Paulis Gianni, Brancato Tommaso
Andrology Service, Complex Operative Unit of Urology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
Inflamm Allergy Drug Targets. 2012 Feb;11(1):48-57. doi: 10.2174/187152812798889321.
Peyronie's disease (PD) is a connective tissue disorder characterized by a fibrous plaque involving the tunica albuginea of the penis. The inelastic fibrous plaque leads to a penile curvature. Several Authors have suggested an immunological genesis of this disease, others have linked PD with Dupuytren's contracture. Signs of this disease are curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing and erectile dysfunction. The natural history of PD and the clinical course can develop from spontaneous resolution of symptoms to progressive penile deformity and impotence. Surgical treatment is indicated when patients fail the conservative medical treatment and however, only in case of disease stabilization with a condition of impossibility of penetration. The medical treatment is indicated in the development stage of PD for at least one year after diagnosis and whenever in case of penile pain. Current non-surgical therapy includes vitamin-E, verapamil, para-aminobenzoate, propoleum, colchicine, carnitine, tamoxifen, interferons, collagenase, hyaluronidase, cortisone, pentoxifylline, superoxide dismutase, iontophoresis, radiation, extracorporeal shock wave therapy (ESWT) and the penile extender. The etiology of this fibrotic disease is not widely known, although in recent years pathophysiological knowledge has evolved and new studies propose the penile trauma as cause of the disease. The penile trauma results in a delamination of the tunica albuginea with a consequent small hematoma, then the process evolves as an inflammation with accumulation of inflammatory cells and production of reactive oxygen species (ROS). In the course of the inflammation, Peyronie's disease occurs due to the activation of nuclear factor kappa-B, that induces the production of inducible nitric oxide synthase (iNOS), with an increase of nitric oxide, leading to increased production of peroxynitrite anion. All these processes result in the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea (penile plaque). Referring to the current knowledge of inflammatory and oxidative mechanisms of PD, a possible therapeutic strategy is then analyzed.
佩罗尼氏病（PD）是一种结缔组织疾病，其特征是阴茎白膜出现纤维斑块。这种无弹性的纤维斑块会导致阴茎弯曲。一些作者提出了该疾病的免疫起源学说，另一些则将佩罗尼氏病与掌腱膜挛缩症联系起来。该疾病的症状包括阴茎弯曲、疼痛、畸形、性交困难、缩短、绞链、变窄以及勃起功能障碍。佩罗尼氏病的自然病史和临床病程可能从症状的自发缓解发展为阴茎逐渐变形和阳痿。当患者保守治疗失败时，且仅在病情稳定但存在无法进行性交的情况下，才考虑手术治疗。在佩罗尼氏病的发病阶段，诊断后至少一年内以及出现阴茎疼痛时，均应进行药物治疗。目前的非手术治疗方法包括维生素E、维拉帕米、对氨基苯甲酸、凡士林、秋水仙碱、肉碱、他莫昔芬、干扰素、胶原酶、透明质酸酶、可的松、己酮可可碱、超氧化物歧化酶、离子导入疗法、放射治疗、体外冲击波疗法（ESWT）以及阴茎延长器。尽管近年来病理生理学知识有所发展，新的研究提出阴茎创伤是该疾病的病因，但这种纤维化疾病的病因尚未广为人知。阴茎创伤会导致阴茎白膜分层，继而形成小血肿，随后该过程发展为炎症，伴有炎症细胞积聚和活性氧（ROS）生成。在炎症过程中，由于核因子κB激活，诱导诱导型一氧化氮合酶（iNOS）产生，一氧化氮增加，导致过氧亚硝酸盐阴离子生成增加，从而引发佩罗尼氏病。所有这些过程都会导致成纤维细胞和平滑肌成纤维细胞增殖，以及阴茎白膜层间胶原蛋白过度生成（阴茎斑块）。基于目前对佩罗尼氏病炎症和氧化机制的认识，随后分析了一种可能的治疗策略。
