The areolar tissue space in the tunica.

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Dipstick

Guys,

I'm trying to narrow down to the specifics of the majority of the scarring and plaques that occur in peyronies. So I can have a better understanding. I can't help notice the areolar tissue that separates and causes a space in the tunica on ventral and dorsal sides.

I'm almost 100% positive that this is the exact location of where a lot of our plaques form. It's not actually the tunica itself in a lot of us right? But that space of areolar tissue, my understanding is that if there is a rupture or tear blood leaks into that space and causes a clot / fibrosis in the area.

So the basic cause of our peyronies is when blood somehow leaks into this space. In my case, I have diffuse thickening which tells me that blood has leaked into my areolar space throughout. Perhaps chronically blood leaks into the area. Hence vascular health is at play once again.

In acute it's sudden and local, in chronic it seems gradual and wide spread. So the cause, wether it be genetically driven or not is simply the reaction to blood leaked into that space.

In rare cases the tunica itself tears and heals with a scar but I doubt this would cause a lump or
Plaque as such and almost ALL cases of peyronies are either dorsally or ventral and always in that exact same spot where it fills the areolar spaces. In areas where there is no areolar spaces we don't get peyronies plaques there.

Can someone else tell me if they think the same?  
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melting

Good idea. I started similar threads with low reception.

It can happen anywhere in the penis tissue.  
Anywhere you have faulty tissue in the penis, that isn't flexible enough to allow the smooth muscle to fill. and then expand the tunica to it's maximum, you will have problems achieving a normal erection.  
That is the prime reason for us having a problem.. The penis tissue has to be flexible. If it isn't you got a problem.

The tissue you describe could very well be an area any injury or inflammation will cause peyronies ..possibly through the mechanism you describe.. but blood leaking get's rather easy absorbed by the body, no? I guess in that space it would be more like a vascular injury/inflammation being patched up by the body resulting in hard tissue.

I'm confident that in my case I had a plaque deeper than the areolar tissue. It was a very palpable lump right in the middle deep inside.

My theory is that the penis is one of the worst spots to have an injury, not just cause of the way it infers with the expansive/flexible tissues but also how it is not as good "reached" by the health mechanism of the body. Low blood circulation compared to a leg or shoulder or stomach..

Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)

Dipstick

Fully agree with that, it's so easy to damage the penis and have a tough time healing it. Unlike a leg or arm.

Hmmm... inflammation. I suppose the question is obviously the causes of that inflammation. And then to eliminate potential causes.

I have a hernia mesh which is designed to cause fibrosis... I wonder if that local inflammation has spread over the years to the penis.

Blood leaking... I don't know, would it be reabsorbed or just form a scab / scarring?
I guess if it's trapped there it would be a problem. Like if vascular damage as you say, would maybe cause a bit of inflammation in that space.

Is the areola tissue very vascular???????
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melting


Inflammation happens all the time in the body. It turns into a problem when it's chronic or doesn't finish it's cycle.
https://en.wikipedia.org/wiki/Wound_healing
which brings us back to the "trapping". If an injury/inflammation is in a place where the body can't finish the cycle of healing, it will deal with it crudely. That's what we get with these fibroids, imo often coated in calcifiation, which solves the inflammation/isolates the fibrosis from the body.

If you're in a bad health state where the whole body is in a "state of inflammation" smaller inflammation herds will not heal.  
For example if you eat food that's allergic to you.. or bad blood as in too much "bad fat" in it. you get the idea.. then a small penis injury, that isn't even noticed, might not heal properly.
Such an "inflammation mesh" "upstream" the penis could correlate to it logically..

areola tissue is vascular.

"Blood leaking", would mean a defective vascular tissue which then the body tries to heal.
I mean that's similar to arteriosclerosis, right? The arteries there get clogged by the body patching up the hurt walls by calcified plaques. It's similar. That's again, the process how the body deal with injury.    

If the circumstances are perfect in wound healing you end up with a very similar tissue like the original one. Everyone can observe that on the skin. Stretch injured skin or mess with the wound or have bad blood circulation to it and you end up with faulty tissue.. scars.

That's why for many ped5, cialis etc. help cause they create a great circulation.
Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)

Dipstick

Yes that makes sense,

Especially in my case where I have a permanent mesh that results in a permanent fibrotic state near the penis region. I have scar tissue all around the mesh, it's not a far stretch to to think this might be the causal link to the type of fibrosis I have in my penis.... which itself is seems very unusual. I haven't heard of anyone having the same thing I have.

