Peyronie's disease is an inflammation of the erectile bodies in the penis, otherwise known as the corpora cavernosa. Peyronie's disease is more common than people think, occurring most often in men between the ages of 40 to 60, but can occur at any age. The causes of Peyronie's disease are unknown. In fact, since the description by the French surgeon, Francois Peyronie, in 1743, not a great deal of progress has been made in understanding the reasons and progression of Peyronie's disease. Peyronie's disease probably represents an inflammation with subsequent scarring of the veins that are in the corpora cavernosa or 'erectile bodies' or channels in the penis. Occasionally, infection or trauma can cause Peyronie's, but for the most part, it's reason for starting is unknown. The disease usually presents with one of three problems: most common is pain on erection; secondly is curvature of the penis with erection; and lastly, difficulty having erections, or impotence. All of these may lead to inability to have satisfactory intercourse.
The usual findings of the patient with Peyronie's disease is a lump in the penis that is usually felt when the penis is soft. This is usually the area where the discomfort occurs in those patients that have discomfort with erections. In many cases, Peyronie's disease will present with mild aching or uneasiness in a specific area of the penis well before any lump or "plaque" can be felt. As time progresses, the plaquing may spread causing more irregularity, bending or discomfort. In most patients, however, only a single lesion is felt.
Because we are not certain of the reason for Peyronie's disease, it is difficult to plan any treatment that is universally effective. There is no definite cure for Peyronie's disease. Spontaneous regression and disappearance of Peyronie's disease and all of the symptoms occur in some patients, and therefore, therapy which is not particularly risky or aggressive is justified.
Two medical therapies include vitamin E and Potaba. Occasionally, these drugs will soften the plaque and relieve the symptoms. Vitamin E is safer and cheaper and has no side effects. It is far and away the most common initial treatment plan. We usually use 400-500 units two times a day. Failure to resolve the symptoms in 12 months usually means that this treatment will not be effective. Potaba is expensive, has a moderate list of side effects and seems to be no more effective than Vitamin E. Treatments that have been recommended or tried in the past include steroid injections into the plaque, ultrasound and radiation therapy. None of these treatments have been uniformly effective.
In patients where discomfort is a significant problem, some form of anti-inflammatory drug such as ibuprofen (Advil) can be used or some other similar drug.
In patients where the bend is so severe that intercourse is impossible, or Impotence has already developed, surgical treatment is probably the only reasonable option. The scarring plaque that is causing the bend may need to be removed or incised (cut) to straighten the penis, which usually impairs the quality of erections. Therefore, a penile prosthesis is often placed at the same time to make certain that a good erection, that lasts long enough to have penetration and normal sexual relations, occurs.
Other medical therapy includes oral Potaba, plaque injections with steroids (cortisone) or verapamil (blood pressure medication). Non-medical treatments include ultrasound and radiation therapy to the penile plaques. None of these techniques have been shown to be more effective than observation. The verapamil injections are too new to evaluate and have not been approved by the US Food and Drug Administration.
Surgical options include incision of the plaque and replacement of the defect that results in some form of graft using another part of the body or even a foreign substance. While the derma-grafting allows straightening of the penis, substitution of the diseased scar tissue by the graft does have complications including recurrence of the deformity because of scarring, or difficulty maintaining an erection. The option that we prefer, if surgery is needed after other options have been tried, is to make simple incisions into the plaque to allow straightening to occur. Then to keep the penis straight, we place a penile prosthesis that will also allow for a good erection postoperatively.
Reprinted with permission from Dialog Medical, dialogmedical.com.
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