Peyronie's Disease is a disorder that causes deformity of the penis. This deformity is a result of scar tissue that develops, which results on a bending or curvature of the penis. It can also cause an hour-glass deformity, shortening of the penis, and sometimes painful erections. In the worst cases, the curvature can be 90 degrees or greater. The bending is most prominent during erection.
Causes of Peyronie's disease
The exact cause of Peyronie's disease is not known. There are many theories as to why there is scar tissue development in the penis (trauma, auto-immune disease, vascular inflammation), but none have been proven. There are likely multiple causes, all resulting in the formation of scar tissue that replaces the normal elastic tissue in the penis. This elastic tissue is called 'elastin' and is what gives the penis the ability to elongate and increase in girth during arousal. Imagine a balloon. If you place glue on one side of the balloon and blow it up, the glue will restrict that part of the balloon resulting in bending or curvature of the balloon. This is similar to what happens in Peyronie's disease.
Incidence and symptoms of Peyronie's disease
It is estimated that 7-12% of men will experiene Peyronie's disease at some point in their lives. Most men experience a relatively sudden change in their penis with curvature that seems to appear overnight. The initial change is often associated with pain during erections. Only about 10% of those will experience resolution of the curvature. About 50% will get worse over time and about 40% will stay the same after the initial formation of curvature. A large number of men will have associated erectile dysfunction or E.D.
Doing nothing is one option. If you have some curvature but are still able to have intercourse, doing nothing may be the best thing to do. If it gets worse, then treatment can be undertaken.
Pills - There are no medications that have been proven effective in Peyronie's disease. During my residency training, we used several drugs like colchicine, potaba, and vitamin E. These have all been studied recently and all have been found to be no better than placebo at helping Peyronie's. Some doctors recommend using pentoxifylline (Trental) for their patients, but this has not been proven to effective in clinical trials and is used "off-label" since it is not an FDA approved use of this medication.
These are mechanical devices that are used to apply constant stretching to the penis. This in theory will help elongate the scar tissue similar to stretching out a tight tendon. Penile stretching devices can be purchased on the internet and there are a whole host of companies selling them. They cost around $150 up to over $400, depending on the 'bells and whistles' you want with them. There are some small studies that seem to show some benefit in gaining some of the length lost due to Peyronie's. I consider this treatment similar to physical therapy for the penis and ask most of my patients to consider purchasing and using one of these, especially if we are going to use injection therapy (see below).
Penile injection therapy
Xiaflex is a new treatment option for Peyronie's disease that was FDA approved in 2013. This medication is a collagenase. It digests or dissolves scar tissue, which is made up primarily of collagen. It is injected with a tiny needle into the Peyronie's scar (also called plaque). The protocol is to perform 2 injections 1-3 days apart and then do some stretching manuvers (I have my patients use the penile stretching devices, see above). We wait 6 weeks after these injections and re-evaluate. If there is still too much curvature or narrowing, we do another 2 injections. This can be repeated for a total of 4 pairs of injections. This medication is very expensive - around $3000/dose. We have been finding that many insurance companies are paying for this treatment, however. Clinical trials have shown a significant number of men experience improvement (less curvature, ability to have intercourse).
There are several surgical techniques to help Peyronie's disease. One is to perform 'plication.' In this technique, sutures are placed to straighten the bent penis by shortening the side that is not bent in order to match the bend side. This technique is acceptable in men with longer penis lenght, but may not be the best choice for a man who is worried about further length loss. It is a fairly simple procedure with low complication rates.
Another option is to either excise (remove) or incise (cut and release) the scar tissue. This releases the shortened side so the penis can be straight again. This leaves a 'gap' in the capsule of the penis which must be covered. We can use the patient's own vein harvested out of the leg. We also use cadaver donated tissue such as Alloderm (skin) and Tutoplast (pericardium). It takes 6 weeks of healing before the penis can be used for intercourse after this surgery.
Finally, a penile implant (internal penis pump) can be placed to straighten the penis. This option is best for men who have both E.D. and Peyronie's as it corrects both problems. Often, the implant alone corrects the curvature enough, but sometimes incision or excision and grafting must be done. Another benefit of using a penile implant is that it prevents the curvature from returning, which can happen with any of the above mentioned treatments. Once the penis implant is in place, we have the patient pump the implant up daily for at least 1 hour. This applies a straightening pressure to the penis from the inside and keeps it straight and functioning well.
If you have Peyronie's disease, please realize that you are not alone. Many men get this at some point in their lives. There are treatment options available. The earlier you see a urologist, the more likely treatment will help.