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Although the description of Peyronie disease, a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis, is attributed to François de la Peyronie, surgeon to Louis XV of France, there are reports previous to that time. Over the intervening 450 years, a variety of empiric treatments, varying in barbarity, have been proposed. The frequency of this condition and the etiology of the fibrosis are unknown. Quality of life for affected men and their partners is adversely impacted. In this review, the authors summarize the history of the discovery of this condition, review contemporary management approaches, and address the pathophysiology leading to the underlying disordered fibrosis. The potential immunomodulatory role of testosterone as well as inflammatory conditions and environmental stimuli that may provoke fibrosis are also considered. Peyronie disease may be part of a spectrum of fibrotic conditions, including Dupuytren contracture. Treatment strategies to date have focused on reversing fibrosis; work is needed to prevent fibrosis and to accurately document disease prevalence.

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PURPOSE OF REVIEW: The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches. RECENT FINDINGS: Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. The goal of these operations is not only to correct curvature, but also to restore length. Not surprisingly, the more complex and aggressive the attempt to correct the curvature, the more complications are possible. While modeling has a low rate of urethral injury, complex lengthening procedure with neurovascular bundle and urethral mobilization may lead to the dreaded complication of glans necrosis. Meanwhile, transcorporal techniques seem to offer a more modest improvement for length and curvature restoration with fewer risks than those seen in more aggressive lengthening procedures. The main limitation to the historical treatment of Peyronie's disease during penile prosthesis, modeling, and plaque incision is there is often no resolution to the penile length-as the maneuvers are made after the implant is already in place. Newer lengthening procedures are promising, however carry increased risks and complexity.

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The discovery of two archaeological objects describing La Peyronie's disease. They come from the archaeological excavation of Pantanacci (Lanuvio, south of Rome), that has returned numerous objects of medical representation dating back to the IV-III sec. B.C.

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Peyronie's disease (PD), more commonly known as penile curvature, is caused by plaque formation in the connective tissue of the penis. PD affects 0.3% to 8.9% of men, most commonly between ages 40 and 60 years and can cause significant psychological distress, regardless of severity. There is a rich history behind the initial reports of PD, initial beliefs about pathogenesis, and initial treatment. This article aims to discuss the history of PD as well as the evolution of causes and treatments throughout time up to present-day theories of pathogenesis and treatment.

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INTRODUCTION: Historians of medicine and urology, sexology, and andrology in particular maintain that many other physicians, surgeons, anatomists, and pathologists have already described "Peyronie's disease" some centuries before the author after whom it has been called, François Gigot de La Peyronie (1678-1747). AIM: To perform a brief historical survey of Peyronie's disease. Methods. A literature review was performed. RESULTS: The main surgeons and anatomists who previously observed and described penile curvature prior to François Gigot de La Peyronie are Theodoricus Borgognoni (1205-1298), 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), who was said to have left the first "postmortem" illustration of the disease in a copperplate engraving in 1691. CONCLUSION: The original texts could easily prove that none of the alleged "precursors" of La Peyronie did ever describe, treat, and cure real cases of Peyronie's disease, and that to award them this merit was somewhat far-fetched, with only Guilielmus of Saliceto and Falloppio possibly excepted.

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François Gigot de La Peyronie, first surgeon to Louis XV, definitively distinguished surgeons from the company of barbers and, by giving them a charter, placed them on an equal footing with physicians. The creation of Académie Royale de Chirurgie, in 1731, that LAPEYRONIE, presided for 11 years, put an end to the intolerable supremacy of medicine over surgery and contributed to the promotion of surgery. In 1743, he was the first to give a valid description of the disease that bears his name.

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The evaluation of the treatments for Peyronie's disease is difficult; the natural history is such that the plaque may resolve spontaneously [82]. In 1973, Alec Badenoch made this comment and noted that no treatment had then been evaluated in a controlled clinical study [83]. The origin of the eponym is vague and the disease remains an enigma. To this day, the treatment can be difficult. It is not surprising that so many treatments have been tried and so much dogma written. Indeed, in 1903, William Johnson Walsham, the famous surgeon from St Bartholomew's Hospital in London, and author of the standard surgical text book of the day, wrote; "... if treatment of the plaque with iodides is unsuccessful ... or if the induration progresses ... then the whole penis must be promptly amputated!' [44]. We no longer believe this dictuml.

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Peyronie's disease on plastic induration of the corpus cavernosum was described by La Peyronie in 1743. Initial clinical descriptions, based on 5 cases, were extremely clear. A surprising similarity is seen between comments on pathology and etiopathogenicity made in the past and current concepts. As early as 1886 it was suggested that inflammation was followed by fibrosis. Similarly, it has been known from 1850 that diabetes and Dupuytren's disease are frequently associated with Peyronie's disease. Although surgical removal of nodules and the use of a prosthesis were not mentioned, a thesis by Merle in 1899 suggested that treatment should consist of contralateral plication to reduce the effect of deviation of the fold resulting from the disease itself.

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Long before De la Peyronie's description of three cases of plastic induration and curvature of the penis (1743) the disorder was already known. The Ephemerides (1687) and the rather scabrous booklet, Venus minzieke gasthuis (Venus Hospital for the lovesick)(1688), contain short remarks on this condition. Two extensive Dutch contributions -- not mentioned in the literature on this subject -- were written by Nicolaas Tulp (1593--1674) and Fredrik Ruysch (1638--1731). The first one is a case history, the second one is more general discussion with a fine engraving added. Treatment varied according to the various early authors. The therapeutic successes claimed must be seen in the light of the natural history of this disease: spontaneous improvement occurs not infrequently. To change the eponym 'Peyronie's disease', however, seems unjustified. It is an homage to François Gigot de la Peyronie (1678-1747) surgeon to King Louis XV and founder of the French Académie de Chirurgie.

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