WHAT IS PEYRONIE’S DISEASE?
Peyronie’s disease (PyD) is a disorder in which fibrous scar tissue, called plaque, forms under the skin of the penis. The plaque builds up in the thick elastic membrane of the penis (tunica albuginea). This membrane helps to stiffen the penis during erection.
The plaque can develop anywhere along the penis. As it develops, the plaque pulls on the tissues surrounding it and causes the penis to curve, usually during an erection. Penile curvature can make erections painful and may make sex painful, difficult or impossible. The plaque is different from that which builds up in blood vessels.
About 15% of men have PyD. The chance of developing it increases with age. Especially in men in their fifty’s and 60s.
PHASES OF PEYRONIE’S DISEASE
There two phases of PyD; the acute phase and the chronic phase. During both phases, the curved penis may cause problems with sexual intercourse.
This phase can last up to 12 months.
- Inflammation may occur and plaque forms in the penis.
- The penis begins to curve
- There is pain without an erection
- Erection may become painful when scars develop.
The chronic phase usually starts 12 to 18 months after appearance of initial symptoms. In this phase,
- The plaque has formed
- The penis does curve any further.
- Pain lessens or ends.
- Erectile dysfunction may develop or worsen.
SIGNS AND SYMPTOMS OF PEYRONIE’S DISEASE
The signs and symptoms may be sudden or gradual in onset and can be mild to severe. Common signs and symptoms include:
- Lumps in the penis. The plaques can be felt under the skin of the penis as flat lumps or band of hard tissues.
- Penile curvature with or without erection. The penis may curve upward, downward or to one side depending on the site of the plaque.
- Shortening or narrowing of the penis
- Penile pain with or without erection.
- Erectile dysfunction (ED). PyD might cause problems getting or maintaining an erection.
WHAT CAUSES PEYRONIE’S DISEASE?
The exact cause of PyD is unknown, but some factors appear to be involved.
- Micro-trauma to the penis: this type of injury is most often caused by vigorous sexual intercourse (such as bending the penis during penetration or hitting the penis against the pubic bone of partner), sports or an accident. The injury may cause bleeding and swelling in the tunica albuginea. As the injury heals, scar tissue may form and a plaque can develop. This plaque pulls at surrounding tissues and causes the penis to curve.
- Autoimmune diseases: this occurs when the immune system attack cells in the penis. It can lead to inflammation and development of plaque in the penis. Examples of such autoimmune diseases are, Systemic Lupus Erythematosus (SLE), sjogren’s syndrome and Behcet’s disease.
- Catheterization/urologic procedures.
FACTORS THAT INCREASE THE RISK OF PyD
The following factors may increase your risk of PyD
- Family history of Peyronie’s disease
- If you have certain autoimmune and connective tissue disorders. Example of such connective tissue disorders are Dupytren’s contracture, plantar fasciitis and scleroderma.
- Vigorous sexual or nonsexual activities that can cause trauma to the penis.
- Aging. The chances of PyD increases with age. Age-related changes in the penile tissues may cause it to be more easily injured and less likely to heal well.
- History of prostate surgery.
- Diabetes with ED. Men with diabetes-associated ED have a 4-5 times higher chance of developing PyD compared with the general population.
POSSIBLE COMPLICATIONS OF PEYRONIE’S DISEASE
Complications of Peyronie’s disease may include
- The inability to have sexual intercourse because of penile curvature.
- Difficulty to achieve or maintain an erection (erectile dysfunction).
- Shortening of the penis.
- Emotional distress or anxiety over sexual ability and appearance of the penis.
- Problems fathering a child because intercourse is difficult or impossible.
HOW IS IT DIAGNOSED?
The diagnosis is based on the medical and family history of the patient as well as a physical examination on the penis. During physical exam, the doctor can feel plaques in the penis whether it is erect or not.
The aim of treatment is to reduce pain, attain normal or close to normal shape of the penis, and restore and maintain the ability to have sexual intercourse. In rare cases, PyD goes away without treatment.
Also, treatment may not be needed if
- The plaques are small
- There is no pain
- Absence of problems with sexual intercourse and
- There is little or no penile curvature.
The treatment options for Peyronie’s disease depends on the severity of symptoms, extent to which the penis curves and the phase of the disease.
INJECTIONS: this involves injecting the medicine directly into the plaques. Examples are
- Collagenase: the intralesional collagenase injection (Xiaflex) helps to breakdown collagen that makeup the plaque hence reducing penile curvature and improving erectile function. It is indicated in penile curvature greater than 30 degrees.
- Verapamil: an antihypertensive drug. It appears to disrupt collagen production. It may reduce penile pain and curvature.
- Interferon-alpha2b: interferon is a protein produced by the white blood cells. Studies show that it reduces pain, curving and size of plaque.
NSAIDs are usually recommended for the pain.
NONDRUG MEDICAL THERAPIES
These therapies include
- mechanical traction and vacuum devices: aims at stretching or bending the penis with a self-applied mechanical device for a period of time to improve penile length, curvature and deformity.
- shockwave therapy: focused, low-intensity electroshock waves directed at the plaque may be used to reduce pain.
Surgery can be done to remove plaque or help straighten the penis during an erection. It may be recommended for men who have Peyronie’s disease when
- symptoms have not improved
- erections or intercourse, or both, are painful
- penile curvature inhibits sexual intercourse.
Common surgical methods include:
Grafting. In this surgery, the surgeon will remove the plaque and replace it with a patch of tissue that was taken from another part of your body, such as skin or a vein from your leg; grown in a laboratory; or from organ donors.
This procedure may straighten the penis and restore some length that was lost due to Peyronie’s disease.
Some men may experience numbness of the penis and ED after the procedure.
Plication: various procedures can be used to suture (plicate) the longer side of the penis — the side without scar tissue. This results in a straightening of the penis, although this is often limited to less severe curvatures.
Several plication techniques may be used, generally resulting in similar success rates depending on surgeon experience and preference.
Device implantation. Penile implants may be considered if a man has both Peyronie’s disease and ED.
A surgeon implants a device into the penis that can cause an erection. The device may help straighten the penis during an erection.
WHAT IS THE OUTLOOK OF PEYRONIE’S DISEASE?
The outlook of this disease varies from good to poor, depending on the response to treatment and the patient’s emotional response to the symptoms and treatments. There is no treatment that will cure PyD, but symptoms can be reduced.
Overall, there is no preventive measure for Peyronie’s disease.
F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.