Peyronie's disease: a review

PURPOSE: We provide a current review of Peyronie's disease. MATERIALS AND METHODS: We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. RESULTS: The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. CONCLUSIONS: Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.     

Physiology and biochemistry of erections

The physiology of erection has received intense clinical and basic research scrutiny over the past two decades. This massive effort has led to a much clearer understanding of the macroscopic aspects of erection as well as identification of the prominent features of the etiology of erectile dysfunction (ED). However, it is clear that the devil is in the details of the erectile process. Therefore, to truly understand the precise mechanistic basis for erection and ED, much more still must be learned about how the biochemical cascades in the corporal smooth muscle cells are integrated to produce a normal erection, or how they are altered to result in ED. The ultimate goal of these basic research and clinical efforts will be to provide a rational scientific basis for mechanism-based, patient-specific therapies for ED. This article reviews fundamental aspects of the physiology of erection and summarizes the most recent information available concerning the putative biochemical correlates of these physiologic events.     

Inhibition of Ras oncogenic activity by Ras protooncogenes

Point mutations in ras genes have been found in a large number and wide variety of human tumors. These oncogenic Ras mutants are locked in an active GTP-bound state that leads to a constitutive and deregulated activation of Ras function. The dogma that ras oncogenes are dominant, whereby the mutation of a single allele in a cell will predispose the host cell to transformation regardless of the presence of the normal allele, is being challenged. We have seen that increasing amounts of Ras protooncogenes are able to inhibit the activity of the N-Ras oncogene in the activation of Elk in NIH 3T3 cells and in the formation of foci. We have been able to determine that the inhibitory effect is by competition between Ras protooncogenes and the N-Ras oncogene that occurs first at the effector level at the membranes, then at the processing level and lastly at the effector level in the cytosol. In addition, coexpression of the N-Ras protooncogene in thymic lymphomas induced by the N-Ras oncogene is associated with increased levels of p107, p130 and cyclin A and decreased levels of Rb. In the present report, we have shown that the N-Ras oncogene is not truly dominant over Ras protooncogenes and their competing activities might be depending on cellular context.     

Complications of Penile Lengthening and Augmentation Seen at 1 Referral Center

Purpose

Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed.

Materials and Methods

During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection.

Results

the chief complaint was poor cosmetic appearance (irregular residual fat nodules in 7 men, skin deformity and scarring in 4 and scrotalization in 4). Reoperation was necessary in 6 patients, wound complications occurred in 6 and sexual dysfunction was reported by 4. Only 1 patient reported a subjective increase in penile length.

Conclusions

Although a verifiable complication rate may never by available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.