I don't have any localized plaque and I've had no local injury. Here is the strange thing however, my entire tunica is thickened, a dorsal strip along the top and a ventral strip underneath both about 1cm wide. It runs along entire length of my penis. In fact it runs right through into my perineum.

It's not very irregular or bumpy, it's even and diffuse and, it's hard and slightly bendable fibrous thickening, from top to bottom. If I rub the top of my penis I also notice two hard strands or lines, on each side which feel like are actually the two dorsal nerves that are inflamed?

I have no pain in my penis.

I keep going back to this mesh and my intuition / gut tells me this hernia mesh could be the cause.
I had a period of about 2 years where I smoked a long time ago, and I'm unsure if that caused it. It slowly progressed chronically over the years.

Funny you mention the "unable to end the cycle", because that makes sense with this mesh, causing constant "inflamed" state.

The urologist tells me the mesh is not able to interact or effect structures of the penis. He said perhaps it's somehow possible but is unsure.  However it's just so near to the area, it's in the groin and is right next to my pubic bone.

I can have it removed, but it has risks so I'm weighing this up and it feels like a coin flip! A gamble. I can't find any other reason why I'd have this type of "peyronies". The urologist was hesitant to even call it peyronies. Since there is no plaque or local injury, just simply a wide spread diffuse thickening of my tunica. He said there is no treatment for me as he doesn't consider what I have to be "clinical peyronies" yet I have this diffuse thickening.

It has to be on going inflammation. The cause is the question.  
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melting


QuoteI don't have any localized plaque and I've had no local injury. Here is the strange thing however, my entire tunica is thickened, a dorsal strip along the top and a ventral strip underneath both about 1cm wide. It runs along entire length of my penis. In fact it runs right through into my perineum.
If it runs right through the middle it could just be the septum. feels like a cord. https://www.researchgate.net/profile/Morteza_Karkan/publication/316592651/figure/fig1/AS:677022552571904@1538426163166/Schematic-penis-anatomy.png



QuoteIt's not very irregular or bumpy, it's even and diffuse and, it's hard and slightly bendable fibrous thickening, from top to bottom. If I rub the top of my penis I also notice two hard strands or lines, on each side which feel like are actually the two dorsal nerves that are inflamed?

Most probably the arteries/veins..


QuoteI can have it removed, but it has risks so I'm weighing this up and it feels like a coin flip! A gamble. I can't find any other reason why I'd have this type of "peyronies". The urologist was hesitant to even call it peyronies. Since there is no plaque or local injury, just simply a wide spread diffuse thickening of my tunica. He said there is no treatment for me as he doesn't consider what I have to be "clinical peyronies" yet I have this diffuse thickening.

It has to be on going inflammation. The cause is the question.

I would call a second or third opinion on this and how to handle the mesh issue, a quick look tells me there are multiple versions and ways and the whole continuous inflammation thing doesn't sound right to me but I have no clue about the meshs.. so just a hunch..

"Diffuse thickening"
weird.

Check how the veins and arteries work in erect and flaccid state.
https://www.georgiadis-urology.com/how-do-erections-work/  

They run through the tunica and if these veins and arteries are "calcified" (you got a doppler showing calcification right?) you will get problems.. But I'm not sure if that's it. Could also be the "space" you mentioned..

Can you have apart from the bend normal hard erections "full of blood"?

Diffuse can be an opportunity though as a thick 1 round plaque is harder to get rid off.  
I personally would use transdermals(dmso) with anti calcification agents (magnesium, ascorbic acid and others..) to "dissolve" these.. If they are very small and have spaces between them then they could be "targeted" rather easily.
You can read in my signature link about it. Of course I have no idea how such transdermal applications (in most countries it would be a DIY thing) are influencing your mesh though(!).
Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)

Dipstick

Quote from: melting on May 22, 2020, 08:44:49 PM
If it runs right through the middle it could just be the septum. feels like a cord. https://www.researchgate.net/profile/Morteza_Karkan/publication/316592651/figure/fig1/AS:677022552571904@1538426163166/Schematic-penis-anatomy.png

Most probably the arteries/veins..


Not the septum, they diagnosed it as dorsal and ventral. The septum is fine. Here you can actually see the thickening on my mri.

https://i.imgur.com/83Y7pVV.jpg

My penis is hanging down flaccid, you can see that strip running down about 1cm wide it runs all the way down. It's fibrous and hard. That's the problem! I am definitely going to do transdermal.

Quote

"Diffuse thickening"
weird.


Exactly, very weird, it's on two of my ultrasounds. No plaques, no calcification either. They don't see any calcification or plaques, just my whole tunica is like inflamed / thickened.

