Peyronie's Disease
What is Peyronie's disease?
A number of men will develop a bend in their penis, and urologists get many referrals to see men with this problem. Peyronie's is always a new bend, rather than having had a bend for as long as a man can remember. The condition typically occurs in men over the age of 40, and can start with pain in the penis on erection, and the development of a bend. The curve is due to formation of a plaque on the lining of the corpora cavernosa (you cannot see this, it is under the skin). The pain tends to be present for around 3-6 months, and the bend (usually only obvious on erection) can increase during this time. Men can often feel a ‘divot' in the penis in the area of the plaque. Sometimes, but not always, the strength or firmness of an erection is also affected.
What if I have always had a bend or curve in my penis?
It can be normal to have a slight curve, up down, left or right. Occasionally, a severe bend may have been present since erections started in a man, and this is more likely a congenital penile curvature that can need correction. If you are concerned about such a bend, do consult your doctor, who may send you to see a urologist.
How common is Peyronie's disease?
Textbook figures suggest that 3% of men are affected, but this is probably just the men who actually go to see a urologist. The figure may be much higher.
What causes Peyronie's disease?
The exact cause is unknown. During intercourse, the tough lining of the corpora cavernosa is possibly exposed to occasional small amounts of trauma, and this causes small areas of scar, which tend to heal completely, particularly in younger men. As a man ages, the microcirculation (blood supply) becomes less efficient, and it is possible that this leads to a greater propensity to scar formation, and a lesser ability for the tissues to heal normally, resulting in a plaque. This is a generally accepted theory but has never been proven. There are some other conditions such as Dupytren's contracture and plantar fasciitis that are associated with Peyronie's disease. There is also some evidence of an hereditary link.
The following are also associated with an increased likelihood of developing Peyronie's:
Smoking, diabetes, hypertension, hyperlipidaemia, and epilepsy (if patients have taken phenytoin).
Association of Peyronie's disease with erectile dysfunction
Many men with Peyronie's disease also report reduced strength of their erections. The process of scar/plaque formation may affect the ability of the penile cylinders to become fully erect. Also, Peyronie's occurs in men at an age where they may be starting to have problems with the strength of their erections anyway, so there may not be a direct link between the two in some men.
Natural history
There is some variation in how Peyronie's presents, but the typical course is as follows: first, pain on erection is noted in one area of the penis. Soon after, a bend is noticed when a man has an erection. This bend may worsen slowly over time. Pain tends to be present for about six months, and becomes less severe. The bend in the erection then stabilises, and doesn't get any worse after about 12 months from the start of the problem. In a proportion of men (approximately 15%) the bend may resolve completely. However, in most men, the bend remains. The decision about whether surgical treatment is needed is made after the bend has stopped getting worse. If you are still able to have intercourse, without difficult and without discomfort for you and your partner, then doing nothing may be the best approach. If you also have erectile dysfunction (impotence) associated with the bend then treatment is certainly worthwhile. Likewise, if the bend is severe enough to make vaginal penetration impossible or uncomfortable, surgical treatment should be considered. Most men will find that they are able to continue having intercourse, perhaps with slight adjustments, and do not need surgical treatment.
Non-operative treatments for Peyronie’s disease
Many different treatments have been tried, including
- Vitamin E/colchicine
- Verapamil creams or injections
- Tamoxifen
- Para-aminobenzoate (PABA)
- Extra-corporeal shock wave treatment
- Verapamil
- PDI5-inhibitors
- Xiaflex (collagenase)
The only treatment that has really been shown to be beneficial is Xiaflex, an injectable enzyme that breaks down collagen in the plaque. This is FDA-approved in the United States.
Many alternative and internet-based treatments are sold, but most urologists would discourage you from trying these – these treatments have not been put through rigorous clinical trials, and have therefore not proved to be beneficial despite claims and reports by individuals. Their safety is not ensured and you may end up spending a lot of money on treatments that do not work.
Operative treatments for Peyronie’s disease
Most men will not need an operation to correct a bend in the penis, but some will. As mentioned above, once the development of the plaque has halted and the bend is not getting worse, consideration of an operation may be needed if the penis is bent to a degree that makes intercourse impossible or uncomfortable. If erection strength is still good, a straightening procedure can be performed. There are different variations of this operation, but the most common one is a plication procedure, where the sutures are laced under the skin on opposite side of the penis to the bend.
The results can be very good from this surgery. Some loss of length is inevitable, but this is a consequence of the disease rather than the surgery. For every 30 degree of bend that is corrected, about 1cm of length is lost. Also, there is a small risk of erectile dysfunction. These will be discussed with you by your urologist.
Penile prosthesis for Peyronie’s disease
A penile prosthesis can be an excellent treatment for men who also have severe erectile dysfunction associated with Peyronie’s. A prosthesis gives a very good and consistent erection on demand, and the penis is straightened at the same time. If you are affected by both conditions badly enough to need treatment, this option is worth discussion with your urologist. You can read more about an inflatable penile prosthesis by clicking [HERE].
Disclaimer
This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.
