Peyronie's disease and autoimmunity—a real-life clinical study and comprehensive review

Research advances in Peyronie's disease: a comprehensive review on genomics, pathways, phenotypic manifestation, and therapeutic targets

INTRODUCTION

Penile induration disease, commonly known as Peyronie's disease (PD), is a connective tissue disorder that affects the penis, leading to the development of fibrous plaques, penile curvature, and erectile dysfunction. PD is a common male reproductive system disease with a complex etiology involving multiple genes, signaling pathways, and different phenotypes.

OBJECTIVES

The etiology and pathogenesis of PD remain poorly understood, hindering the development of effective treatment strategies. By understanding the underlying mechanisms of PD, we can pave the way for targeted therapies and improved patient outcomes.

METHODS

We reviewed the epidemiology and pathophysiology of PD. We performed database searches on Google Scholar, PubMed, Medline, and Web of Science from inception to September 2023. The literature reviewed included priapism guidelines, review articles, current trial studies, and various literature related to PD.

RESULTS

This article provides a comprehensive overview of the current research progress on the disease, focusing on its genetic factors, signaling pathways, cellular mechanisms, phenotypic manifestations, and therapeutic targets. It can help identify individuals at higher risk, aid in early detection and intervention, and provide insights into fibrosis and tissue remodeling. It can also reveal potential therapeutic targets, guide accurate diagnoses and treatment strategies, and address the impact of the disease on patients' quality of life.

CONCLUSION

By integrating insights from genomics, molecular pathways, clinical phenotypes, and therapeutic potentials, our research aims to achieve a deeper and more comprehensive understanding of PD, propelling the field toward innovative strategies that enhance the lives of those affected by PD. The complex manifestations and pathogenesis of PD necessitate the use of multiple treatment methods for personalized care.

Calcification in Peyronie's disease: Its role and clinical influence on the various symptoms and signs of the disease, including psychological impact. Our study of 551 patients

BACKGROUND

The aim of study was to evaluate the impact of plaque calcification on symptoms of patients with Peyronie's disease (PD) and to evaluate mental health in PD patients with or without calcification.

METHODS

We performed a retrospective analysis of the clinical database of a single andrology clinic. We extracted 551 PD patients, and we sorted them into two groups: the first group included 201 PD patients with plaque calcification; the second group included 350 PD patients without plaque calcification. The inclusion criteria for both groups were as follows: aged between 21 and 81 years; thorough and available data on clinical history; baseline levels of blood glucose, glycosylated hemoglobin, cholesterol, and triglycerides; photographic documentation of the penile curvature; dynamic penile eco-color Doppler ultrasound with plaque measurements and volume calculation; and completion of the generalized anxiety disorder-7 questionnaire, patient health questionnaire-9 (for depression), visual analog scale for penile pain measurements, and the International Index of Erectile Function (IIEF) questionnaire.

RESULTS

Plaque calcification was present in 36.4% of cases. The presence of calcification affects the presence and severity of penile curvature. Calcification is associated with the presence of hypertension. In PD patients, the prevalence of significant anxiety and significant depression was 89.1% and 57.3%, respectively. Calcification is associated with the presence of anxiety and depression but does not lead to an increase in their prevalence.

CONCLUSIONS

In PD patients, the calcification was present in more than one third of cases. The size of the plaque calcification was < 15 mm in most cases. Calcification influences the presence of the curve and influences its severity. There was a prominent prevalence of anxiety and depression in PD patients.

Chronic prostatitis as possible risk factor for Peyronie's disease: Psychological, sexual and prostatitis-like symptoms in patients with PD

OBJECTIVE

This study aims to investigate a possible relationship between chronic prostatitis (CP) and Peyronie's disease (PD) and to characterize the psychological profile of patients suffering from PD, with or without concomitant CP.

METHODS

We included 539 patients with PD, of which 200 were found to have underlying CP. As a comparator population, we selected 2201 patients without PD, referring to our tertiary care clinic. In this population, we detected 384 subjects with CP. All 539 PD patients underwent photographic documentation of the penile deformation, and dynamic penile eco-color Doppler with plaque and volume measurements and answered the following questionnaires: the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Visual Analog Scale for penile pain measurements, the International Index of Erectile Function (IIEF), and the NIH-Chronic Prostatitis Symptom Index.

