Sexual Function and Infertility Library - Peyronie's Disease
What is Peyronie's disease?
Peyronie's disease is characterized by a plaque, or hard lump, that forms on the erection tissue of the penis. The plaque often begins as an inflammation that may develop into a fibrous tissue.
Peyronie's disease was first described in 1743 by a French surgeon, Franois de la Peyronie. It was classified as a form of impotence. However, now impotence is recognized as one factor associated with Peyronie's disease, but is not always present.
What causes Peyronie's disease?
Some researchers believe Peyronie's disease develops following a trauma that causes bleeding inside the penis. This trauma may explain acute cases of Peyronie's disease, but does not explain why most cases develop slowly, or what causes the disease after no apparent traumatic event.
What are the symptoms of Peyronie's disease?
The plaque in Peyronie's disease is benign, or non-cancerous. The following are the most common symptoms of Peyronie's disease. However, each individual may experience symptoms differently. Symptoms may include:
- Plaque on the top of the shaft, which is the most common condition, causes the penis to bend upward.
- Plaque on the underside causes the penis to bend downward.
- In cases where the plaque develops on both top and bottom, indentation and shortening of the penis may occur.
- Pain, bending, and emotional distress can prohibit sexual intercourse.
- Painful erections may occur.
The symptoms of Peyronie's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is Peyronie's disease diagnosed?
A diagnosis of Peyronie's disease is usually made when men seek medical attention for painful erections and difficulty with intercourse. In addition to a complete medical history and physical examination, diagnostic procedures for Peyronie's disease may include the following:
- ultrasound examination of the penis - a diagnostic technique which uses high-frequency sound waves to create an image of the internal organs.
- color Doppler examination - a type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel; waveforms of the blood flow are shown on the ultrasound screen (to evaluate erectile function, anatomy, and blood flow).
Treatment for Peyronie's disease:
Specific treatment for Peyronie's disease will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
In general, the goal of treatment is to keep the patient with Peyronie's disease sexually active. Providing education about the disease and its course is often included in the treatment plan. In some cases, treatment is not necessary, as Peyronie's disease often occurs in a mild form that heals without treatment in 6 to 15 months. Treatment may include:
Oral Therapy:
Medications prescribed for erectile dysfunction (Viagra, Levitra, Cialis) are sometimes beneficial for patients in the early stages of Peyronie's disease. Although there is no substantial evidence for their use, we find many patients are initially treated elsewhere with vitamin E, colchicine, POTABA, tamoxifen, and other drugs that may have significant side effects and offer little to no benefit.
Injection Therapy:
Doctors sometimes treat Peyronie's disease by injecting drugs directly into the plaque. This approach is not a cure but can lessen the deformity and pain, especially in the early phase of the disease.
Iontophoresis (Electromotive Drug Administration/EMDA):
Iontopheresis combines topical application of drugs with electric current to drive the medication into the target tissue of the penis, the tunica albuginea. This treatment is not universally recommended but may have a role in some patients, especially those experiencing pain.
Stretching Devices:
Stretching devices, analogous to braces for straightening the teeth, are a relatively new approach to correcting penile curvature. Stretching devices do not cure the condition but can improve the curvature, and are sometimes used along with medical or surgical therapy.
Surgical Treatment:
For some men sexual function is best restored through surgery. Doctors at Columbia Urology at NYP perform three outpatient surgeries for Peyronie's disease:
Plication, a procedure in which sutures are placed on the opposite side of the curvature to straighten the penis.
Plaque incision/excision with grafting, a procedure in which surgeons make an incision into the plaque or remove all or part of it. The area that has been excised is then replaced with one of several possible graft materials. Normally, the graft material need not be taken from the patient himself.
Some patients benefit most from implant surgery (a penile prosthesis), especially patients who have both deformity/curvature and significant erectile dysfunction. A penile implant corrects both problems and is an excellent option for the appropriate patient.
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