plan that addresses both the penile deformity and the associated urinary symptoms.