RESULTS

The overall prevalence of chronic prostatitis in PD patients was 37.1% compared to a prevalence of 17.4% in the non-PD control population (OR = 2.79 and p < 0.0001). The severity of CP symptom total scores (NIH-CPSI) correlated significantly with the severity of erectile dysfunction (p < 0.0001). Significant anxiety was present in 89.2% of PD patients and it is more prevalent in PD patients with CP than in PD patients without CP (93.0% vs. 87.0%, respectively; p = 0.0434). Significant depression was detected in 57.1% of PD patients and it is more prevalent in PD patients with CP than in PD patients without CP (64.0% vs. 53.09%, respectively; p = 0.0173).

CONCLUSION

Chronic prostatitis (CP) and Peyronie's disease (PD) are frequently associated. Our results demonstrate the strong impact of chronic prostatitis on the mental status of PD patients. Anxiety and depression were significantly more pronounced in PD patients with CP than in PD patients without CP.

Congenital penile curvature as a possible risk factor for the onset of Peyronie's disease, and psychological consequences of penile curvature

OBJECTIVE

To investigate a possible relationship between a history of congenital penile curvature (CPC) and Peyronie's disease (PD), and to characterize the psychological profile of patients suffering from PD, with or without concomitant CPC.

METHODS

We included 519 patients with Peyronie's disease (PD), of which 73 were found to have underlaying CPC. As a comparator population, we selected 2166 patients without PD, referring to our tertiary care clinic. In this population we detected 15 subjects with CPC. All patients completed the GAD-7 (Generalized-Anxiety-Disorder - 7 questions) and the PHQ-9 (Patient-Health-Questionnaire - 9 questions) questionnaires.

RESULTS

The overall prevalence of CPC in PD-patients was 14.07%, compared to a prevalence of 0.69% in the non-PD control population (p < 0.00001). Moderate-to-severe anxiety was found to be present in 89.4% of all PD-patients. Significantly higher proportions of patients with CPC associated with PD showed severe anxiety, compared to patients with PD alone (57.5% vs. 36.7%, respectively, p = 0.0008). Moderate- severe depression was found to be present in 57.8% of all PD- patients. Significantly higher proportions of PD patients with a history of CPC showed severe depression, compared to patients with PD alone (13.6% vs. 3.36%, respectively, p < 0.0002). GAD-7 median scores were significantly higher in patients with more severe penile curvatures (> 45°; p = 0.029). We did not detect a statistically significant difference between PHQ-9 medi- an scores based on the severity of PD (p = 0.53). Analysis of PHQ-9 and GAD-7 median scores showed significantly worse depressive and anxious symptoms in younger patients (p < 0.001 and p = 0.0013, respectively).

CONCLUSIONS

The presence of congenital-penile-curvature may represent a risk factor for the subsequent onset of Peyronie's disease. Moderate/severe anxiety and moderate/severe depression were reported in a high fraction of cases. Anxiety was significantly higher in patients with more severe penile-curvatures, and depression was present independently of the degree of penile curvature. Depression and anxiety were found to be more severe in younger subjects.

Are finasteride-related penile curvature/Peyronie's disease Adverse Event Reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases

A limited number of studies have described patients on finasteride showing findings which were consistent with Peyronie's disease (PD). We aimed to detect a pharmacovigilance signal of possible association between finasteride and PD-related clinical features. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was queried to identify the ten drugs which were associated the most with the adverse drug reactions (ADRs) recorded as "penile curvature" and/or "Peyronie's disease". A similar analysis, including the same drugs, was carried out for the EMA (European Medicines Agency) EudraVigilance (EV) database. Descriptive data have been analyzed, and Proportional Reporting Ratios (PRRs) have been computed against the other nine drugs of the database. Overall, 860 reports of "penile curvature" and/or "Peyronie's disease", were identified in the FAERS database, 214 of which (24.9%) were associated with finasteride. Most reports (56.9%) were submitted by healthcare professionals. Where a treatment-indication was stated, the vast majority of reports (176/210; 83.8%) were associated with androgenetic alopecia. The outcome of most ADRs was "serious" (82.2%), with 96 ADRs resulting in levels of permanent disability. For 97/214 individual cases, penile curvature/PD reports were not part of a syndromic cluster suggestive of post-finasteride syndrome (PFS). The PRR resulted 6.6 (95% CI: 5.6-7.8) and 11.8 (95% CI: 9.08-15.33), respectively, in the FAERS and in the EV databases. Notwithstanding the related limitations and biasing factors of pharmacovigilance studies based on spontaneous reporting, the PRR values here identified should be interpreted as strong signals of disproportionality. These findings, per se, are however not useful to confirm any causal association. Clinical studies are needed to investigate on the possible role for finasteride in causing PD-related clinical features, an hypothesis which remains highly speculative due to the very questionable quality of present data.

