Understanding Peyronie's Disease

Peyronie’s Disease is a condition of the connective tissue of the penis that causes the abnormal growth of plaques, or scar tissue in the tunica albuginea, the tissues that encases the corpora caverosa, the two long cylinders that run the length of the penis.  This may cause pain, abnormal curvature, loss of girth and/or shortening of the penis, as well as erectile dysfunction or indentation.

Plaque on the topside of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending (a hinge-like effect), and emotional distress prohibit sexual intercourse.

The plaque is a flat plate of scar tissue that develops inside a thick membrane called the tunica albuginea, which envelopes the erectile tissues. The plaque begins as a localized inflammation and develops into a hardened scar which may become calcified. This plaque has no relationship to the plaque that can develop in arteries.

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SYMPTOMS OF PEYRONIE’S DISEASE

Common symptoms of Peyronie’s disease include: 

  • Abnormal curvature of the penis
  • Loss of girth or shortening of the penis
  • Painful erections
  • Indentation of the penis
  • Difficulty with intercourse
  • Discomfort for your partner
  • Erectile dysfunction

 

In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. In a small percentage of men with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

HOW COMMON IS Peyronie's Disease?

Although it is believed to affect up to 10 percent of all men, it is also thought to be under-diagnosed because many patients are reluctant to discuss the condition with their doctors and many doctors do not ask.

While a small number of cases have been associated with other physical abnormalities, most are thought to be the result of microtrauma to the outer covering of the penis and subsequent scarring, which has resulted in the abnormal curvature. 

Diagnosing Peyronie's Disease

Peyronie’s disease is usually diagnosed based on a physical examination because the plaque can be felt when the penis is flaccid or in a non-erect state. Full evaluation, however, may require examination during erection to determine the severity of the deformity.  Evaluation also may require an ultrasound scan of the penis to pinpoint the location(s) and calcification of the plaque. The ultrasound can also be used to evaluate blood flow into and out of the penis if there is a concern about erectile dysfunction. 

TREATING PEYRONIE’S Disease

Because the course of Peyronie’s disease is different for each patient, and some patients experience improvement without treatment. Your urologist may recommend waiting until the curvature stabilizes for 6-12 months before discussing surgery.

If treatment is indicated, the most common therapies include:

  • Medical management to ease pain
  • Surgery, which is the gold-standard treatment option
  • Injection therapy and penile stretching devices

Medical Management 

Medical therapy is often used in the acute phase to decrease pain and inflammation, or soften plaque, but it is not considered a long-term solution because the penis usually does not straighten.  

Surgery

Surgery remains the standard treatment option, if other methods fail.  

  • Excision – This procedure involves removing or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length from Peyronie’s disease.  Risks of the procedure include numbness of the tip of the penis and decreased rigidity of erections in a small number of patients.

  • Plication – this procedure involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, to straighten out the penis.  This method is less likely to cause numbness or erectile dysfunction, but it is associated with a decrease in penile length.

  • Penile Prosthesis - For patients with Peyronie’s disease and erectile dysfunction, placement of an inflatable penile prosthesis (penile implant) in the penis is used to increase the rigidity and straighten the penis adequately.  Penile prosthesis remains the gold-standard treatment for patients with ED and Peyronie’s disease.   

Injection Therapy and Penile Stretching

Injection therapy remains a controversial approach. Many injectable compounds have been studied, and they have been found to occasionally reduce the degree of curvature and soften the plaque that causes it. However, many studies have found no benefit to plaque injection.  Penile stretching devices are also controversial, although they have gained attention in recent years as a way to decrease degree of curvature and increase the length of the shortened penis.