Peyronies Disease

Peyronie’s disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections. Penises vary in shape and size, and having a curved erection isn’t necessarily a cause for concern. But Peyronie’s disease causes a significant bend or pain in some men.

This can prevent you from having sex or might make it difficult to get or maintain an erection (erectile dysfunction). For many men, Peyronie’s disease also causes stress and anxiety.

Peyronie’s disease sometimes goes away on its own. But in most cases, it will remain stable or worsen. Treatment might be needed if the curvature is severe enough that it prevents successful sexual intercourse.

Symptoms

As per urology doctors, Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:

• Scar tissue. The scar tissue (plaques) associated with Peyronie’s disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.
• Asignificant bend to the penis. Your penis might be curved upward, downward or bent to one side. In some cases, the erect penis might have narrowing, indentations or an hourglass appearance, with a tight, narrow band around the shaft.
• Erection Problems. Peyronie’s disease might cause problems getting or maintaining an erection (erectile dysfunction).
• Shortening of the penis. Your penis might become shorter as a result of Peyronie’s disease.
• Pain. You might have penile pain, with or without an erection.

The curvature associated with Peyronie’s disease might gradually worsen. At some point, however, it typically stabilizes.

Pain during erections usually improves within one to two years, but the scar tissue and curvature often remain. In some cases, both the curvature and pain associated with Peyronie’s disease improve without treatment.

Causes

The cause of Peyronie’s disease isn’t completely understood, but a number of factors appear to be involved.

It’s thought Peyronie’s disease generally results from repeated injury to the penis. For example, the penis might be damaged during sex, athletic activity or as the result of an accident. However, most often, no specific trauma to the penis is recalled.

During the healing process, scar tissue forms in a disorganized manner, which might then lead to a nodule that you can feel or development of curvature.

Each side of the penis contains a sponge-like tube (corpus cavernosum) that contains many tiny blood vessels. Each of the corpora cavernosa is encased in a sheath of elastic tissue called the tunica albuginea which stretches during an erection.

When you become sexually aroused, blood flow to these chambers increases. As the chambers fill with blood, the penis expands, straightens and stiffens into an erection.

In Peyronie’s disease, when the penis becomes erect, the region with the scar tissue doesn’t stretch, and the penis bends or becomes disfigured and possibly painful.

In some men, Peyronie’s disease comes on gradually and doesn’t seem to be related to an injury. Researchers are investigating whether Peyronie’s disease might be linked to an inherited trait or certain health conditions.

Risk factors

According to urologists, minor injury to the penis doesn’t always lead to Peyronie’s disease. However, various factors can contribute to poor wound healing and scar tissue build-up that might play a role in Peyronie’s disease. These include:

• Heredity. If your father or brother has Peyronie’s disease, you have an increased risk of the condition.
• Connective tissue disorders. Men who have a connective tissue disorder appear to have an increased risk of developing Peyronie’s disease. For example, a number of men who have Peyronie’s disease also have a cord-like thickening across the palm that causes the fingers to pull inward (Dupuytren’s contracture).
• Age. The prevalence of Peyronie’s disease increases with age, especially in men over 55.
• Other factors including certain health conditions, smoking and some types of prostate surgery — might be linked to Peyronie’s disease.

Complications

Complications of Peyronie’s disease might include:

• Inability to have sexual intercourse
• Difficulty achieving or maintaining an erection (erectile dysfunction)
• Anxiety or stress about sexual abilities or the appearance of your penis
• Stress on your relationship with your sexual partner
• Difficulty fathering a child, because intercourse is difficult or impossible

Diagnosis

A physical exam is often sufficient to identify the presence of scar tissue in the penis and diagnose Peyronie’s disease. Rarely, other conditions cause similar symptoms and need to be ruled out.
Tests to diagnose Peyronie’s disease and understand exactly what’s causing your symptoms might include the following:

• Physical exam. Your urology doctor will feel (palpate) your penis when it’s not erect, to identify the location and amount of scar tissue. He or she might also measure the length of your penis. If the condition continues to worsen, this initial measurement helps determine whether the penis has shortened.

