What is Peyronie’s Disease?
Peyronie’s disease is a condition in which fibrous plaques form in the penile erectile bodies causing disfigurement, curvature, and sometimes penile shortening. Peyronie’s disease is estimated to affect about 10% of men, as it becomes more prevalent with age. Although the common presentation of Peyronie’s disease is curvature of the penis, the plaque sometimes causes divots or indentations, which can make sexual intercourse both painful and difficult.
What are the Signs and Symptoms of Peyronie’s Disease?
Peyronie’s disease occurs on the dorsal surface (top) of the penis about 70% of the time. Plaques or scars within the tunica albuginea (capsule of the penis) result in contraction of the tissue and therefore bending, curvature, and sometimes shortening of the penis. A normal penis has a certain degree of curvature, however, what differentiates congenital curvature (a benign condition) from Peyronie’s disease is a palpable plaque. This plaque is responsible for the pain, curvature, and penile shortening that some men experience. Peyronie’s disease is not just an anatomic issue as it can also have psychological effects. While most men will continue to be able to have sexual relations, it is not uncommon for men to experience depression and anxiety associated with Peyronie’s Disease. It can be so bad that some withdraw from their sexual partners altogether.
How common is Peyronie’s Disease?
Peyronie’s disease affects approximately 10%, and upwards of 20% in diabetic men. However, the true prevalence of Peyronie’s is likely under reported because men are often times too embarrassed to discuss their condition with their physician or to seek out help. Peyronie’s disease can affect men of any race and age.
What causes Peyronie’s Disease?
Although there is no clear etiology to Peyronie’s, one prevailing thought is that it is due to penile trauma that occurs due to repetitive trauma to the tunica albuginea, resulting in scarring of that traumatized segment, ultimately leading to penile curvature. On more rare occasions it may result from sports or other traumatic injuries. Peyronie’s disease is not a sexually transmitted condition or an infection. Certain environmental and genetic components are associated with Peyronie’s disease, most notably smoking, diabetes, excessive alcohol consumption, genetic predisposition, European heritage, Dupuytren’s contracture, Ledderhose disease (plantar fascial contracture), and tympanosclerosis.
What are the stages of Peyronie’s Disease?
The acute Phase of Peyronie’s disease is characterized by the plaque beginning to form. This phase can last anywhere from 6 to 18 months and is usually associated with painful erections.
In the Chronic Phase, the plaques or scars are already well formed, thus the curvature is stable and erections are no longer painful.
How is Peyronie’s disease diagnosed?
The diagnosis is primarily based on history and physical exam. Typically, a patient will complain of bending, curvature, or shortening of the penis. Men with low testosterone (hypogonadism) and erectile dysfunction are at increased risk of Peyronie’s disease. Occasionally, a penile doppler ultrasound is used to assist in locating the penile plaque and documenting penile blood flow, especially when Peyronie’s is associated with erectile dysfunction. The penile doppler ultrasound entails an injection of an erectogenic agent to induce an erection, thus allowing us to better measure the degree of curvature.
What are the treatment Options available for Peyronie’s disease?
Peyronie’s disease is mild in some men and may resolve on its own without treatment. Others may have some permanent curvature but not enough that it is bothersome to them or their partner and no treatment is needed. Men who have issues with curvature causing embarrassment or inability to penetrate, pain, erectile dysfunction and/or penile shortening can pursue treatment options including:
Oral Therapies:
One commonly used oral therapy is pentoxyphyline, which inhibits some of the inflammatory proteins that lead to abnormal scar formation. Current published literature demonstrates that pentoxyphyline has a roughly 40% chance of improving the plaque after 6 months of therapy. It is generally very well tolerated with few side effects. Although many studies have been done testing other oral supplements and medications such as Vitamin E, Potaba (Potassium amino-benzoate), Tamoxifen, Cochicine and Carnitine none have shown any significant benefit in randomized controlled trials and the use of these agents cannot be supported with scientific data.
Penile Injection Therapy:
Similar to oral therpies, many medications and supplements have been studied for injection directly into the Peyronie’s plaque most notably Verapamil and Interferon. Although some of the studies do show mild benefit with these agents, larger studies are needed to show statistical significance and benefits are mild at best.
Xiaflex:
Many medications have been studied for injection directly into the Peyronie’s plaque, most notably Verapamil and Interferon, with limited success. Xiaflex is the only FDA-approved non-surgical treatment option approved for men suffering from Peyronie’s disease. Xiaflex is a potent collagenase enzyme that when injected into the Peyronie’s plaque works by dissolving the plaque. Xiaflex administration consists of 4 total cycles, patients will receive 2 injections every 6 weeks. Xiaflex benefits are further enhance when combined with modeling and bending exercises performed by the patient to achieve optimal results. Men receiving Xiaflex in clinical studies had a roughly 40% improvement in their curvature and reported improvements in their distress suffered from the disease. Although significant improvement can be seen with Xiaflex, side effects do occur, such as temporary pain, bruising, and swelling. A few men in the clinical trials had a penile injury severe enough to need surgical correction, however, all of these men regained sexual function post-surgery.
Surgical options:
If medical or injections therapies do not improve your Peyronie’s disease, surgical options are available. Surgical options for Peyronie’s include:
Surgical Plication:
Surgical Plication is usually performed under general anesthesia. The surgeon makes an incision around the crown of the penis, pulling down the skin to expose the penile plaque. After an erection is induced using an erectogenic injection, you surgeon will identify your degree of curvature and uses sutures to shorten the corporal body on the opposite side of the plaque thereby shortening the opposite side to make it equivalent to the side with the plaque. This technique can be very successful, but results in significant penile shortening, therefore, satisfaction rates are not high.
Penile plaque excision and graft:
Using a similar incision to the one used in a plication, the skin is pulled down to expose the plaque. The technical challenge of this surgery is that plaque usually lie beneath the penile neurovascular bundle, which is responsible for penile sensation. In order to fully expose the plaque, this bundle needs to be elevated without injury to the nerve fibers. Risks of this procedure include temporary or permanent penile numbness, reduced erection strength, scarring and shortening. In the right surgeon’s hands, however, this represents a powerful and effective treatment option.
Penile Implant:
The penile implant is an excellent option for men with a significant Peyronie’s deformity and associated erectile dysfunction. In these patients, injecting the plaque with Xiaflex or repairing the plaque with a patch may leave the patients with a straight penis, but they would not have the ability to engage in sexual intercourse given their baseline erectile dysfunction. An implant can correct the Peyronie’s deformity because the cylinders will act support beams to straighten the penis. Once the surgeon places the implant, he or she can hold pressure over the erect implant and bend the penis against its curve. With the cylinders in place, the penis has a good chance of holding straight once the man heals.
Shockwave therapy:
At the Men’s Health Institute, we offer low intensity shockwave therapy for the treatment of both erectile dysfunction and pain associated with Peyronie’s disease. As an experimental therapy for Peyronie’s disease, studies are still ongoing to determine its place in the treatment algorithm for Peyronie’s disease.
Have a question or want to schedule an appointment?
Board-certified, fellowship-trained urologists staff Tower Men’s Health. We will pair you with one of our many experienced physicians to help address any concerns you may have and help you on your journey towards improved quality of life. Feel free to reach out to the physicians at Tower Men’s Health at 310-854-9898.