What does Prof. Alessandro Natali?

These are the uro-andrological clinical fields in which Prof. A. Natali practices his profession both from the medical and surgical point of view

CLINICAL FIELDS

Peyronie’s Disease

This disease is known as Induratio Penis Plastica or  Peyronie's Disease (PD). PD was discovered for the first time in 1743 by Francois de La Peyronie, a French doctor, surgeon of Louis XV of France: PD is an inflammatory disease of the vessels running below the surface of a connetive structure that covers the penis inside, called albuginea tunic. The inflammation of this tunic, undergoes phenomena of fibrosis and thickening of the penis..

For this reason, real plaques or scars can form in the penis, which can also undergo calcification processes.

The precise cause of this disease is not known; over the years, inflammatory, immunological and infectious hypotheses have been proposed.

Currently the most probable hypothesis is that on a genetically predisposed ground, micro or macro-traumas at penile level, even simple sexual activity, produce small lesions to the albuginea tunic from which then starts the inflammatory process that progressively leads to the formation of these plaques.

Furthermore, it is known that smoking and lipid and glucose dysmetabolism are important co-factors in the onset of this disease. This affection mainly affects middle-aged men, but can also be achieved in other periods of the male's life. In some studies it indicates that it would have a prevalence around 7-10% in males.

What are Peyronie Disease symptoms?

The onset of the disease is often sneaky and non-specific: discomfort not better specified in the penis, slight pain during sexual intercourse, this is because at the base of the condition there is an inflammatory process, first acute and then chronic, which has the characteristics of progressiveness making the symptoms of the disease worse. When the pathology is overt we have the classical symptoms' triad: penile pain, bowing to erection and progressive erectile dysfunction.

How is Peyronie Disease diagnosed?

The diagnosis, which must be placed as early as possible for the progressiveness of this disease, is based on the autophotography of the penis in erection (which the patient must perform with an erect penis that allows to calculate the exact angle of curvature of the penis) and on a radiological examination, called a dynamic penile ecocolordoppler, performed with a flaccid penis and after a painless intracavernous microinjection practiced at the base of the penis, of a substance, Alprostadil, which provides a drug-induced erection which gives the opportunity to evaluate not only the circulation , but also the internal structure of the organ.

How is Peyronie Disease treated?

The treatment of PD initially involves general medical treatment with drugs that try to block or reduce the inflammatory process and lower the high levels of free radicals that would seem to reach very high concentrations in areas affected by this disease.

Along with this, local physical treatments are used (laser therapy, ultrasound, ion and / or iontophoresis with anti-inflammatory drugs and shock waves), for pain-relief purposes and to reduce the size of the plaques.

Following medical therapy, once the disease has stopped and stabilized and is no longer in an active phase, surgical treatment can be performed.

The surgical procedure, if a valid erection remains, is a so-called penile plastic surgery that consists in straightening the penis if there is a curvature that could prevent penetration from a mechanical point of view. If, on the other hand, there is no valid erection, a penile prosthesis is implanted which at the same time obviates the problem of erection and curvature.

 

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