The contribution of the immune system to genitourinary fibrosis

Fibrotic diseases of the genitourinary tract are devastating and incompletely understood pathologies. These diseases include urethral and ureteral strictures, retroperitoneal fibrosis, and Peyronie's disease. They can contribute to obstructive uropathy and sexual dysfunction. Poor understanding of the pathophysiology of these diseases severely limits our ability to prevent and treat them. Genitourinary fibrotic diseases likely represent related pathologies that share common underlying mechanisms involving wound healing in response to injury. These diseases share the common feature of extracellular matrix abnormalities-such as collagen deposition, transforming growth factor-β accumulation, and dysregulation of collagen maturation-leading to abnormal tissue stiffness. Given the association of many of these diseases with autoimmunity, a systemic pro-inflammatory state likely contributes to their associated fibrogenesis. Herein, we explore the immunologic contribution to fibrogenesis in several fibrotic diseases of the genitourinary system. Better understanding how the immune system contributes to fibrosis in these diseases may improve prevention and therapeutic strategies and elucidate the functions of immunologic contributors to fibrosis in general.

Is Peyronie's an IgG4-related disease?

OBJECTIVE

We believe that IgG4 may have a role in the pathogenesis of Peyronie's disease (PD), and this role could be particularly beneficial for developing new strategies; therefore, we aimed to investigate the role of IgG4 in PD.

METHODS

This study included 3 groups with a total of 139 subjects: (I) PD group (n=61), (II) control group (n=48), and (III) benign prostatic hyperplasia (BPH) group (n=30). IgG4 measurement was performed using the enzyme-linked immunosorbent assay. Plaque size, penile curvature, and the presence of concomitant impotence were evaluated in the PD group. Impotence was assessed based on the International Index of Erectile Function (IIEF).

RESULTS

A significant difference was observed between the PD and control groups and between the PD and BPH groups with regard to IgG4 levels, while no significant difference was found between the BPH and control groups (p=0.0001, p=0.002, and p=0.07, respectively). The IgG4 levels were significantly higher in the PD than in the other groups. The cutoff value determined between the groups was 87.5, 82, and 31.5, respectively. Mean plaque size was 2.0±1.01 cm, and a significant relationship was found between plaque size and IgG4 concentration (p=0.02). Mean penile curvature was 35.6±25.1°, and a significant relationship was found between penile curvature of >60° and IgG4 concentration (p=0.001). Mean IIEF score was 19 (range, 7-25). Moreover, no significant relationship was found between erectile dysfunction and IgG4 concentration. Penile pain was present in 24 (39.3%) patients with PD.

CONCLUSION

The IgG4 levels were significantly increased in patients with PD, which implies that IgG4 may have a role in the pathogenesis of PD. This finding could be particularly beneficial for developing new strategies. Future studies with larger patient series are needed to substantiate our findings.

The relationship between testosterone levels and Peyronie's disease

Aetiologic and predisposing factors are still controversial about Peyronie's disease (PD). However, it is thought to be the result of connective tissue disorder or healing defect. Androgens are known to affect collagen metabolism and wound healing in the body. The aim of this study was to investigate the relationship between PD and low testosterone levels. One hundred and forty-seven Peyronie patients and 137 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Blood samples were collected from all subjects in the early morning hours after an overnight fast. The mean level of serum total testosterone was lower in men with PD compared with the controls (3.9 ± 1.1 vs. 4.2 ± 1.7 ng/ml respectively) (p = .062). However, statistically significant relationship was not found between PD and low serum testosterone levels. There was no significant correlation between penile plaque dimension or penile curvature degree and testosterone levels. Large randomised-controlled prospective studies are needed to reveal this possible association.