Your doctor might also ask you to bring in photos of your erect penis taken at home. This can determine the degree of curvature, location of scar tissue or other details that might help identify the best treatment approach.

• Other tests. Your doctor might order an ultrasound or other tests to examine your penis when it’s erect. Before taking images of your penis, you’ll likely receive an injection directly into the penis that causes it to become erect.

Ultrasound is the most commonly used test for penis abnormalities. Ultrasound tests use sound waves to produce images of soft tissues. These tests can show the presence of scar tissue, blood flow to the penis and any other abnormalities.

Treatment

Your urologist might recommend a wait-and-see (watchful waiting) approach if:

• The curvature of your penis isn’t severe and is no longer worsening
• You can still have erections and sex with no or mild pain
• You have good erectile function

If your symptoms are severe or are worsening over time, your doctor might recommend medication or surgery.

Medication

A number of oral medications have been tried to treat Peyronie’s disease, but they have not been shown to be effective consistently and are not as effective as surgery.

Pentoxifylline is an oral medication used for Peyronie’s disease. When taken for several months, the medication may reduce the amount of scar tissue, though exactly how it does so isn’t known.\

In some cases, drugs injected directly into the penis might reduce curvature and pain associated with Peyronie’s disease. Depending on the therapy, you might be given a local anesthetic to prevent pain during the injections.

If you have one of these treatments, you’ll likely receive multiple injections over several months. Evidence on the effectiveness of penile injections is limited. These medications may also be used in combination with oral drugs.

Medications include:

• Collagenase. The only FDA-approved medication for Peyronie’s disease is collagenase clostridium histolyticum (Xiaflex). This medicine has been approved for use in adult men with moderate to severe curvatures and a palpable nodule.
  This therapy has been shown to improve curvature and bother associated  with Peyronie’s disease. The treatment works by breaking down the buildup of collagen that causes penile curvature. Collagenase appears to be more effective when used in conjunction with “modeling,” which is forcible bending of the penis in the opposite direction of the bend.
• Verapamil. This is a drug normally used to treat high blood pressure. It appears to disrupt the production of collagen, a protein that might be a key factor in the formation of Peyronie’s disease scar tissue. The drug is well-tolerated and seems to reduce pain too.
• Interferon. This is a type of protein that appears to disrupt the production of fibrous tissue and help break it down. One placebo-controlled trial showed improvement using this therapy over placebo.

Surgery

Your urology doctor might suggest surgery if the deformity of your penis is severe, sufficiently bothersome, or prevents you from having sex. Surgery usually isn’t recommended until you’ve had the condition for at least one year and the curvature of your penis stops increasing and stabilizes for at least six months.

Common surgical methods include:

• Suturing (plicating) the unaffected side. A variety of procedures can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This results in a straightening of the penis, although this is often limited to less severe curvatures and might result in greater actual or perceived penile shortening.
  Nesbit plication is an example of this type of procedure. In some cases, this type of surgery causes erectile dysfunction.
• Incision or excision and grafting. With this type of surgery, the surgeon makes one or more cuts in the scar tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon might remove some of the scar tissue.
  A piece of tissue (graft) is often sewn into place to cover the holes in the tunica   albuginea. The graft might be tissue from your own body, human or animal tissue, or   a synthetic material.
  This procedure is generally used in cases of more-severe curvature or deformity, such as indentations. This procedure is associated with greater risks of worsening erectile function when compared to the plication procedures.
• Penile implants. Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse.

Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie’s disease and erectile   dysfunction.

When the implants are put in place, the surgeon might perform additional procedures to improve the curvature if needed.The type of surgery used will depend on your condition. Your urologist will consider the location of scar tissue, the severity of your symptoms and other factors. If you’re uncircumcised, your doctor might recommend a circumcision during surgery.

Depending on the type of surgery you have, you might be able to go home from the hospital the same day or you might need to stay overnight. Your surgeon will advise you on how long you should wait before going back to work — in most cases, a few days. After surgery for Peyronie’s disease, you’ll need to wait four to eight weeks before sexual activity.