While most patients may not know the term Peyronie’s disease (PD), the condition is quite common — affecting one in 10 men over the age of 18. Peyronie’s results from scar tissue in the penis. Scarring can be due to trauma, other surgeries, pre-existing conditions like diabetes, or associated with other diseases like Dupuytren’s contracture. This scar tissue, often referred to as plaque, is not elastic and causes a curvature or bend to the penis in its erect state. This can lead to penile shortening and narrowing. Not all curvature is bothersome, and many times patients are able to continue to be intimate without difficulty. However, if the plaque is causing significant pain with erection, difficulty with intercourse, or significant distress, it is important to know there are treatment options. I try to remind my patients just because PD is benign — not cancerous — does not mean it cannot hinder their quality of life.
Diagnosis and Evaluation
Peyronie’s disease is separated into two phases: active and stable. During the active phase, patients may just start to notice their curvature and have pain with erection. A patient may remain in the active phase from three months to one year. The main course of treatment during this phase is controlling pain with anti-inflammatories as needed. You have reached the stable phase once the curve has not changed for approximately three months. At this time, an evaluation can be performed to determine the degree of curvature and complexity. This consists of a physical exam to establish the location of the plaque. Often, an injection and ultrasound are also used to document the degree of curvature and blood flow to the penis. Based on these results, treatment options can be discussed.
It is paramount to understand a patient’s erectile function when treating someone with PD. If you can obtain and maintain an erection on your own, or with the use of oral medication, non-surgical treatment options may be available. If you have significant erectile dysfunction, are unresponsive to medications, or have a complex curvature, surgery may be the most beneficial.
If your evaluation reveals a curve greater than 30 degrees, but less than 90 degrees, and you do not have severe erectile dysfunction, Xiaflex may be an option for you. This is a medication that is injected directly into the scar tissue to allow for the plaque to soften in nature. After each injection, the physician and patient will perform different modeling techniques to straighten out the curve. This treatment option consists of up to eight injections into the scar tissue. For patients with calcium in their plaque or with a complex curve, this may not be an option.
A surgical option for patients with curvature and good erectile function is plication. This entails placing a series of sutures deep in the penile tissues that once tied down pull the penis straight. The sutures are deep under the skin such that you are not able to feel them during intimacy.
Plaque Incision/Excision and Grafting
Another surgical option for patients with good erectile function is plaque incision or excision and grafting. In this scenario, the scar tissue is cut into or removed entirely to allow penile straightening. The area that has been removed is then “patched” with a grafting tissue. This is not recommended for patients who have any degree of erectile dysfunction as it can significantly worsen your erectile dysfunction.
For patients with significant erectile dysfunction or a very complex curvature, surgery with the inflatable penile implant serves as the recommended treatment option. This is a three-piece device that is completely concealed within the body and allows for erection without affecting sensitivity, spontaneity, or longevity. Frequently, placement of the penile implant will correct the curve on its own. However, if your surgeon notices persistent curvature after the implant is in place, additional maneuvers can be taken during the surgery to further straighten out the bend.
Living with Peyronie’s disease may feel intimidating or even embarrassing but realize there are treatment options available. If you or a loved one is suffering from Peyronie’s disease, then please contact Georgia Urology to set up an appointment.