Quote
Can you have apart from the bend normal hard erections "full of blood"?

I've got a slight bend to the right. But my erections are not completely full and hard. I can bend my erection, and I've lost over an inch in girth. Going from 6"2 down to 5 inches.

I definitely think you're right about it being diffuse will respond better to treatment especially topicals.

I have verapamil as well, which I am unsure if it can be used with dmso. I plan to have different mixtures as you did. I have read your posts and I think your methods will be better suited for my issue.
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Dipstick

Have a look at this melting, you can see what I'm talking about. I've outlined the problem in yellow in this image.

https://imgur.com/gallery/hAPaRag

That strip is the hardened / thickened tissue. But it's not calcified, it's just fibrotic and thickened with chronic inflammation.

It's bizarre!! I have this underneath the penis as well. The urologist doesn't know what to call it, he just refers to it as moderate diffuse fibrous thickening.

I've had a few specialists look at it, they also had a meeting where they all discussed it. It's not your classical peyronies, something else that is chronic and wide spread.  
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melting

Yes, Verapamil can be used transdermal. We discussed it here: https://www.peyroniesforum.net/index.php/topic,12945.msg118905/topicseen.html#msg118905  
Though OP had seemingly problems with his pharmacy making a good solution consistency wise..

If there's no calcification but it's inflamed then the logical solution is to apply anti-inflammatories. Iodine would be one which theoretically could also go transdermal without DMSO.(though not clear how deep but maybe to the areolar tissue).
I would always include an ascorbic acid mix, it's so simple, cheap, safe and necessary for all tissue functions.

Do you have any other medical problems? Especially with the veins or arteries? Overweight? Fitness level?

Also, if you search the condition "hard flaccid" it isn't the same as yours?
It's mostly related to pelvic floor tightness. In any case a relaxed pelvic floor is integral to a working penis too.
Can you explain why and how the mesh was necessary and what the outlook on the mesh and condition is?

Looking at the pic, your idea about areolar tissue kind of makes sense. In any case you need to get that inflammatory fibrotic state calmed down there. At some point the body might try to do it on it's own which then can result in calcification.(so using ascorbic acid and magnesium and others that help with calcifiation makes sense to apply too at some point)



Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)

melting

..and Verapamil is obviously also a calcium channel blocker. Which would help to not get calcification in the first place.
Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)

Dipstick

Quote
Do you have any other medical problems? Especially with the veins or arteries? Overweight? Fitness level?

I'm very lean, I have had a problem with gluten (Coeliac disease) which I have avoided gluten for about 10 years strictly and have had no problems with that. All my blood work, hormones, full blood count, etc are fine. Had a heart scan (ultrasound), that's fine.

I don't have any issues that I know of with arteries or vessels. Perhaps I bruise a bit easier than most people? But maybe I'm nit picking. I don't find bruises randomly on my body, so I doubt it's that.

I'm not diabetic, I don't smoke, I don't drink much. Quite healthy otherwise, no other weird issues such as tissue or bone problems elsewhere on my body. I'm 38, exercise about 2 times a week. Sometimes have achy joints if lay around all day.
Can't think of anything else.
Quote
Also, if you search the condition "hard flaccid" it isn't the same as yours?
It's mostly related to pelvic floor tightness. In any case a relaxed pelvic floor is integral to a working penis too.

You know melting, I haven't spent much time on this but it has caught my attention now that you've mentioned it. The only reason why I've ignored hard flaccid is because it appears that with hard flaccid there is no scarring or fibrous tissues as such. In my case there is clear thickening / inflammation of the tunica. So I've now come to one very important question, is it possible hard flaccid syndrome over years could cause inflammation? Tunica / vessel strain? That is something that is interesting to me.

It seems hard flaccid is not entirely understood. Could it simply be a case of years of chronic pressure on the vessels from pelvic strain, thus leading to a thickened tunica, which so happens to be in the area of those same vessels that extend throughout the penis?

Quote
Can you explain why and how the mesh was necessary and what the outlook on the mesh and condition is?

Absolutely, initially when I was 19 I had a varicocele repaired on the left side via the groin which was 100% solved. About 5 years later I had a left inguinal hernia in the same area where the varicocele was repaired because the muscle had weakened there. So they repaired the hernia with a basic flat square mesh (ethicon mesh), this was in 2005. I recall vividly a few days after that mesh, an erection that felt very different. It was very hard with a lot of tension more than what was normal. (Perhaps inflammation?)

