Peyronie’s disease (PD) is a condition characterized by the development of fibrous plaques in the tunica albuginea of the penis, leading to penile curvature, deformity, and pain during erection. The prevalence of PD in the general population is around 9%, with the highest incidence reported in diabetic men. Diabetes mellitus (DM) is a metabolic disorder that affects the function of blood vessels, nerves, and connective tissues, which can lead to the development of PD for men. This paper aims to review the literature on the pathogenesis, risk factors, clinical manifestations, diagnosis, and management of PD in men with diabetes.
Pathogenesis of Peyronie’s disease
It’s crucial to know what causes PD in men. There is still much to learn about the precise causes and mechanisms of PD. However, it is believed that PD develops as a result of a combination of genetic, vascular, and inflammatory factors. The disease begins with the activation of fibroblasts in the tunica albuginea, leading to the accumulation of collagen and fibrous tissue. This, in turn, leads to the formation of plaques and subsequent penile curvature and deformity. Several studies have shown that oxidative stress, inflammation, and hypoxia play a crucial role in the development of PD.
Reactive oxygen species (ROS) generation and the body’s capacity to neutralize them are out of balance during oxidative stress. ROS can cause cellular damage by inducing DNA mutations, lipid peroxidation, and protein oxidation. In PD, oxidative stress leads to the activation of fibroblasts and the production of collagen and fibrous tissue. In diabetic men, the high levels of glucose in the blood can increase oxidative stress, leading to the development of PD.
Inflammation is also a key factor in the pathogenesis of PD. Several cytokines and growth factors, such as transforming growth factor-beta (TGF-β) and platelet-derived growth factor (PDGF), have been implicated in the development of PD. These cytokines and growth factors can induce fibroblast activation, collagen synthesis, and extracellular matrix deposition. In diabetic men, chronic inflammation resulting from insulin resistance and hyperglycemia can lead to the development of PD.
Hypoxia, or a decrease in the supply of oxygen to tissues, can also contribute to the development of PD. The tunica albuginea has a limited blood supply, and any disruption in blood flow can lead to hypoxia. In hypoxic conditions, fibroblasts can produce more collagen, leading to the formation of fibrous tissue and plaques.
Risk factors for Peyronie’s disease in diabetic men
Several risk factors have been associated with the development of PD in diabetic men. These risk factors include:
Age: PD is more common in men over the age of 40. In diabetic men, the risk of PD increases with age.
Diabetes duration: The longer a man has diabetes, the higher his risk of developing PD.
Poor glycemic control: Poorly controlled diabetes can lead to chronic inflammation, oxidative stress, and hypoxia, all of which can contribute to the development of PD.
Erectile dysfunction (ED): ED is a common complication of diabetes and can lead to trauma to the tunica albuginea during intercourse, which can trigger the development of PD. Peyronie’s disease and Erectile Dysfunction are interlinked according to some studies.
Smoking: Smoking is a risk factor for PD, as it can lead to oxidative stress and inflammation.
Trauma: Trauma to the penis, such as during intercourse or from a fall, can lead to the development of PD.
Clinical manifestations of Peyronie’s disease in diabetic men
PD can present with a variety of clinical manifestations, including penile curvature, deformity, pain, and erectile dysfunction. The severity of PD can vary widely from mild curvature to severe deformity, and symptoms may worsen over time. In diabetic men, PD can be more severe and progress more rapidly than in non-diabetic men.
Penile curvature is the most common manifestation of PD. The curvature can be either dorsal, lateral, or ventral, and may be present during erection or flaccidity. In some cases, the curvature may be severe enough to make sexual intercourse difficult or impossible. In diabetic men, the curvature may be more severe and may progress more rapidly than in non-diabetic men.
Penile deformity is another common manifestation of PD. Deformities can include hourglass deformities, hinge deformities, and narrowing of the penis. In severe cases, the penis may become significantly shorter or narrower.
Pain during erection is also a common symptom of PD. The pain can range from mild to severe and may be localized to the site of the plaque or may be more diffuse. Pain may be more common in diabetic men due to the increased severity of PD in this population.
Erectile dysfunction (ED) is also common in PD, as the plaques can interfere with the normal filling of the penis with blood. In diabetic men, ED may be more severe due to the presence of other diabetic complications, such as neuropathy and vascular disease.
