Peyronie's disease

Peyronie’s disease (curved erection)

What is Peyronie’s disease?

In Peyronie’s disease, hard masses called (plaques) form in the covering surrounding the vascular erectile tissue inside the penis. These lumps are not cancerous and cause the penis to curve toward the affected part. This may interfere with erection and penetration, reduce the length of the penis, and cause anxiety for the man and his wife.

There are no clear causes of Peyronie’s disease. Fortunately, as the disease continues to be studied, new medical treatments and new surgical techniques have emerged.

Curved erection cases

There is a lot of mystery about Peyronie’s disease, but research has indicated that it may be a wound-healing disease. Peyronie’s disease lumps are hard scar tissue. The common belief is that the disease results from a wound to the erect penis – often wounds that men go unnoticed. The mystery is why a small wound has developed into a large scar.

Naturally, wounds heal in three stages: First, the enzymes clean the wound in dead or damaged tissue. Second, the body repairs the wound by creating a scar that helps strengthen the injured tissue. Finally, the collagen fibers that make up the scar are broken down and re-formed leaving a small “new” scar. In Peyronie’s disease, the scar is exaggerated and the new scar remodeling process fails or is insufficient.

The abnormal scarring of Peyronie’s disease is thought to be related to the actions of fibrin and cytokines, which are responsible for stimulating the formation of scar tissue in the second stage of wound healing. It appears that – in Peyronie’s disease – these substances allow large amounts of collagen to accumulate. Proteases and collagenases may also play a role, which is responsible for remodeling scar tissue in the third stage of wound healing. Peyronie’s patient secretes too little of these enzymes, or the enzymes he secretes do not do their job fully to remodel the scars.

Some researchers believe that susceptibility to Peyronie’s disease is due to genetics. There is a close association between Peyronie’s disease and another genetic disease called Dupuytren’s contracture. In this disease, tissue that extends over the covering around the tendon in the palm of the hand forms scars, causing the ring finger to curve inward.

Peyronie’s disease diagnosis

Peyronie’s disease plaques form in the tunica albuginea – the fibrous tissue that lines the erectile chamber of the penis, which is known as the corpus cavernosum. These plaques prevent the penis from stretching during an erection and cause the erect penis to bend toward the presence of these plaques, which are often located on the upper (or “dorsal”) surface and may be located on the lower surface (“lower” surface) or either side (“lateral” plaques “). Some plaques are very small and cause only a slight concavity. These plaques may spread around the penis and cause the penis to turn into an hourglass shape. In general, the more curved the penis, the more difficult it is for penetration during sexual intercourse. Hourglass deformities and concavity can also make sexual intercourse difficult, and sometimes cause the penis to bend during penetration.

Peyronie’s disease may be accompanied by pain, especially in the early stages, and with the shrinking of the penis. Many men with Peyronie’s disease have erectile dysfunction, which means that they find it difficult to get an erection or to maintain an erection long enough for a satisfying sexual act.

Contrary to popular belief, in most cases, Peyronie’s disease does not improve without treatment. In any case, improvement or spontaneous recovery has been reported to represent 3% to 15% of all cases.

How common is Peyronie’s disease and who gets it?

At the end of the 1990s, Peyronie’s disease was thought to be almost uncommon, with many researchers reporting that it was only 1%. However, recent research indicates that the condition has spread widely. In a 2004 survey of 534 men who underwent urogenital testing at prostate cancer screening centers, nearly 9% of men had signs of Peyronie’s disease.

Peyronie’s disease is most often diagnosed in middle-aged men, so men of any age may have it, from adolescence onwards; Although it occurs more frequently in Caucasian men, it can be affected by any man of any ethnic group.

Peyronie’s disease treatment

Peyronie’s disease pills

Researchers have studied some oral treatments for Peyronie’s disease, including L-carnitine, colchicine, amino potassium benzoate, tamoxifen, and vitamin C. It was the first treatment for Peyronie’s disease thought to have a benefit due to its antioxidant properties. Other oral agents have been studied for their properties interfering with collagen synthesis and scar formation.

