Peyronie’s disease is a condition in which painful, hard plaques form underneath the skin of the penis leading to penile curvature. This plaque is dense and can usually be felt through the penile skin. This plaque is not a tumor but it may lead to serious problems such as curved and/or painful erections. If you have pain and penile curvature characteristic of Peyronie’s disease, the following information may help you understand your condition.
What are the symptoms of Peyronie’s disease?
The plaques of Peyronie’s disease most commonly develop on the upper side of the penis. Plaques reduce the elasticity of the tunica albuginea and may cause the penis to bend upwards during an erection. Although Peyronie’s plaques are most commonly located on the top of the penis, they may also occur on the bottom or side of the penis, causing a downward or sideways bend, respectively. Some men have more than one plaque, which may cause complex curvatures.
In some men an extensive plaque that goes circumferentially all the way around the penis may develop<>. These plaques typically do not cause curvature but may cause a “wasting” or “bottleneck” deformity of the penis. In other severe cases, the plaque may accumulate calcium and become very hard, almost like a bone. In addition to penile curvature, many patients also report shrinkage or shortening of their penis.
Since there is great variability in this condition, men with Peyronie’s disease may complain of a variety of symptoms. Penile curvature, lumps in the penis, painful erections, soft erections, and difficulty with penile penetration due to curvature are common concerns that bring men with Peyronie’s disease to see their doctors.
Peyronie’s disease can be a serious quality-of-life issue. Studies have shown that over 75% of men with Peyronie’s disease have stress related to the condition. Unfortunately, many men with Peyronie’s disease are embarrassed about the condition and choose to suffer in silence rather than speaking with their health care provider about it.
How common is Peyronie’s disease?
It is estimated that Peyronie’s disease can be found in up to 1% to 23% of men between the ages of 40 and 70. The condition is rare in young men but has been reported in men in their 30s. The actual prevalence of Peyronie’s disease is difficult to ascertain since patient embarrassment prevent them from bring up the issue to their physicians.
What causes Peyronie’s disease?
Peyronie’s disease is in essence a derangement of normal wound healing. Because it is related to normal wound healing, Peyronie’s disease is a very dynamic process early on but over time, the inflammatory changes may decrease. In fact, this disease is usually divided into two distinct stages. The first phase is the acute phase; this portion of the disease persists for six to eighteen months and is usually characterized by pain, worsening penile curvature, and formation of penile plaques. The second phase is the chronic phase where the deformity remains in a stable state. As in the first stage the deformity may interfere with sexual activity and there may be associated erectile dysfunction. Pain with erection has typically resolved during this phase.
How is Peyronie’s disease diagnosed?
A physical examination by an experienced physician is usually sufficient to diagnose Peyronie’s disease. The hard plaques can usually be felt with or without erection. It may be necessary to induce an erection in the clinic for proper evaluation of the penile curvature; this is usually done by direct injection of a medication that causes penile erection. Pictures of the erect penis may also be useful in the evaluation of penile curvature. In some cases an ultrasound or x-ray examination of the penis is used to characterize the plaque and check for the presence of calcification.
For commonly asked questions, please see answers provided by Dr. Ramasamy
How is Peyronie’s disease treated?
In about 13% of cases, Peyronie’s disease goes away without treatment. Many physicians recommend conservative (non-surgical) treatment for at least the first 12 months after symptoms present. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function do not require treatment. Men with active phase disease who do have one or more of the above problems may benefit from medical therapy.
Oral vitamin E: An antioxidant that is a popular treatment for disease because of its mild side effects and low cost. Studies have demonstrated that vitamin E does not appear to give better results than the placebo, which calls into question whether or not vitamin E is an effective treatment. Pentoxifylline: An antioxidant medication that is designed to reduce inflammation and thereby decrease abnormal wound healing. Like many other oral Peyronie’s therapies, this medication has not been demonstrated to be superior to placebos.
Injecting a drug directly into the plaque of Peyronie’s disease is a more effective alternative to oral medications. Injection permits direct introduction of drugs into the plaque, permitting higher doses and more local effects. To improve patient comfort a local anesthetic is usually given prior to the injection. Because plaque injection is a minimally invasive approach, it is a popular option amongst men with active phase disease and men who are reluctant to have surgery. Direct injection of the enzyme collagenase to break down the plaque of Peyronie’s disease has been approved in 2013 as XIAFLEX. XIAFLEX is a prescription medicine used to treat adult men with Peyronie’s disease who have a “plaque” that can be felt and a curve in their penis greater than 30 degrees when treatment is started. Prescription XIAFLEX is injected into the scar tissue, or Peyronie’s plaque. Each injection of XIAFLEX works to help weaken and break down the plaque and help straighten the curve caused by Peyronie’s disease.
Surgical Treatment of Peyronie’s Disease
Surgery is reserved for men with severe, disabling penile deformities that prevent satisfactory sexual intercourse. Most physicians recommend avoiding surgery until the plaque and deformity have been stable and the patient pain-free for at least six months. An evaluation of the penile blood supply using injection of erection producing medications is often done prior to any surgery. A penile ultrasound may be performed at the same time. These two tests permit assessment of whether or not the man has significant erectile dysfunction (ED) and may also provide important anatomical information that will help guide the choice of surgical procedure.
Procedure that shorten the side of the penis opposite the plaque/curvature
This procedure is generally safe, technically easy, and carries a low risk of complications such as bleeding or worsening erectile function. One particular disadvantage of these approaches is that they tend to be associated with some loss of penile length. For this reason shortening procedures are generally preferred in men with mild or no ED, mild to moderate curvatures, and long penises.
Procedures that lengthen the side of the penis that is curved
These procedures are indicated when the curvature severe or there is significant indentation causing a hinge-effect or buckling of the penis due to the narrowed segment in the penile shaft. In these cases, the surgeon cuts the plaque to release tension. In some cases a segment of the plaque may be removed. After the plaque has been cut, the resulting hole in the tunica must be filled with a graft. These procedures can correct severe curvatures, in most cases without significant shortening of the penis. Unfortunately, this type of procedure is technically challenging and carries a risk of worsening erectile function. Therefore, lengthening/grafting procedures are typically not recommended except in cases of severe deformity in men with adequate erectile function at baseline.
Placement of penile prosthetic devices
Placement of an inflatable penile pump or malleable silicone rods inside the corpora is a good treatment option for men with Peyronie’s disease and moderate to severe erectile dysfunction. In most cases, implanting such a device alone will straighten the penis, correcting its rigidity. When device placement alone does not sufficiently straighten the penis, the surgeon may further straighten the penis by cracking the plaque or by incising the plaque and subsequently covering the incision with a graft material.
What can be expected after surgery for Peyronie’s disease?
A light pressure dressing is typically left on the penis for 24 to 72 hours after the surgery to prevent bleeding and hold the repair in place. In some cases, patients will wake up with a catheter in the bladder but this is usually removed in the recovery room. Most patients are discharged later that same day or the following morning. The patient is also often given several days of antibiotics to reduce the risk of infection and inflammation and a pain medication for discomfort. In most cases surgeons recommend not engaging in sexual activity for at least 4-6 weeks after surgery, longer in some cases of complex repairs.
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