Peyronie's Disease is an inflammatory condition of the penis that causes the development of scar tissue within the erectile portion of the penis. Some men with this condition develop painful erections and some may develop a curve or a kink when erect. It is normal to have a slight bend in the penis when erect, but in some men, the degree of curvature is severe and may make sexual activity difficult.
The causes of Peyronie's disease have not yet been completely elucidated. However, some things are known to cause Peyronie's such as trauma to the penis during sexual activity or after an accident with a significant injury to the penis. However, most men with the disease do not remember any significant event. As the penis heals from a trauma, it develops scar tissue that sometimes develops as a lump. This may lead to curvature.
The goal of any treatment for Peyronie's disease is to decrease pain and to allow normal sexual intercourse. There are generally two phases to the disease, an active or acute phase and a chronic phase. During the acute phase, most men experience some pain with erections. It is in the is phase that they may start to notice a bend to the penis. In this phase, the scar tissue is actively developing, and a urologist may prescribe anti-inflammatories to help with pain and to perhaps stop the progression. This phase may last up to 6 months. Treatment to fix the curvature is not generally performed at this time because it has not stabilized and may get worse. Once in the chronic phase, the scar tissue may become a plaque and the curvature has stopped progressing. At this point there are medical treatments and surgical options.
There is one FDA approved medication for the treatment of Peyronie's disease. Collagenase Clostridium histolyticum, also known as Xiaflex, is approved for the treatment of a palpable penile plaque that causes a curvature of 30 degrees or greater. Collagenase is a protein that breaks down the collagen that is present within the plaque. When used in conjunction with penile stretching and modeling, it was shown to significantly reduce penile curvature in most men. There are potential side effects, some can be severe so talk with a urologist about the risks prior to undergoing treatment.
There are several surgical treatments for Peyronie's disease and the choice of surgery depends on the degree of curvature, if erectile dysfunction is already present, as well as the side effect profile of the surgery. Similar to medical treatments, usually surgery is delayed until the curvature stops.
Plication surgery - there are a number of methods that involve placing small sutures on the side opposite the penile plaque. This corrects the curvature by shortening the opposite side. This procedure may shorten the penis, but has low rates of erectile dysfunction. This procedure generally works well for less severe curvatures.
Grafting surgery - in this procedure there is either an incision in the scar tissue or it is removed. A graft is a piece of tissue similar to the fascia (outer covering) of the erectile body within the penis. The graft is then sewn in place where the tissue was cut or removed. This procedure may work better for more severe curvatures and in those where there is penile narrowing (hour-glass like deformity). There is generally no penile shortening with this procedure, the downside is there is a high risk of erectile dysfunction.
Penile prosthesis - in those with both severe erectile dysfunction and Peyronie's disease a penile prosthesis may be placed and address both issues. Learn more about a penile prosthesis.
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