Treatment of Peyronie’s Disease | Part 1

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Dec 29, 2014/ 0 Comments / in Uncategorized / by
Treatment of Peyronie’s Disease | Part 1

Treatment of Peyronie’s Disease

Certain diseases and disorders significantly alters the entire course of a person’s life. One such condition is Peyronie’s disease that is caused by chronic history of microtrauma to the penile tissue. Healthcare providers use several diagnostic protocols to identify and manage this condition; such as physical examination, assessment of penile length, sexual and medical history, assessment and palpation of penile nodules and fibrotic plaques and sexual function.

It is imperative to understand that although Peyronie’s disease is a serious condition, the symptoms and complications can be optimally managed by a variety of pharmacological and surgical modalities to restore the normal quality of life.


Pharmacological / Conservative Management

Peyronie’s Disease ImageConventionally, pharmacological management is less effective, but is nevertheless an excellent option for males with mild fibrosis. If you have following symptoms, you are an ideal candidate for conservative management:

  • You can still participate in sexual activity or intercourse but with bearable discomfort or pain.
  • You have mild erectile issues (problems in achieving and sustaining erection during the act of sexual intercourse) without serious arching of penile shaft

Pharmacological Options

  • Clostridium Histolyticum: Pharmacological options aim to resolve/ slow down the process of fibrosis to restore normal penile functions. The Food and Drug Administration has approved a collagenase, Clostridium histolyticum (also sold under the brand name of Xiaflex) for this purpose (1). It is indicated for males who have palpable plaques of fibrotic cords under the penile skin (with less than 30 degrees of shaft arching). It is usually administered via a penile injection. This collagen treatment works best at restoring the normal anatomy and physiology of penis, but it is recommended to use this drug after consulting your primary care provider.

There are certain other drugs that are also used for the treatment of this disease but they are not officially approved by FDA these are:

  • Verapamil (topical gel or injections)
  • Interferon (injections)
  • Pentoxifyllin (trental)

Surgical Interventions

dr-elist-2Surgical intervention is only recommended if the symptoms are severe and interfering with the normal quality of sex life.

Surgical Methods include;

  • Incision, Excision or Grafting: This surgical method is only used if the arching severe. Clinical data and prior statistics suggest that it is a risky procedure and may worsen the erectile/ sexual dysfunction. As part of this procedure, surgical cuts are carefully introduced along the cicatrix fibers and some tissue is extracted to allow the fascia to bulge out along with its content. After that the surgeon fills the cavity in tunica albuginea with graft and then stitch it back.
  • Penile Implant: Surgically infused penile implant replaces the function of spongy tissue of the penis. Artificial penile implants is a semi-rigid structure. There is also another type of implant that is introduced in the scrotum with a pump. Penile implant is effective in resolving Peyronie’s disease as well as erectile dysfunction. According to the study reported in The Journal of Sexual Medicine (2) patient satisfaction rate after penile implants is over 90%. Most frequently reported complaints are disturbance in the sensitivity/ sensation of the glans (in 20%) and persistence of penile curvature deficits of less than 15 degrees (reported in about 15% of the patients who underwent this procedure).
  • Suturing (Plicating) the Unaffected Area: In this surgical method the longer part or the unaffected part of penis is plicated. Although this procedure helps in restoring penile erection, yet the overall length of penis is compromised. In few cases placation can also result in erectile dysfunction.

Other Peyronie’s Treatments

Extracorporeal shock wave treatment: In this treatment a weak wave of current is allowed to pass through a mixture of dexamethasone and verapamil (without introducing any cut). The technology uses sound waves to dissolute the cicatrix fibers, while other devices like vacuum device are also used for penile traction and lengthening as part of the procedure.

Coping and Support

Peyronie’s disease is a serious condition that affects the confidence, self-esteem and moral of male patients. However, it is imperative to understand that the disease process can be controlled with interventions. Therefore treatment should not be delayed.

If you are experiencing psychological issues, counseling is definitely the best option to manage erectile dysfunction due to anxiety, stress and depression.  Additionally:

  • Describe your partner that how can you keep the sexual and physical affection in continuity.
  • Make your partner aware of your feelings regarding the appearance of your penis and discuss potential treatment options.
  • Consult any health advisor who can solve family and sexual issues.
  • Gives awareness to your partner about your condition and adopt healthy strategies to maintain a healthy and functional sexual life.

References:

  1. Goldstein, I., Karsh, L., Mills, J., Smith, T., Kaufman, G., & Shabsigh, R. (2014, April). Clinical Evaluation of Treatment of Peyronie’s Disease With Collagenase Clostridium Histolyticum: Analysis of Penile Curvature Deformity by Duration of Disease and Plaque Calcification. In JOURNAL OF SEXUAL MEDICINE (Vol. 11, pp. 170-170). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY-BLACKWELL.
  2. Sansalone, S., Garaffa, G., Djinovic, R., Egydio, P., Vespasiani, G., Miano, R., … & Ralph, D. J. (2012). Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie’s disease, refractory erectile dysfunction, and severe penile shortening. The journal of sexual medicine, 9(1), 316-321.
  3. Palmieri, A., Imbimbo, C., Creta, M., Verze, P., Fusco, F., & Mirone, V. (2012). Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie’s disease and erectile dysfunction: results from a prospective randomized trial. International journal of andrology, 35(2), 190-195.
  4. Chung, P. H., Scott, J. F., & Morey, A. F. (2014). High Patient Satisfaction of Inflatable Penile Prosthesis Insertion with Synchronous Penile Plication for Erectile Dysfunction and Peyronie’s Disease. The journal of sexual medicine.
  5. Hartzell, R. (2014). Psychosexual Symptoms and Treatment of Peyronie’s Disease Within a Collaborative Care Model. Sexual Medicine.