Sexual Function and Infertility - Peyronie's Disease
About Peyronie's Disease
Peyronie's disease is the development of scar tissue inside the penis that causes penile curvature, circular or hourglass deformity, shortening of the penis, pain with erection and/or difficulty with erection. Most doctors believe Peyronie's disease is caused by repetitive trauma to the penis or, in some cases, genetic factors that cause a scar or plaque to develop, which restricts the elasticity of this area of the penis during erection. Most men with Peyronie's disease cannot identify or recall a traumatic event that precipitated the condition.
Peyronie's disease was once thought to be rare but is now believed to occur in as many as 10% of men. It can be a severe hindrance to healthy sexual functioning and in its most progressive state the curvature of the penis is so severe sexual intercourse is impossible.
At the Columbia University Department of Urology at New York-Presbyterian Hospital, we not only evaluate the patient but we also assess the sexual function of the patient and his partner, because pain with intercourse can sometimes arise from a woman's anatomy.
Treatment for Peyronie's Disease
Dr. Peter Stahl, a sexual function expert at Columbia University Department of Urology at New York-Presbyterian Hospital, is a leading investigator in treatments for Peyronie's disease. He has a wide range of experience with therapies ranging from verapamil injection to surgical procedures to straighten the penis, including grafting. Dr. Stahl can help determine which treatment approach will be most effective for each patient with Peyronie's disease.
Oral Therapy for Peyronie's Disease:
Medications prescribed for erectile dysfunction (Viagra, Levitra, Cialis) are sometimes beneficial for patients in the early stages of Peyronie's disease. There is some evidence that pentoxifylline, a medication used to treat other conditions, may also have a role in the treatment of Peyronie's but so far the evidence is limited.
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 for Peyronie's Disease:
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. Columbia Urology's Dr. Stahl has extensive experience in verapamil injection and co-authored one of the largest studies on this treatment. New agents such as collagenase may soon become available for injection therapy.
Stretching Devices for Peyronie's Disease:
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 Peyronie's Disease:
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.