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Peyronie's Disease
Peyronie's disease is a relatively common problem in men. It is characterized by the complaints of penile
curvature and/or pain during an erection. The pain of Peyronie's disease can be present even without the presence
of an erection, and usually the patient will notice a lump at the point of pain or curvature. This lump represents
a scar that has developed on one or both of the structures in the penis that provide the firmness of an erection -
the corpora cavernosa.
The corpora of the penis are cylindrical structures that are designed to fill with blood under high pressure during an erection. Not surprisingly, these paired structures are sheathed in a tough, leathery tissue called the tunica albuginea. In Peyronie's disease, a scar develops among the two laminations of this tunica. What causes the development of this scar is largely unknown, but it is theorized that intercourse or manipulation in the absence of a perfectly firm erection can cause bending of the tunica which leads to microtears in this tissue. The scars, or plaques, seen in Peyronie's disease are simply the body's attempt to heal an injury.
As a Peyronie's plaque is initially formed, the scar is sensitive and thus usually painful. As the disease progresses, pain usually lessens but the ability to feel or palpate the plaque increases. Since the tunica albuginea is designed to stretch uniformly, a scar that disallows this expansion will cause an erection to curve around this spot on the tunica thus causing a bent erection. Over the next year or so, the body may remodel this scar and lessen the curvature, the scar may remain unchanged, or the curvature may progress. Each of these fates are equally likely. There may even be indentations in the penis called hourglassing due to the inability for the tunica to expand. If extensive, Peyronie's disease can even cause erectile disfunction and penile numbness.
There have been many medical treatments over time that have been proposed and used to treat Peyronie's disease. Among these are Vitamin E, Colchicine, injections of steroids, etc.. None of these treatments have been shown definitively to show efficacy in well designed studies in the literature. One drug, named Potaba, has shown very modest effect. However, one must take nearly 18-24 pills a day for an extended period of time to achieve very little. The cost is high. Not surprisingly, Potaba is not very often used but remains an option prescribed by some Urologists.
The first medical treatment to be proven to have benefit was and is injection of the Peyronie's plaque with a drug called Verapamil. Verapamil, a drug designed for blood pressure, induces a body chemical called collagenase. After 12 injections spaced 2 weeks apart, one can expect a 50% chance of reduction of angulation of the penis, and an 80% chance of resolution of pain. Attempts have been made to create a Verapamil cream so as to avoid injections, but well controlled studies have failed to prove a benefit for this route of delivery. Ongoing research on using electrical currents with Verapamil cream are ongoing.
The only reliable way to straighten the curved penis of Peyronie's disease is surgery. There are two types of surgery for this. The first is called placation. Here, sutures are applied under the skin opposite to the plaque to bend the penis back to the midline. The main problem with this surgery is penile shortening, which can be expected to some degree nearly uniformly. The second type of surgery that is performed at USW is the incision and grafting of the plaque. Here, penile shortening is usually avoided. However, there is a 5% or so risk of impotence with the operation, as well as a 50% risk of penile numbness to some degree that can last several months.
Patients that are bothered by their penile angulation or pain due to Peyronie's disease are encouraged to call and make an appointment with one of our physicians to discuss options. In general, Verapamil injections a re always offered before surgery. Aggressive surgery is only offered to those patients with a degree of curvature that disallows normal, enjoyable intercourse so as to make the risks of surgery worth the likely benefits. If you think you may be one of these patients, please bring a picture of your erection clearly showing the maximum angulation that can be demonstrated to you appointment.