What is Peyronie’s disease?
Peyronie’s disease is a disorder in which scar tissue, called a plaque, builds up inside the tissues of a thick, elastic membrane in the penis called the tunica albuginea. Peyronie’s disease begins with inflammation, or swelling, which later becomes a plaque. The plaque, which may not be palpable, can cause the penis to bend, making sexual intercourse difficult and painful. The most common area for the plaque is on the top or bottom of the penis.
What causes Peyronie’s disease?
The exact cause of Peyronie's disease is unclear. Most doctors believe that the plaque of Peyronie's disease develops following trauma that causes localized bleeding inside the penis. The injury or trauma may not be noticeable. As the injury heals, the immune system cells may release substances that lead to the formation of too much scar tissue. The disease is most common in middle-aged men, may run in families and may be associated with other connective tissue and auto-immune disorders (eg. Plantar fasciitis, Dupuytrens contracture). Researchers estimate that Peyronie’s disease may affect 1 to 23 percent of men between 40 and 70 years of age. However, the actual occurrence of Peyronie’s disease may be higher due to under-reporting.
How is Peyronie’s disease treated?
The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. In some cases, Peyronie’s disease may resolve on its own without treatment. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. The treatment offered may be surgical or non-surgical and may depend on the degree of curvature and erectile dysfunction.
Many oral medications have been utilized to treat Peyronie’s disease. These include Vitamin E, potassium para-aminobenzoate (Potaba), tamoxifen, colchicine, acetyl-L-carnitine and pentoxifylline. Scientific studies have shown poor results with medical therapy. Intralesional therapy (injection of plaque) has shown promising results in patients with mild to moderate disease. The most common medications used for intrlesional therapy include Xiaflex and Verapamil. Recent studies show upto 30 degree improvement in curvature in patients with intralesional therapy.
Surgery is reserved for patients with moderate to severe curvature. In patients with no or mild erectile dysfunction, reconstructive surgery involving excision (removal) of the plaque followed by grafting with patch of vein, skin, intestine or pericardium offers the best results (>80% success). The graft is usually obtained from cadaveric or swine tissue. This procedure may straighten the penis and restore some lost length from Peyronie’s disease. However, some men may experience numbness of the penis and worsening of erectile dysfunction after the procedure. In patients with moderate to severe erectile dysfunction, a penile implant surgery is indicated.
The urologists at Medstar Georgetown University Hospital provide the whole range of medical and reconstructive surgical therapies for treatment of Peyronie’s disease.