Peyronie’s Disease

Diagnosis and treatment

What is Peyronie’s Disease?

Formation of fibrous scar tissue inside the penis

Peyronie’s Disease is a disorder in which scar tissue, called a plaque, forms in the penis. The plaque builds up inside the tissues of a thick, elastic membrane called the tunica albuginea. As the plaque builds up, the penis will curve or bend, which can cause painful erections. Curves in the penis can make sexual intercourse painful, difficult, or impossible. Peyronie’s Disease begins with inflammation and may become a hard scar. Peyronie’s Disease is not contagious or caused by any known transmittable disease. Some men with Peyronie’s Disease may have erectile dysfunction.

Usually men with Peyronie’s Disease are referred to an urologist.

 

What causes Peyronie’s Disease?  

It is not completely known the exact cause of Peyronie’s Disease. Many specialist believe that Peyronie’s Disease could be either the result of acute injury to the penis or chronic, or repeated, injury to the penis or caused by an autoimmune disease—a disorder in which the body’s immune system attacks the body’s own cells and organs

Specialists estimate that Peyronie’s Disease may affect more than 20 percent of men between 40 and 70 years of age.

However, the actual occurrence of Peyronie’s Disease may be higher due to men’s embarrassment and health care providers’ limited reporting. The disease is rare in young men, although it has been reported in men in their 30s. The chance of developing Peyronie’s Disease increases with age.

 

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Who is more likely to develop Peyronie’s Disease?

The following factors may increase a man’s chance of developing Peyronie’s Disease:

  • Excessive vigorous sexual or nonsexual activities that cause microscopic injury to the penis
  • Certain connective tissue and autoimmune disorders: Dupuytren’s Disease, Systemic Lupus Erythematosus, Sjögren’s Syndrome, Behcet’s Syndrome
  • A family history of Peyronie’s Disease
  • Ageing

What are the signs and symptoms of Peyronie’s Disease?

The signs and symptoms of Peyronie’s Disease may include:

  • Hard lumps on one or more sides of the penis
  • Pain during sexual intercourse or during an erection
  • A curve in the penis either with or without an erection
  • Narrowing or shortening of the penis
  • Erectile dysfunction

Symptoms may develop slowly and usually progress  in the first 12 months. In many cases, the pain decreases over time, although the curve in the penis may remain.

What are the complications of Peyronie’s Disease?

Complications of Peyronie’s Disease may include:

  • The inability to have sexual intercourse
  • Erectile dysfunction
  • Anxiety, or stress, about sexual abilities or the appearance of the penis
  • Stress on a relationship with a sexual partner

How is Peyronie’s Disease treated?

The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. 

Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronie’s Disease often resolves on its own without treatment. A urologist may recommend changes in a man’s lifestyle to reduce the risk of Erectile Dysfunction associated with Peyronie’s Disease.

An urologist may treat Peyronie’s disease with nonsurgical treatments or surgery.

Nonsurgical Treatments

Medications and medical therapies

Oral medications:

  • Vitamin E
  • Potassium para-aminobenzoate (Potaba)
  • Tamoxifen
  • Colchicine
  • Acetyl-L-carnitine
  • Pentoxifylline

Injections:

  • Verapamil
  • Interferon alpha 2b
  • Steroids
  • Collagenase (Xiaflex)

To date, collagenase is the first and only medication specifically approved for Peyronie’s Disease.

 

Medical therapies

A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include:

  • High-intensity, focused ultrasound directed at the plaque
  • Mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.
  • Platelet-Rich-Plasma: An innovative treatment of Peyronie’s disease using intralesional injections of PRP. A significant improvement of the deformation may be observed in 70% of the cases without any serious adverse events

Surgery  

Expert urologist recommend surgery for Peyronie’s Disease cases when:

  • Symptoms have not improved after one year
  • Intercourse is painful and/or dificult (the curve or bend in the penis does not allow the man to have sexual intercourse)
Medical expertssuggestwaiting1yearormorefromtheonsetofsymptomsbeforehavingsurgerybecausethecourseofPeyronie’sDiseaseisdifferentineachman.
Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronie’s Disease–such as shortening of the penis. Some surgical methods can cause shortening of the penis.

A urologist may recommend the following surgeries:

  • Grafting. the plaque is cut or removed and a patch of skin, a vein, or material made from animal organs is attached to the deffect. This procedure may straighten the penis and restore some lost length from Peyronie’s disease. However, some men may experience numbness of the glans (usually reversible) and ED (low frequency) after the procedure.
  • Plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. However, plication cannot restore length or girth of the penis and may cause shortening of the penis.
  • Deviceimplantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronie’s disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.

A urologist performs these surgeries in a hospital.

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