Unfortunately, most studies that have used oral treatments for Peyronie’s disease have not been well supervised. There are some cases of Peyronie’s disease that have improved on their own, and there are only a few studies of oral medications that have compared treated patients with untreated patients (“control group”), and it is not known whether there is a benefit in using oral medications to treat Peyronie’s disease. Peyronie compared to leaving the patient untreated in all stages of the disease: the curvature of the penis, pain, and the ability to have intercourse. The active stage of Peyronie’s disease lasts from 12 to 18 months. After that, the pain generally disappears, but the plaques and ridges remain. Peyronie’s plaques cause the erect penis to bend and contract. 

Treatment by injection into the affected site

Several agents have been studied for use as intravenous treatments, which means that they are injected directly into Peyronie’s disease plaques or the site of damage. Steroids were among the first drugs used in this way. Currently, it is not recommended to use internal injections of steroids in the treatment of Peyronie’s disease because there are no clear benefits, as it may cause atrophy or damage to the penis, and may hinder subsequent surgery. 

Verapamil is a calcium channel blocker often used to treat high blood pressure. It has been shown to stop collagen synthesis and increase the activity of collagenase, thereby stimulating scar remodeling.

And the same with interferon injections were accompanied by an improvement in Peyronie’s disease. In studies comparing a real drug to a placebo, proven benefits have been documented. Interferon works by increasing collagenase and decreasing collagen synthesis.

Treatment with a topical gel

Verapamil was introduced as a topical gel in the mid-1990s. It was hoped that this drug would be as effective as the internal injection and that it would provide the same results without pain in this non-invasive method. Unfortunately, when the drug is used topically, it does not reach the tunica albuginea. This was proven when verapamil was applied topically on the penis of men who had undergone penile implants, the application was at night and the procedure was done in the morning. During the surgery, small samples of tunica albuginea tissue were removed from each man and checked for the presence of verapamil. No verapamil was found in any of these tissue samples. 

Iontophoresis

Iontophoresis, also known as electroconvulsive therapy (EMDA), uses an electric current to pass medication through contact skin. In the treatment of Peyronie’s disease, this technique is used to administer vera-dexamethasone via a fluid-filled reservoir that is attached to the skin of the penis to cover the plaques. Early research suggests that the drug is effective in reducing pain, plaque size, and penis curvature. In addition, record levels of verapamil were found in tunica albuginea samples from men who underwent penile modification and plaque removal surgery.

Electroconvulsive therapy

ECT has been tested as a treatment to break down plaques, improve ulcers, improve blood flow to the penis, and modify the penis. So far, no lasting improvement has been reported with this treatment in an improvement in penile curvature, plaque size, sexual function, or rigidity.

Surgery

Men with Peyronie’s disease for more than a year are unable to have satisfactory sexual intercourse, and those with the stable pain-free disease are recommended for this surgery (see “Is Peyronie’s disease surgery right for you?” p10). Surgery remains the “gold standard” for correcting penile curvature associated with Peyronie’s disease, and surgical techniques have improved dramatically over the past several years.

No single type of surgery is suitable for all patients. If you can get a satisfactory erection (with or without medication), the curvature of your penis is less than 60 degrees, and it doesn’t take on the distorted hourglass or hinge shape, your doctor may suggest tunica albuginea frill (folding) surgery. When ruffles are performed, the tunica albuginea is ruffled or sutured in the part opposite the plaques, to overcome the effect of curvature.

If your penis has a severe curvature, or if the penis is too tight so an erection does not occur without torsion, then a more complex surgery is needed: excision and grafting. This requires excision of the protrusion, repair of the curvature, and grafting of the place, either living tissue from another place in the body or taken from human or animal tissue.

If your erection after surgery is not satisfactory, your doctor may prescribe Salis, Levitra, or Viagra to improve erections.

Penile prosthesis surgery was one of the primary methods of treating Peyronie’s disease. Today, this surgery is only used to treat Peyronie’s and erectile dysfunction patients. The cyst is removed only for men with calcified Peyronie’s disease.

All Peyronie’s disease surgery has side effects, including incomplete correction of the penis curvature, erectile dysfunction, and loss of penile sensation. Before undergoing any type of Peyronie’s disease surgery, you should be sure to discuss all side effects with your doctor.

In most cases, penile modification surgeries for Peyronie’s patients are successful and harden the penis, but only in the early stages of the disease, and always after other treatments have been tried. If you have signs and symptoms of Peyronie’s disease, talk to your doctor about the best treatment for you.