Peyronie’s disease is a condition in which plaque or scar tissue is formed within the tunica albuginea of the penis.
This may cause problems such as curved and painful erections.
Anatomy of the Penis
The male penis serves a very important role in urinary function and as a sexual organ. The penis is a cylindrical organ which consists of 3 separate parts.
In the upper portion, there are 2 cylindrical bodies which lie side by side (corpora cavernous) and are surrounded by a layer of connective tissue called the tunica albuginea.
The 3rd chamber is a column of connective tissue which covers the urethra (a narrow tube which carries urine and semen outside the body).
Causes of Peyronie’s Disease
The exact reasons why Peyronie’s disease forms in certain individuals is unclear. The underlying cause is often a genetic susceptibility combined with some sort of trauma to the penis.
Often the trauma is mild and not obvious to the man. It can be related to multiple “micro-traumas” which cause impaired wound healing in the tunica and scar formation.
Incidence of Peyronie’s Disease
The incidence of Peyronie’s disease has been found to be as high as 9% of the male population. After a radical prostatectomy, one study found that the incidence was 16%.
Symptoms of Peyronie’s Disease
The initial symptoms of Peyronie’s disease are painful erection and thickening of the penis. You may also notice a curvature or bend in the penis which is most obvious when the penis is erect. There can also be symptoms like lumps in the penis, soft erection and difficulty in penetration. In very severe cases the plaque may accumulate calcium and become very hard.
A significant proportion of men with Peyronie’s disease develop symptoms of depression. We screen men for these symptoms and arrange follow-up if necessary. However, often with the treatment of the Peyronies’ disease, the depressive symptoms resolve.
Diagnosis of Peyronie’s Disease
A good history combined with a thorough physical examination of the penis is sufficient to diagnose Peyronie’s disease. A photograph can also help illustrate the extent of the problem to the specialist.
However, to help characterise the extent of the disease or to confirm a focussed ultrasound could be undertaken.
This test helps the specialist to plan the appropriate intervention and can also help to more accurately inform the patient of the expected outcomes.
Peyronie’s Disease Treatment
There are various types of treatments for Peyronie’s disease. You may also decide not to have the condition treated if the condition is very mild and if you have few or no difficulties during sexual activity.
Non-Surgical Treatments of Peyronie’s Disease
Non-surgical treatments include:
- Stretching: This process involves wearing a traction device which stretches the penis to help reduce the deformity or bend.
- Oral medications: Oral medications have a rather limited utility but have been shown to improve pain, reduce progression, and plaque formation.
- Injectile medications: Under a local anaesthetic, medications injected directly into the plaque can decrease the degree of curvature.
- Shock wave therapy: This therapy may be useful in patients who do not want surgery and other conservative measures have not worked. Although some men gain the benefit, there is no strong data to support its use.
Surgical Treatments of Peyronie’s Disease
Your doctor will suggest a surgical treatment only if the condition has attained stability and you have been pain-free for at least 6 months (12-18 months after the onset).
Some of the surgical treatments are:
- Plication: This day case procedure involves placing sutures in the “long” side of the penis to make it straight.
- Plaque incision and grafting: This procedure is much more complex than a plication procedure. It is indicated for severe curves (>60 degrees) and for patients with a very short penis. It involves lifting the nerves that supply the penis with sensation, cutting the plaque and placing a specialised material to cover over the defect.
- Penile implant surgery: In some men, especially those with some erectile dysfunction, the best treatment is a penile prosthesis. This device not only fixes the curvature but also gives a very strong erection.