PEYRONIE’S DISEASE | CAUSES AND TREATMENTS
Peyronie's Disease can impede both urination and ejaculation, and can even cause a bend in the penis. Learn about causes and treatments here.
What sets Peyronie’s Disease (PD) apart from other causes of incontinence is that it is the only one you can actually see. Technically a wound-healing disorder, Peyronie’s Disease occurs when scar-like tissue builds up in the penis. The excess collagen, called plaques, can impede both urination and ejaculation. In more severe cases, the build up can cause an abnormal bend or curvature of the penis.
Other symptoms may include indention (e.g., hour glass shape), shortening (loss of length), or thinning (loss of girth). Not surprisingly, intercourse may be too painful or impossible to engage in.
Obviously this is a very sensitive subject. So here’s what you want to be on the look out for:
- Hard lump(s) or plaque that forms within the penis shaft
- Pain with or without an erection
- Erectile dysfunction
First thing to know is that Peyronie’s Disease is an acquired condition and must be distinguished from hereditary curvature of the penis. A key marker is PD changes the appearance of the penis over time while hereditary curvature remains constant.
The next thing to note is that if you have PD you did nothing wrong. The root cause of Peyronie’s Disease is trauma to the penis suffered from one significant event or several small traumas experienced during normal intercourse.
Peyronie’s Disease is exasperating on many levels. Physically, it can interfere with basic and sexual functions. Mentally, the disease can create a tremendous amount of psychological anguish. Depression is often a side effect of contracting PD.
To add to the frustration, many questions surrounding the disease still remain unanswered. It is still unknown why certain men are more susceptible to contracting Peyronie’s disease. On that note, it is unclear if PD is hereditary, though there is a general consensus that it is. If you have PD you should discuss this with your brothers and sons. While there aren’t any precautions to be taken, they can be aware of what to look for.
While none of this paints an overly optimistic picture, the fact that men are staying sexually active later in their lives has inspired more research and studies to uncover solutions and viable treatments.
The first course of action is to speak with your physician and/or specialist to better understand the severity of your condition. In addition, we will update our information as advancements are made in the treatment of Peyronie's Disease. For now, the treatments below are still in the early stages of practice and should be considered only after serious consultation.
While none of the procedures below have been practiced long enough to be considered "the solution" for Peyronie's Disease, there is one thing to note about each procedure: it is critical that your PD has reached the chronic stage and that the curvature stops increasing before surgery can be considered.
- Suturing (plicating) the Unaffected Side. There are several plication (or suturing) techniques used to correct curvature. Nesbit plication is an example of this type of procedure in which the longer side of the penis (the side without scar tissue) is plicated. This results in a straightening of the penis, although it can cause penile shortening as well as erectile dysfunction.
- Incision or Excision and Grafting. The surgeon cuts into the scar tissue, allowing the penile sheath to stretch out and for the penis to straighten. Tissue grafts (whether from your own body, human or animal, or synthetic) are used to cover the holes in the tunica albuginea. Typically used in more severe cases, this procedure is associated with greater risks of worsening erectile function when compared to the plication procedures.
- Penile Implants. The two most common implants are semi-rigid and pump implants. Semi-rigid implants take the place of the spongy tissue that fills with blood during erections. This allows the patient to bend the penis upwards during intercourse. Pump implants work how you would expect. A pump is surgically placed in the scrotum and is used to inflate the implant for sexual intercourse. Your physician may recommend such implants if you are dealing with both PD and Erectile Dysfunction.
Oral medications have not shown to be effective consistently in treating Peyronie’s Disease. However, drugs injected directly into the penis might reduce curvature and pain associated with Peyronie's disease in some cases. Not enough evidence exists to prove the effectiveness as these treatments are still in the early stages. If your physician recommends this approach, you'll likely receive multiple injections over several months. Here are some of the medications being used today to treat PD.
- Verapamil. You may recognize this as the drug that is used to treat high blood pressure. Its use in PD treatment is to disrupt the production of collagen, the protein that forms the unwanted scar tissue.
- Interferon. There has been one placebo-controlled trial, which demonstrated significant improvements using this therapy over the placebo. This type of protein is believed to disrupt the production of fibrous tissue.
- Collagenase. As the name suggests, this drug targets and breaks down the build up of the collagen that causes penile curvature. Collagenase clostridium histolytic (Xiaflex) has recently been approved by the FDA for treating Peyronie's disease thanks to its success in several trials. Adult men with moderate to severe curvatures and a palpable nodule might benefit from this therapy.
OTHER INVESTIGATIVE THERAPIES
As noted on urologyhealth.org, many alternative methods for treating Peyronie's disease have been reported. Examples include high-intensity focused ultrasound, radiation therapy, shock-wave treatment, topical verapamil, hyperthermia, and many others. While the scientific rationale for these other approaches is sound, at this time there is not enough data to support their use outside of a research setting. A recent pilot study (2007) using external penile traction therapy demonstrated measured improvements in girth, length, and curvature after 6 months of daily stretch therapy lasting from 2-8 hours per day.