Propranolol and Peyronie's disease

Labetalol-induced Peyronie's disease? A case report

Peyronie's disease (induratio penis plastica) has been observed in a 58-year-old man 8 months after initiation of treatment with the new combined alpha- and beta-blocking agent, labetalol. During the last 2 months before onset of symptoms he had received 2400 mg labetalol daily. He showed no other signs of abnormal fibrous tissue production and the ANF test was negative. Cessation of the drug revealed no improvement. Peyronie's disease has also been observed in relation to treatment with propranolol, practolol and metoprolol and might be due to an impaired balance between alpha- and beta-receptors in connective tissue, but there may also be an immunological basis for the fibrosis. A possible coincidence is stressed, as the ages of the reported cases are within the range where this disease most often develops.

Penile trauma: an etiologic factor in Peyronie's disease and erectile dysfunction

PURPOSE

It has been postulated that trauma to either the partially or fully erect penis is a potential cause of Peyronie's disease. In addition, it has been proposed that engaging in sexual relations with a partial erection due to mild impotence is a risk factor for the development of Peyronie's disease. This study was performed to determine whether patients with either Peyronie's disease or non-Peyronie's disease impotence had an increased rate of penile trauma compared with potent controls.

MATERIALS AND METHODS

We mailed surveys to 207 men who had been seen for management of Peyronie's disease, 250 impotent men without Peyronie's disease, and 275 age-matched urologic patients without a history of either impotence or Peyronie's disease. The survey inquired whether the individual had a history of penile trauma to the flaccid or erect phallus or injury during sexual intercourse. In addition, patients were questioned whether they had been engaging in sexual relations with a partial erection.

RESULTS

The mean age of the impotent patients was slightly less than both the Peyronie's disease patients and controls. A similar response rate to the survey was found among the 3 groups. The mean duration of illness was 6 years for Peyronie's disease and 10 years for impotence. The frequency of penile trauma of any kind was significantly greater in both the Peyronie's disease (40%) and impotence (37%) patients than in the controls (11%). There was no significant difference between the Peyronie's disease and impotence groups. However, the Peyronie's disease patients had a lower frequency of attempting sexual relations with a partial erection than the 2 other groups.

CONCLUSIONS

The results of this survey demonstrate a significantly higher incidence of penile trauma in both impotent patients and patients with Peyronie's disease compared with controls. This study demonstrates an association between penile trauma and both Peyronie's disease and impotence. The reduced incidence of engaging in sexual relations with a partial erection among the Peyronie's disease patients implies that partial impotence is not a predisposing factor for Peyronie's disease.

Morphea after bromocriptine therapy

A 57-year-old man developed morphea while taking bromocriptine. This drug is a semisynthetic ergot alkaloid, one of a class of drugs that is associated with fibrotic disorders. Other agents known for such association are serotonin (5-hydroxytryptamine) and beta-adrenergic blockers. A common pathogenesis to link these agents to fibrosis remains uncertain.

Drug-induced sexual dysfunction

A large body of data, as well as clinical experience, link prescribed medications and substances of abuse with sexual dysfunction. This review surveys the relevant literature and summarises key points relating various classes of medications and their possible sexual side effects. Surprisingly, there were very few carefully designed, well organised, systematic studies of the effects of medication upon sexual performance. The preponderance of data is in the form of either case studies or collections of patient reports of side effects. As a result, there are great variations in the reported rates of sexual disturbances associated with the administration of a given medication. A further difficulty is the lack of precision in the use of terms which describe the various sexual disorders. A final problem is the almost total lack of data concerning both disordered and normal sexual functioning in females.

Identification of an inherited form of Peyronie's disease with autosomal dominant inheritance and association with Dupuytren's contracture and histocompatibility B7 cross-reacting antigens

Peyronie's disease is an inflammatory disorder with no confirmed etiology. We have documented the familial transmission of the disease as an autosomal dominant trait in 3 pedigrees. The occurrence of Dupuytren's contracture in 7 of 9 (78 per cent) affected individuals, which is a significant increase over the average 0 per cent reported in sporadic cases, suggests that both of these fibrosing disorders are pleiotropic effects of the same gene in these families. Similarly, the histocompatibility B7 cross-reacting antigens were present in 90 per cent of the patients with Peyronie's disease. Additional studies, including careful family histories and histocompatibility antigen typing, are necessary to elucidate the role of histocompatibility antigens as a relative risk factor.