Peyronie’s Disease

Peyronie’s disease is a condition in which painful, hard plaques form underneath the skin of the penis leading to penile curvature. If you have pain and penile curvature characteristic of Peyronie’s disease, the following information may help you understand your condition.

What Is Peyronie’s Disease?

Peyronie’s disease (also known as induratio plastica penis) is an acquired inflammatory condition of the penis. The principle manifestation of Peyronie’s disease is the formation of a plaque (a segment of flat scar tissue) within the connective tissue of the penis. The plaque is felt through the penile skin usually. This plaque is not a tumor but it may lead to serious problems such as curved and/or painful erections.

The name “Peyronie’s Disease” is derived from the physician Francois Gigot de la Peyronie, personal physician to King Louis XV of France. De la Peyronie’s name has been associated with the condition since that time after he wrote an authoritative description of the disorder in 1743.

What Are the Symptoms of Peyronie’s Disease?

The plaques of Peyronie’s disease most commonly develop on the upper (dorsal) side of the penis. Plaques reduce the elasticity and may cause the penis to bend upwards during the process of erection. Although Peyronie’s plaques are most commonly located on the top of the penis, they may also occur on the bottom (ventral) or side (lateral) of the penis, causing a downward or sideways bend, respectively. In some men may have more than one plaque,, which may cause complex curvatures.

In some men an extensive plaque that goes all the way around the penis may develop. These plaques typically do not cause curvature but may cause a “waisting” or “bottleneck” deformity of the penile shaft. In other severe cases, the plaque may accumulate calcium and become very hard, almost like a bone. In addition to penile curvature, many patients also report shrinkage or shortening of their penis.

Since there is great variability in this condition, men with Peyronie’s disease may complain of a variety of symptoms. Penile curvature, lumps in the penis, painful erections, soft erections, and difficulty with penile penetration due to curvature are common concerns that bring men with Peyronie’s disease to see their doctors.

Peyronie’s disease can be a serious quality-of-life issue. Studies have shown that over 75 percent of men with Peyronie’s disease have stress related to the condition.

Embarrassment about the condition affects many men with Peyronie’s disease and several men choose to suffer in silence.

How common is Peyronie’s disease?

Peyronie’s disease can be found in up to 9 percent of men between the ages of 40 and 70. The condition is rare in young men but has been reported in men in their 30s. The actual prevalence of Peyronie’s disease may be much higher than 9 percent due to patient embarrassment and limited reporting by physicians.

Interestingly, more Peyronie’s disease cases have been reported in recent years. This is likely due to the availability within the last decade of highly effective oral medications for the treatment of erectile dysfunction (ED). With more men seeking treatment for erectile problems, many cases of Peyronie’s disease that would have gone undiagnosed in the past have come to the attention of doctors.

What Causes Peyronie’s Disease?

In recent years, an understanding of the disorder has created much progress. Most experts believe that Peyronie’s disease is likely the consequence of a minor penile trauma. The most common source of this type of penile trauma is thought to be vigorous sexual activity (e.g., bending of the penis during penetration, pressure from a partner’s pubic bone, etc.) although injuries from sports or accidents may also play a role. Injury to the connective tissue may trigger a cascade of inflammatory and cellular events resulting in a process called fibrosis or formation of excessive scar tissue. This abnormal scar tissue in turn forms the plaque of Peyronie’s disease.

Not all men who suffer occasional mild trauma to the penis develop Peyronie’s disease. For this reason, most researchers believe that there must be genetic or environmental factors that contribute to the formation of Peyronie’s disease plaques. Men with certain connective tissue disorders (such as Dupuytren’s contractures ) and men who have a close relative with Peyronie’s disease have a greater risk of developing the condition. Certain health conditions such as diabetes, tobacco use, or a history of pelvic trauma may also lead to abnormal wound healing and may contribute to the development of Peyronie’s disease.

