Peyronie's Disease, also known as curvature of the penis, is a condition in which the penis, when erect, bends abnormally. It is a rare cause of erectile dysfunction - a condition where a man has difficulty achieving or maintaining and erection.
Peyronie's Disease Symptoms
Peyronie’s disease plaques mostly (70% of the time) form on the top (or dorsal side) of the penis. The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. When plaques form on the bottom or side of the penis, the bend will be downward or sideways. Some men have more than- plaque, which may cause complex curves.
Sometimes plaques form that go all the way around the penis. These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”). In bad cases, the plaque may collect calcium and become very hard, almost like a bone. Men may also notice that their penis has shrunk or gotten shorter.
Other signs that you may have Peyronie's disease are:
- bent/curved penis
- lumps in the penis
- painful erections
- soft erections
- having trouble with sex because of a bent/curved penis
Peyronie’s disease can make your quality of life worse. Over 75 out of 100 men with Peyronie’s disease are stressed and depressed because of it. Unfortunately, many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help.
How Common is Peyronie's Disease?
Peyronie’s disease is thought to happen in about 6 out of 100 men between the ages of 40 and 70. It’s rare in young men, but has been seen in men in their 30s. The number of cases may be higher than the estimates because many men may be embarrassed and choose not to see their health care provider.
Interestingly, more Peyronie’s disease cases have been noted in recent years. This may be because new meds for erectile dysfunction (ED) have come to market, and health care providers may notice Peyronie’s disease in men seeking help for ED. For this reason, the number of Peyronie’s disease cases reported will likely keep growing.
Peyronie's Disease Treatments
Your doctor 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.
Drug therapy may help men who are badly affected by the disease during the acute phase. There haven't been enough studies to tell exactly how well these drugs work, though.
Oral vitamin E
Vitamin E is an antioxidant that's popular because of its mild side effects and low cost. Studies as far back as 1948 show that taking vitamin E may make plaques smaller and help straighten the penis. But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn't work better than placebo. (A placebo is a pill with no drugs in it - a "sugar pill.")
Potassium amino-benzoate ("Potaba")
Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It also can upset your stomach, so many men stop taking it.
This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie's disease. There are only a few controlled studies of this drug and they haven't shown that tamoxifen works better than placebo.
Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn't been proven to work better than placebo.
Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn't show it to work better than placebo.
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren't sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection also works for penile pain and curving. Verapamil appears to be a good, low-cost option for Peyronie's disease. More controlled studies are needed to prove how well it works.
Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue.
A large-scale test of interferon injection for Peyronie's disease showed that this treatment can help. But more studies are needed.
Collagenase is made in the body and breaks down certain tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie's disease. This drug (Xiaflex®) is now approved in the U.S. for treatment of men with penises curving more than 30 degrees.
Other Peyronie's Disease Treatments
Other Peyronie's Disease treatments are being studied. But there isn't enough data on them yet to prove they work.
Some small studies have shown that stretching the penis for 2 to 8 hours a day for at least 6 months may help restore length and curving.
Treating the penis with ultrasound, radiation, shock-waves, heat, and verapamil on the skin are also being studied. These, for the most part, are not proven and are not recommended by experts in the field.
Your 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 Peyronie's Disease Treatments 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 doctor 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.
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