Induratio Penis Plastica

INDURATIO PENIS PLASTICA (induration plastique des corps caverneux - French authors; in American manuals often - Van Buren's disease), plastic hardening of the penis - a peculiar disease described as an independent nosological unit, differing from chronic cavernitis and ossification of the penis. In I. p. p., foci of cartilaginous, fibrous, or keloid-like tissue appear in the septum between both cavernous bodies of the penis and the tunica albuginea. They appear in the form of thin plates or in the form of a groove on the dorsal surface of the penis with edges from which extensions go into the substance of the cavernous bodies. - The etiology of this disease is completely unclear; without particularly convincing reasons among etiological factors, fibroplastic constitution (Sachs, Callomon), gout (Morris), syphilis, rheumatism, diabetes, arteriosclerosis, etc. are mentioned. One thing is certain, that the most careful anamnesis of such cases, unlike chronic cavernitis, gives no indications of an inflammatory process. - Pathologically - anatomically, we are talking (as proved by Sachs, Sonntag and others) about changes similar to Dupuytren's contracture, with which I. p. p. often exists simultaneously. Resembling a keloid, poor in nuclei and vessels, connective tissue is interwoven with closely adjacent elastic fibers. The finding of lime deposits, cartilage and bone formations in the cavernous tissue is by some attributed to atavistic phenomena ('os priapi' in mammals, e.g., in dogs, cats, etc.), while others with more right connect it with metaplastic changes and calcification of small extravasates occurring in the presence of sclerosis from minimal trauma. Clinically, the disease is observed in patients over 40 years of age, proceeds slowly and attracts attention only due to the disturbance of erection it causes. The penis in front of the hardening appears completely flaccid, or weakly erect. More important, however, is the curvature of the penis during erection - chorda venerea, and the angle of curvature corresponds to the localization of the hardening. In the erect state of the penis, patients often experience pulling pains radiating to the glans penis or to the testicles; sometimes there is difficulty in urination. - In differential diagnosis, one should keep in mind the possibility of confusion with gumma of the cavernous bodies (cylindrical syphiloma), which, however, unlike, affects only one cavernous body; with gonorrheal cavernitis, which develops acutely during gonorrhea and is accompanied by phenomena from the canal; much more rarely - with injuries, differing in anamnesis, and with tumors possessing progressive growth. In most cases, the diagnosis is not difficult: sometimes radiography comes to the aid of simpler methods. - The prognosis quoad vitam is favorable; as for recovery, excluding rare cases of spontaneous absorption of nodes, it is undoubtedly unfavorable. - As for treatment, the multitude of proposed methods already speaks to the fact that none of them is ideal. Surgical treatment, which only replaces one scar with another, is clearly contraindicated. Of local remedies, various ointments (mercurial, potassium iodide), local mud baths, iontophoresis and diathermy are used. All these methods, as well as injections of thiosinamine or fibrinolysin around the hardening, as a rule, do not give success. The same can be said about the recently proposed injections of Pregl's pepsin. Treatment with radium and X-rays only in very rare cases gave improvement. The difficulty of preventing I. p. p. is clear from the above about the etiology of the suffering.