Ever since the mesh, I've just noticed a slow but steady decline in erection quality and my size. Followed by this thick cord running through my penis (which I've shown you in that mri image). It seems that cord has gotten worse slowly over the years. I can't pin point it to anything else, other than tracing it all the way back to when the mesh was installed as that's when I first noticed a change, albeit a small one at first.

So currently the mesh is on my left side and is near the pubic bone, it's scarred up a lot. It has a lot of hard bumps and fibrotic nodules that I can feel under the surface of the skin. So the entire mesh is now encapsulated with scar tissue. The genitofemoral nerve has been entrapped in the mesh with scar tissue adhesions on it, however the urologist says the genitofemoral nerve does not go into the penis.

Either way, the current situation is the mesh is covered in hard fibrous tissue. And the bottom edge of the mesh is sutured to my pubic bone about 2cm away from the base of my penis. So it's very close to the base of my dick. From there the mesh then extends up about 5 inches along the side of my groin. It's on the surface installed right under the skin, I can feel it as I'm very lean.  

So.... I've narrowed it down to some conclusions that I can go on.

1. I have inflammation that has been chronic. Strangely diffuse. Whats stranger is that the thickening is evenly spread, symmetrical as you can see in the image. It's the entire tunica above (dorsal) and below (ventral).
It's confined to the top and bottom surfaces, where the veins run through, not the sides. No septal involvement.
2. No plaques, no local nodules, no calcification. No history of acute or obvious injuries.
3. Inflammation is current and persistent, it seems there is still an ongoing cause. So I'm left with the question, what is the cause of this inflammation? I need to know since if it's the mesh, nothing I do will work until I get it out. I'm going through a process of elimination.
Mesh?
Hard flaccid?
Small micro trauma every time I orgasm, over the years?
Immune system or systemic health?

I think Hard flaccid is my next area of research. If I can tackle each cause then end up with the mesh as a last resort. Since its a massive choice to have it removed.

Melting, I just want to say something here. You are an absolute legend helping people on this forum. I endeavor to do the same once I find a fix. Thanks for the inspiration and enthusiasm.
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melting

Sounds to me that the mesh is the prime culprit and many people seem to have problems with these types of mesh's.  
Mostly woman(big lawsuit settled months ago) but also some men. A quick google reveals that.

The genitofemoral nerve might not get to the penis but everything down there is in some way connected indirectly. It's not like nose and thumb ;)

The Pelvic floor is all intervened and any tight muscles can create problems downstream. Lower back problems could create problems for erections.. So an issue on one side can't be seen isolated. I noticed docs, especially surgeons, like to do that.  
You might check out a pelvic floor therapists who might also be able to understand the implication of the mesh on the PF.

The idea as I understand of the mesh is to assist healthy tissue and not to trigger scarring and fibrous tissue in that amount.  
I'm sure docs have theoretically some options how to deal with the state of it. Obviously getting it out might create more problems/risks..
To me it sounds like your PF is "out of whack" physically and chemically(inflammation).

I personally, that's just my idea in the confines of my medical system(in the US people have much better options - just think stem cells etc.), would carefully work on the PF and stretching it(easing into everything, warm-up,..) I would ensure to have great blood supply down there(which means working out legs strength and endurance - they draw blood through the same arterial system).
Variocelle is an issue of blood not draining properly/"backed up". So get it going like a well oiled machine.

Of course any movement, intercourse, masturbation can also be too much, creating friction with the mesh or the fibrous tissue there and in the penis. So always observe to not do too much and give it a good rest.

I would also flood the whole area with transdermals, as often as possible, daily 1-x times, to soften the tissue around the mesh and at the penis. Now this is obviously not in any medical treatment plan you will get with the docs. So that is your responsibility  and most people wouldn't do it cause most docs wouldn't approve.. I'm checking my pm's(sometimes it takes some weeks) and give my opinion to anyone who asks but I'm no doc and I only go off my knowledge of my case and what I learned there.
I personally doubt that neither dmso nor known supplements will mess with the mesh as it's surely a product that isn't toxic. But observe if you decide to go down that path if anything moves or changes..
If you do that it will take time I guess. If you can palpate specific nodules around the mesh you might be able to observe changes from week to week. DMSO is theoretically able to go through all tissues down there transporting for example iodine or ascorbic acid with it. It's obviously not as pinpoint like getting an injection(xiaflex for example) that's why I say "flood the area".

I help here cause I got helped here in a very bad situation where the medical system in germany had no other option than cutting parts of my dick out(nesbit procedure). All the DIY I did I might not had to do in the US..
Daily Transdermals and Traction/VED solved my Peyronies Disease https://www.peyroniesforum.net/index.php/topic,12587.0.html (DMSO+X)