Treatment of Peyronie’s Disease | Part 2

Dec 31, 2014 0 Comments in Erectile Dysfunction by
Treatment of Peyronie’s Disease | Part 2

Treatment of Peyronie’s Disease

Peyronie’s disease is a condition that occurs when the wall of the sponge-like cavernous body of the penis (corpora cavernosa) hardens. As a result, fibrous tissue (plaque) disrupts and replaces the natural tissue, resulting in compromised structure and blood flow. Occurring most often in men between the ages of 40 to 60, Peyronie’s disease can occur at any age and according to the National Institute of Health can effect as much as 1% of the male population.

Peyronie’s Disease ImageSigns and Symptoms

1. Significant penile curvature and/or deformity
2. Palpable scar tissue or plaque under the penile skin
3. Painful erections
4. Shortening of the penis

Causes of Peyronie’s Disease

The causes of Peyronie’s disease are unknown and there is no definitive cure. Many researchers believe the plaque of Peyronie’s disease can develop following trauma (hitting, sudden bending while erect, and penile fracture) that causes localized bleeding inside the penis. Genetic, connective tissue disease and aging are also known risk factors.

Treatment of Peyronie’s Disease

Treatment of Peyronie’s DiseaseIt is worth noting that a slightly curved or deviated erection is common and isn’t necessarily a cause for concern. However, in some men the stress and anxiety caused by having a moderately deformed/bent penis can prevent a man from achieving or maintaining an erection culminating in an inability to have intercourse.

Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function do not require treatment. The plaques responsible for Peyronie’s disease resolves in about 13% of cases without treatment and conservative (non-surgical) treatment is recommended for at least the first year after symptoms present.

Men who experience erectile pain, considerable curvature or sexual dysfunction may benefit from medical therapy. If medical treatment begins at the early stages of the disease, usually within three to six months after the onset of the disease, non-surgical treatments can be effectively used to reduce, and even stop, plaque formation.

Non-Invasive Medical Therapies

Non-invasive medical therapies include vitamin E and Potaba, however the former has been called into question regarding its efficacy. Potaba, a vitamin B-complex substance which mostly effects on plaque size but not curvature, is an expensive treatment, has been associated with a high rate of upset stomach and needs to be taken for 3-6 months. Based on studies, after taking Potaba for 1 year, 1/3 of patients improve, 1/3 do not respond, and 1/3 experienced worsening of the plaque.

A number of oral medications have been tested to treat Peyronie’s disease, but have not been shown to be definitively effective and are not regarded as effective as surgery. Such medications include: Tamoxifen, Colchicine, Carnitine, Verapamil cream, Steroid injections, Interferon injections and Collagenase Injections (Xiaflex). Of the aforementioned medications, the only ones I have experience with are the verapamil cream and collagenase injection. I do not use the others in my practice due to insufficient medical information. The collagenase injection functions by breaking down the Peyronie’s disease plaque. However, this recently approved FDA medication is very expensive and the literature and long-term results have not been documented as of yet.

Surgical Correction

Surgery is performed on patients with severe disabling penile deformities that prevent satisfactory sexual intercourse. The surgical procedure can includes: suturing (plicating) the unaffected side, and/or making an incision or excision with grafting, which both will shorten the length of the penis. For patients who are suffering from total impotence, severe deformity, and penetration of the plaque to the corpus cavernosum, penile prosthetics for impotence is recommended. Another recently published discovery and approach involves the use of a subcutaneous soft-silicone penile implant for penile deformities and curvature correction. For further information, please refer to the following article in the Open Journal of Urology:

Surgical Treatment of Penile Deformity Due to Curvature Using a Subcutaneous Soft Silicone Implant