Peyronie's disease: is it genetic or not?

Peyronie's disease (PD) is a devastating disease that affects up to 13% of adult men. While trauma to the erect penis is common prior to onset, it is clear that trauma alone is not sufficient to cause PD. Over the past 40 years, multiple lines of evidence have pointed to a genetic factor that predisposes some men to develop PD. Despite dramatic technological advances in the field of genetics, we have made little progress in identifying the genetic contributors to the disease. This review will critically evaluate the literature concerning the genetics of PD published to date. Particular focus will be placed on study design as much of the data are contradictory yet may still give some insight into the etiology of PD. The challenges in identifying the genetic underpinnings of PD will be discussed along with the potential mechanisms that can overcome these challenges.

Increased Risk of Cancer in Men With Peyronie's Disease: A Cohort Study Using a Large United States Insurance Claims Database

Background

Men with Peyronie’s disease (PD) may have an increased prevalence of certain comorbidities, including malignancy. We sought to examine the clinical relationship between PD and subsequent diagnosis of malignancy.

Methods

Using data from the IBM Health MarketScan claims database from 2007 to 2013, we compared men with PD to a control group of men without PD or erectile dysfunction matched for age and duration of follow-up. We compared incidence of 18 categories of malignancy between both groups using a Cox regression model.

Results

In total, 48,423 men with PD and 484,230 controls were identified. The mean age within both cohorts was 50 ± 9.4 years old, and mean follow-up time was approximately 4.4 ± 2.1 years. After being controlled for age, year of evaluation, obesity, smoking, number of outpatient visits, number of urologist visits, and duration of follow-up, men with PD had an increased risk of all cancers (hazard ratio = 1.10, 95% CI = 1.06–1.14), stomach cancer (1.43, 1.06–1.14), testis cancer (1.39, 1.05–1.84), and melanoma (1.19, 1.02–1.38) when compared with controls. The strengths in using the MarketScan database are the anonymous nature of the data, accessibility, and the power provided by the large number of patient visits recorded. Limitations include a lack of detail in certain facets of patient clinical data, and the lack of long-term follow-up to assess the impact of time on other potentially associated conditions.

Conclusions

This manuscript is the first to our knowledge to describe a relationship between PD and cancer. Men with PD may be at increased risk for certain malignancies compared with age-matched controls. Further investigation is needed to explore the clinical implications of these findings.

Pastuszak AW, Thirumavalavan N, Kohn TP, et al. Increased Cancer Risk in Men With Peyronie’s Disease: A Cohort Study Using a Large US Insurance Claims Database. Sex Med 2019;7:403–408.

A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease

Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.

Penile Sensory Changes After Plaque Incision and Grafting Surgery for Peyronie's Disease

INTRODUCTION

Plaque incision and grafting (PIG) for Peyronie's disease (PD) is not devoid of complications such as erectile dysfunction and penile sensory changes.

AIM

To define the rate and chronology of penile sensation loss after PIG surgery and to define predictors of such.

METHODS

The study population consisted of patients with PD-associated penile curvature who underwent PIG surgery with at least 6 months of follow-up. Demographics and PD factors were recorded. Patient had preoperative assessment of penile sensation and deformity. Postoperative follow-up occurred at 1 week, 1 month, 6 months, and 1 year after surgery. Neurovascular bundle elevation was conducted with loupe magnification.

MAIN OUTCOME MEASURE

Penile sensation was evaluated with a biothesiometer and graded on a patient-reported visual analog scale (0-10) in which 0 defined a completely numb area and 10 defined perfect sensation. The degree of sensation loss was defined as extensive (any 1 area >5 cm), major (2-5 cm), and minor (≤2 cm). The penile sensation loss distribution was defined as focal (1 site) or diffuse (>1 site).

