Peyronie's-like changes in the tunica albuginea were identified in reconstruction patients

Tunica albuginea plays a critical role in the biomechanics of the penis, as the main bearer of mechanical forces during erection; collagen is central to changes that occur in the tunica of Peyronie's patients; however, our understanding of tunica collagen composition remains poorly understood.

To quantify collagen abundance and subtypes in tunica and corpora cavernosa of reconstruction patients treated with 0-25 years of 17β-estradiol and Spironolactone.

Tunica and corpora cavernosa (n = 25) were obtained from patients undergoing penectomy with reconstruction surgery. Collagen was quantified and evaluated with 17β-estradiol treatment, age, antiandrogen, and testosterone concentration. Immunohistochemistry (IHC) for collagen I-IV was performed with ImageJ quantification. Primary tunica cell cultures were established and characterized for P4HB (fibroblast), α-ACTIN (smooth muscle), and CD31 (endothelium). Fibroblast growth with Sonic hedgehog (SHH), BMP4, and GREM1 treatment were quantified.

Hydroxyproline, IHC, and cell culture were performed.

Collagen abundance did not correlate with duration of 17β-estradiol and antiandrogen treatment, age, and testosterone level. Collagen III was more abundant in the corpora cavernosa than the tunica, and collagen III increased 35.4% (P = .05) in tunica of patients treated with 17β-estradiol and antiandrogen, mimicking the increased collagen III observed in Peyronie's patients. Collagen I was 12.1% higher in the corpora cavernosa than the tunica (P = .049) and was unchanged in tunica (P = .34) and corpora cavernosa (P = .41) with 17β-estradiol and antiandrogen treatment. Collagen IV increased 26.6% in corpora cavernosa with 17β-estradiol and antiandrogen treatment (P = .005). P4HB staining fibroblasts were isolated from patient tunica; fibroblasts increased growth with GREM1 and decreased growth with BMP4.

Reconstruction patients develop Peyronie's-like changes in collagen subtypes (collagen III) in the tunica that offer a unique opportunity to study how collagen signaling becomes dysfunctional and provide novel insight into early-stage collagen changes.

Collagen III increased in tunica of reconstruction patients. It is of interest that tunica of reconstruction patients, which do not display a plaque as in Peyronie's patients, show a similar change in collagen III abundance. It is unclear how changes in collagen subtype impact erectile function.

In addition to 17β-estradiol and antiandrogen treatment, reconstruction patients practice aggressive taping and compression of their tissue, which may induce Peyronie's-like collagen changes from the repeated microtrauma and/or ischemia; reconstruction patient tunica may provide a novel model to study changes in collagen signaling and offer insight into development of Peyronie's changes in tunica architecture.

Reconstruction patients develop a Peyronie's like condition with increased collagen III in the tunica, that offers a unique opportunity to study how collagen signaling become dysfunctional and provide novel insight into early stage Peyronie's collagen changes.