Peyronie's disease can manifest as various penile abnormalities such as curvatures, indentations, palpable plaques, nodules, hourglass deformity, penile shortening (with or without curvature), or a combination thereof. These deformities are most noticeable during an erection when the tunica albuginea loses its compliance (ability to stretch) at the fibrosis site, which prevents the corpus cavernosum from expanding. This lack of expansion causes the sides of the penis to become different sizes, with the fibrosis (plaque) causing the short side as it cannot expand. The opposite side is the long side (as seen in the picture). The initial acute phase always has an inflammatory component that can lead to pain.

Erectile dysfunction is a common occurrence in individuals with Peyronie's disease, with around 20 to 54% of patients (averaging 1/3) experiencing this issue. Other factors and conditions linked to Peyronie's disease include hypertension, dyslipidemia, low testosterone levels, Dupuytren's contracture, plantar fascial contracture (also known as Ledderhose disease), tympanosclerosis, trauma, transurethral procedures, gout, Paget's disease, and the use of beta-blockers.

Peyronie's disease, in its classic form, differs from fibrosis of the corpora cavernosa that arises due to external trauma, fractures, or as a secondary effect of intracavernous injection (ICI) with a vasoactive drug.

François Gigot de La Peyronie (1678 - 1747)

The first recorded instance of penile curvature was attributed to Theodoricus Borgognoni (1205-1298), and later mentioned by various surgeons and anatomists including Guilielmus of Saliceto (circa 1210-1276), Gabriele Falloppio (or Falloppia) (1523-1562), Andreas Vesalius (1514-1564), Giulio Cesare Aranzi (or Aranzio) (1530-1589), Claas Pieterzoon Tulp (Nicholaus Tulpius) (1593-1674), and Anton Frederik Ruysch (1638-1731). However, the only comprehensive and genuine description of the condition was given by François Gigot de La Peyronie in his work "Mémoir sur quelques obstacles quis'opposent à l'éjaculation naturelle de la semence," which was published in the first volume of the "Mémoires de l'Académie Royale de Chirurgie" (1743, pp. 425- 39), which he himself created. As a result, the disease came to be known by his name.

Image from the original publication of Peyronie's disease (1743)

We can classify Peyronie's disease into two phases:

The first phase, is called the "acute" or inflammatory phase

The second phase is called the "chronic phase".

During the first phase, the patient usually experiences pain (which may be absent) and progressive worsening of the curvature due to intense local inflammation and collagen deposition.
The pain and progression of curvature typically resolve spontaneously after 6-18 months, marking the end of this phase. The subsequent phase (chronic) is characterized by the absence of pain and stabilization of penile curvature, with a halt in the progression of genital deformity.

One crucial factor to assess is the decrease in penile length, which typically results in a reduction of 2.1-3.2 cm on average.

We know that penile curvature is the result of the inequality between the sides of the corpora cavernosa, where one side is short (X) and the other is long (Y) (figure to the side). The aim of surgical treatment is to equalize this difference in lengths of each side of the corpora cavernosa. They can be divided into two types:

1- Reduction of the longer side of the corpora cavernosa (Nesbit and variants).
2- Lengthening of the shorter side (grafting).

The disadvantage of the first method is penile shortening, more significant for deviations > 30 degrees. By performing geometric analysis, we know that for every 30 degrees of curvature, there will be a difference of approximately 1.6 cm (W) between the sides of the penis. This means that in a patient with a 60-degree curvature, we will have to reduce 3.2 cm (2 x 1.6) (W) on the long side (Nesbit) or increase 3.2 cm on the short side (graft).

In general, the decision on the type of technique to be used is based on penis size, presence of an hourglass defect, and degree of deviation.

Small penis in length = Grafting

• < 60 degrees - Plication (Reduction of the long side)
• > 60 degrees - Grafting (Lengthening of the short side)
• If there is an hourglass deformity = Grafting
• Small penis in length = Grafting

Peyronie's disease is often associated with erectile dysfunction (SDR), which affects from 20% a 54% of patients [1]. When these patients do not respond to oral and non-invasive treatments, they are indicated for penile prosthesis insertion.
The treatment normally used by most urologists is the implantation of a penile prosthesis, without actually correcting the curvature. Unfortunately, placing a penile prosthesis without augmenting the side that has been shortened by the disease results in smaller penile sizes and residual curvatures, which can cause patient dissatisfaction.

Another possible option during the insertion of the penile prosthesis is the  recovery of penile volumetryboth in lengthas in caliber. However, there is a limit to the length gain, as the nerve that reaches the glans (head of the penis) has a limited capacity to stretch. The average increase in the length of the patient's penis is 2.0 cm, varying from more or less.

[1] J Urol. 2004;172(1):259-62.