Editing Peyronie's Disease (section)

== Pathophysiology ==

* '''<span style="color:#ff0000">Peyronie's disease (PD) is an inflammatory disorder of the tunica albuginea</span>'''
** '''Exact cause not known.'''
***'''Some injury to the erect or flaccid penis is necessary to trigger the cascade of events that leads to PD in the susceptible individual.'''
****'''Microvascular trauma to the penile shaft associated with penile buckling in the erect or semi-erect state secondary to sexual activity is thought to be the most common inciting event'''
*****Most males cannot recall a specific event
**** '''Not all trauma is associated with PD'''
*** '''In PD, the scar does not undergo a normal remodeling phase in the wound healing process''' and therefore the scar and deformity persists
****Normal wound healing involves 3 phases:
****# An acute phase
****# A proliferative phase
****# A remodeling phase

=== Risk factors ===

* '''<span style="color:#0000ff">IT DRAG A C</span><span style="color:#ff0000">rooked </span><span style="color:#0000ff">W<span style="color:#ff0000">and (9):</span>'''
# '''<span style="color:#0000ff">I</span><span style="color:#ff0000">nfection'''
# '''<span style="color:#0000ff">T</span><span style="color:#ff0000">rauma'''
# '''<span style="color:#0000ff">D</span><span style="color:#ff0000">iabetes'''
# '''<span style="color:#0000ff">R</span><span style="color:#ff0000">adical prostatectomy''' (prevalence 11-16%)
# '''<span style="color:#ff0000">Increasing </span><span style="color:#0000ff">A</span><span style="color:#ff0000">ge</span>'''
# '''<span style="color:#0000ff">G</span><span style="color:#ff0000">enetic predisposition</span>'''
# '''<span style="color:#0000ff">A</span><span style="color:#ff0000">utoimmune factors</span>'''
# '''<span style="color:#0000ff">C</span><span style="color:#ff0000">ollagen disorders (Dupuytren contracture, fibrosis of plantar fascia (Ledderhose’s disease), tympanosclerosis</span>''')
# '''<span style="color:#ff0000">Aberration of localized <span style="color:#0000ff">W</span><span style="color:#ff0000">ound healing</span>'''
# '''<span style="color:#ff0000">Others: hypertension, hyperlipidemia, smoking, heart disease</span>'''
* '''Hypogonadism is associated with more severe Peyronie's disease'''. 
**Supplemental testosterone improved the efficacy of intralesional verapamil in patients with hypogonadism
* PDE5 inhibitors are not associated with Peyronie's disease

=== Cellular physiology ===
*Oxidative stress has a well-documented role in tissue fibrosis and has been studied in the pathogenesis of PD
* Nitric oxide has anti-fibrotic effects
* Myofibroblast activation is a key event in the development of fibrosis
* TGF-β1 has been shown to be significantly associated with PD. TGF-β is a strong activator of myofibroblasts and is known to be a potent fibrotic growth factor by stimulating the deposition of ECM.
* A variety of alterations may be present in a given patient so no treatment works uniformly for all patients