Peyronie's Disease

Peyronie's disease, is caused by scar tissue, called plaque, which forms along the length of the penis in the corpora cavernosa. This plaque is not visible, and depending on the severity of the condition, the plaque can cause the penis to bend, making sexual intercourse difficult and occasionally painful.

In a small percentage of men, Peyronie's disease goes away on its own. But in most

cases, it will remain stable or worsen. Treatment might be needed if the curvature is severe enough that it prevents successful sexual intercourse.

Causes

The cause is not known but it has been suggested that one-off or repeated damage to blood vessels cause leakage into areas of the penis which do not usually come into contact with blood. This triggers an attack by the body's immune system, resulting in scarring. Other suggestions are that there is a defect in the person's genetic make-up or associated with low levels of the male hormone testosterone. There is also a form in which a baby is born with the condition (congenital) but this is not recognised until sexual maturity develops.

Symptoms

Peyronie's disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:

• Scar tissue. The scar tissue (plaques) associated with Peyronie's disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.
• A significant bend to the penis. Your penis might be curved upward, downward or bent to one side. In some cases, the erect penis might have narrowing, indentations or an hourglass appearance, with a tight, narrow band around the shaft.
• Erection problems. Peyronie's disease might cause problems getting or maintaining an erection (erectile dysfunction).
• Shortening of the penis. Your penis might become shorter as a result of Peyronie's disease.
• Pain. You might have penile pain, with or without an erection.

The curvature associated with Peyronie's disease might gradually worsen. At some point, however, it stabilizes in the majority of men.

In most men, pain during erections improves within one to two years, but the scar tissue and curvature often remain. For a few men, both the curvature and pain associated with Peyronie's disease improve without treatment.

Diagnosis

First, your doctor will talk to you and ask about any circumstances, such as injury, that may have occurred prior to symptoms appearing. Your doctor can feel the hardened tissue caused by the disease during an exam, although sometimes it is necessary to do the exam with the penis erect. In some cases where the doctor's exam does not confirm Peyronie's disease, or in cases where the condition develops rapidly, your doctor may perform a biopsy. A biopsy involves removing tissue from the affected area to be examined in a lab.

Treatment

If you have a mild version of the disease which does not cause much pain, if you are not sexually active, or if you have few or no difficulties with sexual intercourse, you may decide that you do not want any treatment.

There are many non-surgical treatments available for Peyronie's disease but research has so far failed to prove that they are guaranteed to work in all people.

• Stretching: the technical name for this is external penile traction. It involves wearing a device which stretches the penis. It has shown some effect in improving the length of the penis and lessening deformity.
• Vacuum devices: these work in a similar way to traction devices by creating a vacuum around the penis, which stretches the shaft.
• Medicines taken by mouth: medicines tried in the past for this condition include para-aminobenzoate, colchicine, propoleum, pentoxifylline, vitamin E, tamoxifen and acetyl-L carnitine. Only para-aminobenzoate has the backing of European guidelines and a UK licence to be used for this condition.
• Medicines applied to the surface of the penis: topical verapamil has been used with some success in reducing the amount of curvature and thickening of the fibrous tissue; however, it needs to be used for about nine months to have any significant effect.
• Medicines injected into the plaques: various medicines have been tried, including verapamil, interferon and a substance extracted from a germ called clostridial collagenase. Research studies have reported some improvement in pain, the size of the plaques and the amount of bend of the penis after these injections.
• Electrical currents: the technical term for this treatment is iontophoresis. A medicine is applied to the surface of the penis and a mild electrical current is applied. The idea behind this is to help the medicine penetrate into the deeper tissues of the penis, where they will have the greatest effect. Some research studies report that this method has some benefits whilst others say it has little effect.

Surgery

Surgery is the only treatment guaranteed to have a beneficial effect on Peyronie's disease but it would only be offered to you once the changes caused by the condition had settled down. This normally takes 12-18 months. Surgery is not without risks and can include shortening of the penis and a chance that the distortion will return. If your foreskin is already tight, you may need a circumcision to prevent it getting even tighter after the operation. Some people can feel knots or stitches under the skin. You should consider all these issues carefully before consenting to surgery.

There are various options available:

• Extracorporeal shock wave therapy: This uses vibrations from sound waves to break down the tough fibrous plaques. The sound waves are delivered by a device outside the body. You may be offered sedation during the procedure. The technique is safe but its effects are uncertain.
• 'Cold steel' surgery: This means surgery involving conventional surgical instruments. Several operations are available including:
• The Nesbitt tuck procedure: This involves removing some tissue from the side of the penis opposite the plaque. This has the effect of straightening but shortening the penis.
• Plication: This involves folding the normal tissue on itself rather than removing it completely.
• Cutting out the plaque: This sometimes is combined with the insertion of a plastic rod (prosthesis) to counteract any shortening.
• Laser surgery:  carbon dioxide laser is used to thin the plaque.

Counseling

Peyronie's Disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie's Disease to exhibit depression or withdrawal from their sexual partners.

Coping and Support

Peyronie's disease can be a source of significant anxiety and create stress between you and your sexual partner. The following suggestions might help you cope with Peyronie's disease:

• Explain to your partner what Peyronie's disease is and how it affects your ability to have sex.
• Let your partner know how you feel about the appearance of your penis and your ability to have sex.
• Talk to your partner about how the two of you can maintain sexual and physical intimacy.
• Talk to a mental health provider who specializes in family relations and sexual matters.

Prognosis

One research study found that only 13 out of a 100 men got better completely without treatment. Of the rest, half had mild but continuing symptoms, the other half got increasing amounts of pain and/or curvature of the penis. With treatment, the situation can often be improved. However, more research is needed to investigate the effect of the various available treatments on prognosis.