title: The pathophysiology of Peyronie's disease.
abstract: OBJECTIVE
  To review the contemporary knowledge of the pathophysiology of Peyronie's disease (PD).
  
  
  METHODS
  Medline was searched for papers published in English from 2000 to March 2013, using the keywords 'Peyronie's disease' and 'pathophysiology'.
  
  
  RESULTS
  More than 300 relevant articles were identified for the purpose of this review. Unfortunately only a few studies had a high level of evidence, and the remaining studies were not controlled in their design. Many theories have been proposed to explain the cause of PD, but the true pathogenesis of PD remains an enigma. Identifying particular growth factors and the specific genes responsible for the induction of PD have been the ultimate goal of research over the past several decades. This would provide the means to devise a possible gene therapy for this devastating condition. We discuss present controversies and new discoveries related to the pathophysiology of this condition.
  
  
  CONCLUSIONS
  PD is one of the most puzzling diseases in urology. The pathogenesis remains uncertain and there is still controversy about the best management. The pathogenesis of PD has been explored in animal models, cell cultures and clinical trials, but the results have led to further questions. New research on the aetiology and pathogenesis of PD is needed, and which will hopefully improve the understanding and management for patients with this frustrating disease.
authors.affiliation: Department of Urology, Suez Canal University, Ismailia, Egypt.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: El-Sakka
authors.affiliation: Department of Urology, Faculty of Medicine, Istanbul University, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Salabas
authors.affiliation: Department of Urology, Faculty of Medicine, Istanbul University, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Dinçer
authors.affiliation: Department of Urology, Faculty of Medicine, Istanbul University, Turkey.
authors.forename: Ates
authors.initials: A
authors.lastname: Kadioglu
keywords: (i)NOS, (inducible) nitric oxide synthase; DM, diabetes mellitus; ED, erectile dysfunction; EF, erectile function (domain); FGF, fibroblast GF; Fibrosis; GF, growth factor; MMP, matrix metalloproteinase; PD, Peyronie’s disease; Pathophysiology; Peyronie’s disease; ROS, reactive oxygen species; TA, tunica albuginea; Tunica albuginea