RESULTS

63 patients were analyzed. Mean age was 56 ± 10 years. Mean duration of PD at the time of PIG was 15 ± 7 (12-38) months. 75% had curvature alone, and 25% had hourglass/indentation deformities. Mean primary curvature was 64˚ ± 28˚. The mean operation duration was 3.5 ± 1.8 hours. 21% had some degree of sensation loss at 1 week, 21% at 1 month, 8% at 6 months, and 3% at 12 months. Only 1 patient (1.5%) at 2 years continued to have extensive sensation loss on the glans and distal shaft with a very elevated sensitivity threshold. Using multivariable analysis, the only predictor of penile sensation loss ≥6 months was a duration of operation >4 hours (odds ratio = 2.1; 95% confidence interval = 1.2-3.0; P < .01).

CLINICAL IMPLICATIONS

The study highlights the need during patient consent to discuss penile sensation loss. Patients should be informed that rates of penile sensation loss ranges from 2-30% and most patients will have complete resolution of any sensation loss within one year of follow-up.

STRENGTH AND LIMITATIONS

To our knowledge no other studies have described the chronology and severity of penile sensation following PIG, our study demonstrates the utility of biothesiometry in measuring penile sensation before and after PIG. Number of patients and absence of control group represent a limitation.

CONCLUSION

Sensation loss is not uncommon after PIG surgery. It decreases in frequency and severity with time with only rare cases occurring >12 months. Longer operations appeared to be more likely associated with sensation loss. Terrier JE, Tal R, Nelson CJ. Penile sensory changes after plaque incision and grafting surgery for Peyronie's disease. J Sex Med 2018;15:1491-1497.

Cavernosopatía traumática crónica. Un nuevo síndrome de fibrosis peneana

Introdución La llamada genéricamente «enfermedad de Peyronie» es un diagnóstico que explica un porcentaje de ciertos estados de fibrosis peneana grave, pero se queda corta para abarcar la amplia gama de grises de la fibrosis peneana secundaria a microtrauma sexual repetido.

Objectivo Describir un nuevo síndrome por trauma repetido en el pene al que se propone denominar «cavernosopatía traumática crónica» (CTC), con 4 componentes: fibrosis (leve, moderada o grave), disfunción eréctil, curvatura y fugas venosas peneanas.

Materiales y métodos Se realizó un estudio de corte transversal en una base de datos de 128 pacientes que tenían al menos una ecografía de pene con vasoactivo y en los que se había detectado algún grado de fibrosis cavernosa según la clasificación de Levine. Se evaluó la presencia de disfunción eréctil, curvas y fugas venosas según el grado de fibrosis. El estudio contó con la aprobación del Comité de Ética en Investigación.

Resultados Se estudió a 128 pacientes con fibrosis, con 51,3 años de edad promedio (DE = 13). El grado de fibrosis fue leve (Levine 1) en 30 (23,43%), moderado (Levine 2) en 23 (17,96%) y grave (Levine 3) en 75 (58,6%). Se demostró que, a mayor fibrosis, mayor disfunción eréctil, 66,6; 83,6 y 96% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia de curvatura secundaria (n = 71) fue de 0; 4,2 y 95,7% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia en los 44 pacientes con fugas cavernosas fue de 9; 20,4 y 70,4% (p = 0,0060) y en los 15 de fugas dorsales fue de 80; 13,3 y 6,6% (p < 0,0001) para Levine 1, 2 y 3 respectivamente. El grupo de 79 pacientes (64,03%) con mayor posibilidad de CTC, con presencia de 3 o 4 criterios que incluyeran curvatura secundaria y fuga cavernosa, tuvo un promedio de edad de 59,2 años (DE = 8,7), comparado con 41,7 años (DE = 11,7) en el grupo de menor posibilidad, diferencia estadísticamente significativa (p ≤ 0,0001).

Conclusiones Proponemos que existe un síndrome de microtrauma repetido en el pene, que puede denominarse CTC, análogo a la encefalopatía traumática crónica, con 4 componentes: fibrosis cavernosa, disfunción eréctil, curvatura peneana y fugas venosas. La fibrosis es un continuum que el paciente recorre por fases leves y moderadas, a menudo inapreciables para los clínicos. Las curvaturas secundarias y las fugas cavernosas están relacionadas directamente con el grado de fibrosis y con mayor riesgo de disfunción eréctil. La edad empeora algunos factores de la CTC.

Objective measurements of the penile angulation are significantly different than self-estimated magnitude among patients with penile curvature

Introduction:

The study was aimed to assess the presence of actual differences between the objective and the perceived magnitude of a curvature between patients affected by Peyronie's disease (PD) and congenital penile curvature (CPC).

