Expanding the paradigm for plaque development in Peyronie's disease.

Despite centuries of recognition, Peyronie's disease remains somewhat of an enigma. Conventional wisdom suggests that trauma to the erect or semierect penis is the inciting event that sets off a cascade of events at the cellular level that results in localized fibrosis of the tunica albuginea. However, many questions remain unanswered at this juncture among the most important of which are why do so few men manifest this condition? Why is there such an ethnic predilection? What are the cofactors that along with penile trauma lead to plaque development. Historically, cytokine overexpression, autoimmune and genetic factors have been cited as contributors. This treatise endeavors to conduct an evidence-based assessment of the literature as it pertains to the pathophysiology of Peyronie's disease. Furthermore, an effort is made to evaluate contemporary literature pertaining to novel concepts in Peyronie's disease pathogenesis including NOS alterations, free radical generation, microarray analysis, pathogen involvement and animal model development. In conclusion, it is likely that in the near future we will see dramatic developments in our understanding of this condition.