Diagnosis of Peyronie’s disease in diabetic men
Diagnosis of PD is usually based on clinical history and physical examination. The diagnosis is confirmed by ultrasound or magnetic resonance imaging (MRI) of the penis. Ultrasound can provide information on the size and location of the plaque, as well as the degree of curvature. MRI can provide more detailed information on the extent of fibrosis and the location of the plaque.
In diabetic men, additional tests may be necessary to assess the extent of diabetic complications, such as neuropathy and vascular disease. These tests may include nerve conduction studies, Doppler ultrasound, and angiography.
Management of Peyronie’s disease in diabetic men
The management of PD in diabetic men can be challenging due to the increased severity and rapid progression of the disease in this population. Peyronie’s disease treatments include medical management, minimally invasive procedures, and surgical intervention.
Medical management of PD includes the use of oral medications, such as pentoxifylline and vitamin E, and intralesional injection therapy with verapamil or collagenase. These medications have been shown to reduce plaque size and improve penile curvature, but their efficacy in diabetic men is not well established.
Minimally invasive procedures
Minimally invasive procedures, such as extracorporeal shockwave therapy (ESWT) and penile traction therapy, have been shown to improve symptoms of PD in diabetic men. ESWT uses high-energy shockwaves to break up plaque and stimulate the healing process, while penile traction therapy uses a device to stretch the penis and reduce curvature. Shockwave therapy for peyronie’s disease in particular has shown a lot of promise. In the Europe, not all clinics offer shockwave therapy as a potential treatment option for PD. Among who do provide this treatment however, MansMatters is the best. MansMatters, a specialized men’s health clinic situated in London, provide excellent shockwave therapy, EMTT therapy, Tesla Chair and NanoVi in order to treat men with PD and other sexual issues.
Surgical intervention may be necessary in cases of severe curvature or deformity that interfere with sexual function. Surgical options include penile plication, penile lengthening, and penile prosthesis placement. Penile plication involves suturing the tunica albuginea on the opposite side of the curvature to reduce curvature, while penile lengthening involves releasing the ligaments that attach the penis to the pubic bone to increase length. Penile prosthesis placement involves the implantation of a device to enable erections. The risks and benefits of surgery should be discussed with the patient, and the decision to proceed with surgery should be made on a case-by-case basis.
PD is a common condition in diabetic men, with a higher prevalence and more severe manifestations than in non-diabetic men. Diagnosis of PD in diabetic men requires a thorough clinical history and physical examination, as well as imaging studies to confirm the diagnosis and assess the extent of fibrosis and plaque formation.
Management of PD in diabetic men can be challenging due to the increased severity and rapid progression of the disease. Medical management, such as the use of oral medications and intralesional injection therapy, may be helpful in reducing plaque size and improving curvature. Minimally invasive procedures, such as ESWT, penile traction therapy, EMTT therapy, Tesla Chair and NanoVi may also be effective in reducing symptoms of PD.
In cases of severe curvature or deformity that interfere with sexual function, surgical intervention may be necessary. Surgical options include penile plication, penile lengthening, and penile prosthesis placement. The decision to proceed with surgery should be made on a case-by-case basis after a thorough discussion of the risks and benefits with the patient.
Prevention of PD in diabetic men is also important. Tight glycemic control and management of other diabetic complications, such as neuropathy and vascular disease, may help prevent or delay the onset of PD. Regular physical activity and a healthy diet may also be beneficial in preventing the development of PD.
So, PD is a common condition in diabetic men, with a higher prevalence and more severe manifestations than in non-diabetic men. Diagnosis of PD in diabetic men requires a thorough clinical history and physical examination, as well as imaging studies to confirm the diagnosis and assess the extent of fibrosis and plaque formation. Management of PD in diabetic men can be challenging, but a combination of medical management, minimally invasive procedures, and surgical intervention may be effective in reducing symptoms and improving sexual function. Prevention of PD in diabetic men is also important through tight glycemic control, management of diabetic complications, and a healthy lifestyle.
Both PD and diabetes can have a significant impact on a person’s sexual health and overall quality of life. The Peyronie’s Disease Forum provides a supportive community where individuals with these conditions can connect and find information and resources to help them manage their symptoms and improve their sexual health.