Materials and Methods:

Wee analysed a cohort of 88 consecutive patients seeking medi- cal help for either CPC or PD. All patients were invited to provide a self-made drawing of their penis in erection in order to obtain self-provided description of the deformity. An objective measurement of the deformity was also performed drawing two intersecting lines through the center of the distal and proximal straight section of the penile shaft.

Results:

Our findings showed significant differences between patient self-estimation and the objective measurements of the penile angulation performed by trained experts, with only 32% of patients correctly assessing their own curvature. Overall, patients tended to overestimate (56%) their degree of curvature, but the results are different in patients with PD than those with CPC. In the 60 men (68%) who did not accurately assess their curvature, PD patients generally overestimated their curvature versus CPC patients (67% vs 16%). On the contrary CPC patients underestimated their curvature compared to PD (42% vs. 4%).

Conclusion:

In order to improve patients' satisfaction rates, the surgeon needs to take into consideration the patient's perception of the deformity when planning the type of surgical correction.

The Genetic Basis of Peyronie Disease: A Review

INTRODUCTION

Peyronie disease (PD) is a progressive fibrotic disorder of the penile tunica albuginea that results in fibrotic penile plaques and can lead to penile deformity. Characterized by aberrant fibrosis resulting in part from the persistence of myofibroblasts and altered gene expression, the molecular factors underpinning PD and other related fibrotic diatheses are just being elucidated. A genetic link to PD was first identified three decades ago using pedigree analyses. However, the specific genetic factors that predispose patients to aberrant fibrosis remain unknown, and the relations between these fibrotic conditions and other heritable diseases, including malignancy, are uncharacterized.

AIM

To review the current landscape linking molecular and genetic factors to aberrant fibrosis in PD and related fibrotic diatheses, including Dupuytren disease.

METHODS

Review and evaluation of the literature from 1970 to the present for genetic factors associated with PD were performed.

MAIN OUTCOME MEASURES

Data describing the genetic factors associated with PD were obtained.

RESULTS

We describe the known structural chromosomal abnormalities and single-nucleotide polymorphisms associated with fibrotic diatheses and discuss the spectrum of differential gene expression data comparing normal tissues with those derived from men with PD or Dupuytren disease. We discuss epigenetic mechanisms that might regulate gene expression and alter predisposition to fibrosis.

CONCLUSION

Although the current understanding of the genetic factors associated with PD is limited, significant advances have been made during the past three decades. Further research is necessary to provide a more comprehensive understanding of the landscape of genetic factors responsible for the development of PD.

Clinical and epidemiological characteristics of young patients with Peyronie's disease: a retrospective study

The average age of men affected by Peyronie’s disease (PD) is approximately 50–55 years, but cases have been reported even in adolescence. Several studies have already investigated the presence of PD in young men, and these studies reported a PD prevalence that varies between 1.5% and 10.8%. Having noticed a greater number of young patients in our centers in recent years, we decided to carry out a retrospective study to evaluate the prevalence of PD in patients aged <40 years, as well as to investigate any possible difference in evolution based on the age of PD patients. We selected a sample of patients (n=271) with a similar time of onset of disease. We then stratified all 271 patients into two groups: group A (age <40 years [n=46]) and group B (age ≥40 years [n=225]). All 271 patients were evaluated for the following variables: penile plaque volume, degree of penile curvature, penile pain, and erectile function. Plaque volume was measured in cm³ by dynamic penile color Doppler sonography after administration of intracavernosal alprostadil 10 mcg. The number of younger patients was 46, accounting for 16.9% of the whole sample. Our study showed more frequent appearance and greater progression of penile curvature in younger patients. The average angle of penile curvature and average score of penile pain intensity in the younger men were significantly higher than in patients aged ≥40 years (P=0.025 and P=0.0001, respectively). In the younger patients, not only was the pain more intense (visual analog scale [VAS] of 5.2 versus 3.8), but it was also more frequently present than in patients aged ≥40 years (78.2% versus 62.2%) (P=0.042). We may conclude that since PD in young patients has a more acute onset and a greater possibility of progression, it should be treated conservatively as soon as it is diagnosed.