fibrosing cavernitis of penis
Introduction
Introduction to penile fibrous cavernitis Penile fibrous cavernitis (hereinafter referred to as Peyronie's disease) is a fibrotic lesion between the corpus cavernosum and the white membrane, and single or several lesion plaques appear on the corpus cavernosum. Francoisde LaPeyronie described the characteristics of fibrotic penile cavernitis in his paper in 1743 and was therefore named Peyronie disease. Peyronie disease is also known as penile unnatural induration, penile fibromatosis and penile sclerosis. It is the damage of the corpus cavernosum. During the erection, the penis bends to the damaged side, which may be related to multiple mild injuries of the penis, but the exact cause is unknown. The lesion is located in the cellular connective tissue between the corpus cavernosum and the white membrane. Microscopically, lymphocytes and plasma cells infiltrate around the blood vessels in the connective tissue layer, and collagen plaques are formed in the vicinity of the corpus cavernosum. basic knowledge Probability ratio: 1.31% of men over 20 years old Susceptible people: male Mode of infection: non-infectious Complications: sexual dysfunction
Cause
Cause of penile fibrous cavernitis
(1) Causes of the disease
1. Trauma: Trauma is a promoting factor of Peyronie's disease. Many authors have already explained that penile wounds caused by sensitive individuals during sexual intercourse can develop into Peyronie's disease. Kadioglu et al reported that Peyronie's disease is associated with penile vascular disease and erectile dysfunction: the author In 136 patients with Peyronie disease, 76.5% had penile vascular abnormalities; 87.5% of patients with a history of spontaneous erectile dysfunction had penile vascular abnormalities, and arterial lesions reduced penile erection hardness and were susceptible to Peyronie's disease.
Some patients have Peyronie disease after transurethral resection of the prostate with TURP. The mechanism of penile curvature is also suitable for these patients, but the cause of penile curvature injury is due to the routine placement of thick caliber catheters after surgery. When the penis is erect at night, it is easy to cause the above injury. .
In addition to penile curvature injury, other external factors on the white membrane tissue may also lead to the same result, some car accidents or work accidents directly lead to penile trauma, can also gradually develop into a lesion similar to Peyronie disease, and some patients denied sexual intercourse or other incentives The history of penile injury, the exact pathogenesis of these people is still unclear.
2. Other possible reasons
(1) Genetic factors: Perichery et al. first found that the microsatellite instability (MSI) and heterozygous deletion (LOH) of plaque cells 3, 8, and 9 are very frequent, and it is speculated that the occurrence of Peyronie disease is related to this. .
(2) Immunity factors: Schiavino et al. detected lymphocyte transformation test in 64 Peyronie patients, serum IgA, IgG, IgM, anti-DNA antibody, anti-nuclear antibody, anti-smooth muscle cell antibody, C3, C4 complement fragment, anti-streptolysin As well as the C-reactive protein titer, it was found that 75.8% of patients had at least one abnormality, while the control group was only 10% abnormal.
(two) pathogenesis
In 1966, Smith described the pathology of Peyronie's disease, arguing that the lesion was caused by perivascular inflammation in the gap between the erectile tissue and the white membrane (this gap is called the Smith gap), and histology showed that the lesion was in the gap. There is inflammation, and sometimes this inflammation can also be seen in the Bucks fascia and under the fascia. It has been proven that the plaque of the lesion is scar tissue.
Somers used a Peyronie disease plaque, Dupuytren contracture nodules and normal human corpus cavernosum (control group) in 1997 to study the structure and distribution of collagen, elastin fibers, and found 32/33 (97%) Peyronie lesions. The block had significant collagen staining, 31/33 (94%) elastic fiber rupture, fibrin deposition in 18/19 plaque tissues (confirmed by immunospot assay), and fibrin deposition was not found in the control group; 7/8 Dupuytren Significant collagen staining and fibrin deposition were also observed in the contracture nodules, and the fact that fibrin deposition was present in plaque tissue was consistent with the theory that repeated microvascular damage caused fibrin deposition in interstitial spaces.
Mulhall et al. measured b-FGF (basic fibroblast growth factor) in plaque tissue and foreskin of patients, and found that b-FGF protein expression in plaques was much higher than that in the foreskin; El-Sakka et al. used - The injection of FGF analog Cytomodulin into the murine corpus cavernosum was successful in animal models similar to Peyronie's disease, confirming that -FGF is involved in the pathogenesis of Peyronie's disease.
Most Peyronie patients have erectile dysfunction. In most cases, erectile dysfunction precedes Peyronie's disease. According to axially unstable erectile stiffness mechanisms (possibly caused by mild erectile dysfunction), these patients have experienced chronic or acute penile curvature. damage.
The white membrane is layered in most of its surrounding area, the outer layer is longitudinal fiber, the inner layer is annular, the two layers are present on the dorsal and ventral sides, and the ventral midline longitudinal fibers are thinner. It may be a single layer. The septal filaments of the sponge are arranged in a fan shape and closely intertwined with the fibers of the inner layer of the white film. Under normal circumstances, the sponge tissue has symmetrical elasticity, and the erection of the penis causes the white membrane tissue to stretch and change. Thin, if there is no inner fiber support structure, the penis erection is not hard enough, and the fiber skeleton in the sponge provides this support structure, and the sponge septum fiber bears most of the abdominal-back axial hardness support during erection.
