Wagenknecht L V, Meyer W H, Wiskemann A
Urol Int. 1982;37(5):335-48. doi: 10.1159/000280838.
Etiology, pathogenesis and optimal therapy of Peyronie's disease are, 240 years after its first description, still unclear. Diagnosis includes palpation, measurement and exact drawing of the mostly dorsally and laterally located penile induration, photography of erectile deviation, cavernosography and ultrasound as follow-up controls. Pathogenesis of fibrotic stimulation is related to direct local causes such as vascular lesions, microtrauma and hemorrhage and to indirect induction of plasma exudation via autoimmune mechanisms by toxins, infections and vasoactive substances. Symptomatology in 116 of our own patients included the obligatory penile scar, erectile deviation in 75%, pain during erection in 33% and difficult or impossible intercourse in 40%. Radiotherapy in 113 patients led to healing or marked improvement in 44% of cases. In 41% the disease came to a standstill and in 15% of cases symptoms became worse. An analysis of the world literature shows surprisingly a 75% improvement by vitamin E therapy and almost a 60% amelioration by p-aminobenzoic acid and corticoid injections. Favorable results of radiotherapy vary in the literature between 50 and 70%. Reports on these successful treatments include unclear and optimistic criteria in small series and the possible spontaneous standstill or regression of the disease. Indications of operation are erectile pain, impossible invagination and a high degree of penile deviation. Surgical techniques are: (1) Excision of smaller fibrotic segments followed by longitudinal suture of the corpora cavernosa; (2) symmetric and cylindrical resection of both cavernous bodies followed by a watertight reanastomosis after mobilization of the corpus spongiosum; (3) after excision of larger plaques the defect may be covered by autologous material (danger: scar formation, aneurysmatic protrusion, impotence), and (4) hydraulic or semirigid penile prostheses are an ultima ratio. Since there was a 85% improvement or standstill of the disease and little side reactions in 113 of our patients following radiotherapy we recommend it particularly in the early inflammatory phase. An operation might be indicated for patients who do not benefit from this treatment and who show above-mentioned symptoms.
佩罗尼氏病的病因、发病机制及最佳治疗方法，在其首次被描述240年后，仍然不清楚。诊断包括触诊、测量以及精确描绘大多位于阴茎背侧和外侧的硬结，拍摄勃起时的弯曲情况，进行海绵体造影以及超声检查作为后续对照。纤维化刺激的发病机制与直接的局部原因有关，如血管病变、微创伤和出血，也与毒素、感染和血管活性物质通过自身免疫机制间接诱导血浆渗出有关。我们自己的116例患者的症状包括必然出现的阴茎瘢痕，75%有勃起弯曲，33%勃起时疼痛，40%性交困难或无法性交。113例患者接受放射治疗后，44%的病例治愈或明显改善。41%的病情停止发展，15%的病例症状加重。对世界文献的分析令人惊讶地发现，维生素E治疗的改善率为75%，对氨基苯甲酸和皮质类固醇注射治疗的改善率近60%。放射治疗的良好效果在文献中的报道在50%至70%之间。关于这些成功治疗的报告包括小样本中不明确和乐观的标准，以及疾病可能的自然停止或消退。手术指征为勃起疼痛、无法内陷和阴茎高度弯曲。手术技术包括：（1）切除较小的纤维化节段，然后纵向缝合海绵体；（2）对称并圆柱形切除两个海绵体，在游离尿道海绵体后进行水密再吻合；（3）切除较大斑块后，缺损可用自体材料覆盖（风险：瘢痕形成、动脉瘤样突出、阳痿），以及（4）液压或半硬性阴茎假体是最后的手段。由于我们的113例患者在接受放射治疗后，85%的病情得到改善或停止发展，且副作用很少，我们特别推荐在早期炎症阶段进行放射治疗。对于那些未从这种治疗中获益且出现上述症状的患者，可能需要进行手术。