The disease is usually divided into two distinct stages. The first phase is the acute phase; this portion of the disease persists for six to 18 months and is usually characterized by pain, worsening penile curvature and formation of penile plaques. The second phase is the chronic phase, during which the plaque and penile curvature are stable but problems with calcification and erectile dysfunction may occur.

How Is Peyronie’s Disease Diagnosed?

Upon physical examination by an experienced urologist, the hard plaques can usually be felt with or without erection. It may be necessary to induce an erection in the clinic for proper evaluation of the penile curvature; this is usually done by direct injection of a medication that causes penile erection. An ultrasound examination of the penis when it is erect is used to characterize the plaque and check for the presence of calcification.

How Is Peyronie’s Disease Treated?

In about 13 percent of cases, Peyronie’s disease goes away without treatment. Many physicians recommend conservative (non-surgical) treatment for at least the first 12 months after symptoms present.

Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function do not require treatment. Men with active phase disease who do have one or more of the above problems may benefit from medical therapy.

Oral Medications

Oral vitamin E: An antioxidant that is a popular treatment for acute stage Peyronie’s disease because of its mild side effects and low cost. While studies as far back as 1948 have demonstrated decreases in penile curvature and plaque size from vitamin E treatment, most of these studies have not used placebo controls. Those few studies of vitamin E that have included a placebo treatment group have demonstrated that vitamin E does not appear to give better results than the placebo, which calls into question whether or not vitamin E is an effective treatment.

Potassium amino-benzoate: Also known as Potaba. Small placebo controlled studies have shown that this B-complex substance popular in Central Europe yields some benefits with respect to plaque size, but not curvature. Unfortunately, it is somewhat expensive and use of the medication requires taking 24 pills a day for three to six months. This medication has also been associated with a high rate of stomach upset. This leads many men to stop taking it.

Tamoxifen: This non-steroidal, anti-estrogen medication has been used in the treatment of desmoid tumors, a condition with properties similar to Peyronie’s disease. Unfortunately, placebo controlled trials of this drug are rare and the few that have been conducted have not shown that Tamoxifen is better than placebo.

Colchicine: An anti-inflammatory agent that decreases collagen development. Colchicine has been shown to be slightly beneficial in a few small, uncontrolled studies. Many patients taking colchicine over the long term develop gastrointestinal problems and must discontinue the drug early in treatment. No proof has determined Colchicine to be superior to placebo.

Carnitine: An antioxidant medication that is designed to reduce inflammation and thereby decrease abnormal wound healing. Like many other Peyronie’s therapies, uncontrolled trials have demonstrated some benefit to this treatment but a recent controlled trial has not demonstrated it to be superior to placebo.

Penile Injections

Injecting a drug directly into the plaque of Peyronie’s disease is an attractive alternative to oral medications. Injection permits direct introduction of drugs into the plaque, permitting higher doses and more local effects. Usually, to improve patient comfort, a patient receives a local anesthetic prior to the injection.

Surgical Treatment of Peyronie’s Disease

Your doctor may suggest surgery if the deformity of your penis is severe or prevents you from having sex. Surgery usually isn’t performed until the condition is stabilized, the curvature hasn’t changed, and your erections have been pain-free for at least six months.

Surgical methods include:

1. Shortening the unaffected side.
2. Lengthening the affected side.
3. Penile implants. Penile implants are essentially artificial versions of the spongy, tube-like tissues in the penis (corpora cavernosa). The implants may be semi-rigid — manually bent down to appear flaccid or bent up for sexual intercourse. Other penile implants may be inflated with a pump implanted either in the groin or the scrotum. The inflated implants cause the penis to be erect.  Usually, penile implants are for men with both Peyronie’s disease and erectile dysfunction. When the implants are put in place, the surgeon will likely make some incisions in the scar tissue to relieve tension on the tunica albuginea.

You’ll likely go home from the hospital the same day as the surgery. You’ll need to leave the dressing on your penis for 24 to 72 hours. Your urologist will advise you on how long you should wait before having sex. You’ll likely need to wait at least four to six weeks.