When the membranous sheath and septal fibers are stretched to the limit, the septal and ventral-dorsal tunica sheaths form a "work" beam-like structure to resist the bending force from the dorsal-ventral side, and the blood accumulated in the sponge. Hydraulically, the force exerted on the surrounding white film is at right angles, and the vector force of the dorsal and ventral forces causes the septal fiber filaments to stretch, and the stress applied to the penis when the penis is bent on the dorsal-ventral surface Concentrated on the part of the septum and the white film, and this is where the Peyronie disease plaque occurs, so the bending shear force causes the layer of the white film to detach. At this point, the intervening fiber filament is connected to the white film. After separation, blood is infiltrated into the gap of the separation layer, or the filament of the septal fiber is torn off, and the wound and blood infiltration cause inflammation, induration, and finally scar formation in a sensitive patient.
Prevention
Penile fibrous cavernitis prevention
1, exclude the disease should go to the hospital when necessary, to exclude urinary system diseases, such as chronic prostatitis, epididymitis, urethritis, or other such as endocrine diseases, various systemic chronic diseases.
2, active participation in physical exercise continuous, appropriate physical exercise and outdoor activities will be beneficial to you, adhere to daily exercise, can regulate nervous mental work or neurological fluid disorders, such as jogging or walking for 30 minutes a day. Strive for a regular life, ensure adequate sleep, and actively lose weight.
3, to avoid bad habits to avoid unhealthy eating habits, reduce entertainment, avoid alcohol, control diet, fully recognize the importance and necessity of smoking cessation.
Complication
Penile fibrous cavernitis complications Complications
Patients are often accompanied by psychological and sexual dysfunction.
Sexual dysfunction refers to the inability to perform normal sexual behavior or to be satisfied in normal sexual behavior. Most sexual dysfunction has no organic lesions, which means that there are no abnormalities or lesions in the sexual organs, but because of psychological factors. Therefore, it is often called sexual psychological dysfunction in sex. Sexual dysfunction is generally divided into psychological sexual dysfunction and organic sexual dysfunction. Organic sexual dysfunction mainly refers to impotence, premature ejaculation, and no ejaculation.
Symptom
Penile fibrous cavernitis symptoms common symptoms dyspareunia painful penis erection penis pain penile induration
Penile fibrous cavernitis can be divided into acute phase and chronic phase. The former is characterized by acute inflammatory reaction and pain. Pain mainly occurs when penile erection occurs. 30% to 40% of patients have obvious pain symptoms. This period can last for several months. During this period, the penis can form nodules, the penis is continuously bent to the disease side, and when the penile leukocytic active inflammation stops, it enters the chronic phase. In this period, the pain symptoms usually disappear, the plaque forms induration, the curved penis cannot be restored, and the penile fibrosis Cavernous inflammatory disease is also considered to be penile fibromatosis. In some important tissues of the human body, physiological processes similar to penile fibrous cavernositis may occur, such as Dupuytren contracture in the formation of scar of the fascia, and scar contracture of the plantar fascia. The Ledderhose sign, as well as tympanic membrane sclerosis caused by tympanic scarring, about 30% of penile fibrous cavernositis with Dupuytren contracture, while Dupuytren contracture only 3% of penile fibrosingitis, although noted family-borne Prone, but did not find the correlation between the disease and HLA-B7 or HLA-B 27, mostly middle-aged people, mainly 45 to 60 years old, most penis Uretary cavernous inflammation is an occult disease, the patient's penile erectile function is not satisfactory, the penis has painful plaque, the penis bends slowly, and there are sudden onsets. Suddenly, the penis is bent, generally does not progress, and the penis is deformed to cause sexual intercourse difficulties. If there is impotence, there is a psychological disorder, or penile vascular organic disease, the dorsal side of the penis can touch the induration or cord-like plaque, the size is different, single or multiple, no tenderness or tenderness, when the penis is erect Pain, lesions do not invade the urethra, no urination or ejaculation disorders, plaque calcification or ossification, X-ray film can show lesions, and can measure size.
Examine
Examination of penile fibrous cavernitis
1. X-ray examination of the corpus cavernosum angiography shows the shadow of calcification, cavernous angiography can show filling defects in the lesion.
2.B Ultra
Type I: thickening of the tunica albuginea, no stun, and increased density of the lesion.
Type II: moderate calcification, with typical sonic, slightly dense lesions.
Type III: severe calcification, with typical sonic, increased lesion density.
3. MRI suggests that the lesion has an inflammatory response.
4. Dynamic infusion cavernosometry and cavernography (DICC) can show the size of the induration range.
Diagnosis
Diagnosis and differentiation of penile fibrous cavernitis
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
1. The ossification of the penis ossification is relatively rare. It is caused by calcification and fibrosis of the corpus cavernosum. Its nodules are often prominent. It seems to be a horn, which can cause pain when the penis is erect, and can lead to difficulty in sexual intercourse. X-ray examination can be seen. There is a shadow of increased density in the penis.
2. Penile cancer Penile cancer occurs most often in the penis head, the inner skin of the foreskin and the coronary sulcus. When the penile cancer invades the corpus cavernosum, it can be indurated in the cavernous body. Local biopsy can help to determine the diagnosis.
3. Penile tuberculosis penis tuberculosis is quite rare, mostly manifested as nodules or chronic ulcers of the penis head. Tuberculosis can be found in ulcer secretion examination. The pain is generally not obvious. When penile tuberculosis spreads in the cavernous body, it can cause local fibrosis and cause Penile curvature, the diagnosis depends on pathological examination.
4. It should also be differentiated from congenital penile curvature deformity, penile dorsal artery embolization, post-traumatic fibrosis of penis, and corpus cavernosum leukocyte infiltration.
