***Trost Commentary and Key Take-Home Points***
The current study specifically investigates Peyronie’s Disease in teenagers and compares their condition to that of men >40 years old. The diagnosis of PD is often confused with congenital penile curvature (CPC) in younger men. CPC is typically a life-long curvature and is not typically associated with penile plaques. It also usually results in a broader, banana-like curvature rather than an abrupt curve or bend, and it is not associated with penile indentation or hourglass deformity. It is often first noticed in the teenage years, and in our experience, the far majority of teenagers who present with suspected PD actually have CPC. The differentiation of PD and CPC is somewhat academic though, since the treatment for both conditions is the same.
Dr. Mulhall’s group (the group publishing the paper below) is a very astute group, and having worked with them over a period of 4 months, I believe that they have meticulously separated out teenagers with true PD in the study below. In summary of their findings, teenagers with PD often experience higher levels of distress and a more severe condition overall (multiple plaques). This is also consistent with our experience. In my opinion, PD in teenagers likely represents a distinct subtype of PD which does not behave similarly to the PD which develops later in life. Often, these men will experience multiple recurrent curvatures throughout their lives, compared to men in their 50-60’s, who usually only develop one site of curvature.
Introduction
Peyronie’s disease is a connective tissue disorder affecting between 3-9% of men. It is characterized by the formation of inelastic fibrotic plaques in the penis causing penile deformity, curvature, pain and difficulty with sexual function. While it is known to be more common middle-aged men and prevalence increases with age, it does occur in younger men and is unique to this age group as their sexual activity can greatly differ from middle-aged to senior men. Peyronie’s disease in this population has been understudied and there is little to no specificity in treatment options or evaluation of this age group.
Of particular concern, Peyronie’s disease is shown to increase depression and lower quality of life, which can have a more dramatic negative effect on men of such a young age who live with the disease much longer than a middle-aged man. This study includes a 10-year span of evaluating Peyronie’s disease at one institution and compares the treatments, characteristics and evaluations of teenagers versus older men with the diagnosis.
Methods
This retrospective analysis categorized males 19 or younger over a 10-year period who had characteristics of Peyronie’s disease. Patients were evaluated for deformity and underwent a Doppler ultrasound to assess plaque formation and calcification. The results were compared to men 40 or older with Peyronie’s disease.
Results
Over the 10-year period, 32 (2.5%) of Peyronie’s disease patients were teenagers with 1,050 being 40 or older. The teenage group had a mean duration of PD of 3 ± 1 months, 16% recalled penile trauma, 22% had penile pain, 37% had subsequent ED, and 94% reported high levels of distress caused by their Peyronie’s disease. In comparing the teenagers to the older group of men, 37% of the teenagers had multiple non-contiguous plaques whereas this was the case with only 5% of the older group, and 18% of teens had HbA1C levels >5% and only 5% of the older group fell into this category. Trauma was reported in 16% of the teenagers, while only 5% of the older group reported penile trauma. Additionally, teens were more likely to get help earlier, with 87% of them being diagnosed within 6 months whereas only 28% of the older group were seen within 6 months.
Discussion
The study of Peyronie’s disease is lacking in information about men in their teens. Teenagers made up 2.5% of the Peyronie’s disease cohort, and men younger than 40 made up 1.5% to 9.9%. Many of the teenagers seen had previously been misdiagnosed or untreated by other doctors who likely believe that Peyronie’s disease only occurs in older men.
Physical assessments must be done to correctly diagnose Peyronie’s disease, including Doppler ultrasound to explore plaques and calcification, penile examination for palpable plaques, possible trauma and history of disease. In teenagers, it is important to differentiate Peyronie’s disease from congenital penile deviation (CPD) and correctly diagnose the patient since the courses of treatment are very different. CPD differs from Peyronie’s disease in several ways including lack of fibrotic plaques and calcifications, normal-appearance inside the penis, surgery can be done anytime the patient desires correct and usually results in extremely high (nearly 100%) satisfaction rates.
Psychological distress is an important factor as 94% of the teenage group reported feeling high levels of distress and intimacy issues due to Peyronie’s disease. At any age, Peyronie’s disease is known to increase the risk of depression due to the negative psychological effects and self-image issues. When the disease presents at a younger (and more sexually active) age, this can be especially distressing as it can inhibit relationships.
Conclusion
Though less common in teenagers, Peyronie’s disease does occur and should be correctly diagnosed using patient history, physical exam and Doppler ultrasonography. Correct diagnosis will lead to more effective management of the disease in teenagers.
References
Tal R, Hall MS, Alex B, Choi J, Liu L, and Mulhall JP. Peyronie’s disease in teenagers. J Sex Med 2012;9:301–308.
https://www.jsm.jsexmed.org/article/S1743-6095(15)33748-6/fulltext