WHAT IS PEYRONIE’S DISEASE?
Peyronie’s disease is where plaques (segments of flat scar tissue) form under the skin of the penis. These plaques can cause the penis to bend or become indented during erections. The plaques can often be felt through the skin, and can also be painful.
HOW DOES THE PENIS NORMALLY WORK?
The main roles of the penis are to carry urine and sperm out of the body. There are 3 tubes inside the penis. One is called the urethra, a hollow tube that carries urine from the bladder through the penis to the outside. The other 2 tubes are called the corpora cavernosa. These are soft, spongy tubes that fill with blood to make the penis stiff during an erection. The 3 tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea. During sex, the stiffness of the penis makes it hard enough to push into the woman’s vagina. Then the urethra acts as a channel to carry semen into the vagina.
Peyronie’s disease plaques mostly (70% of the time) form on the top (or dorsal side) of the penis. The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. When plaques form on the bottom or side of the penis, the bend will be downward or sideways.
Sometimes plaques form that go all the way around the penis. These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”). In bad cases, the plaque may collect calcium and become very hard, almost like a bone. Men may also notice that their penis has shrunk or gotten shorter.
Other signs of Peyronie’s disease are:
- Bent/curved penis
- Lumps in the penis
- Painful erections
- Soft erections
- Having trouble with sex because of a bent/curved penis
Peyronie’s disease can make your quality of life worse. Over 75 out of 100 men with Peyronie’s disease are stressed and depressed because of it. Unfortunately, many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help.
HOW COMMON IS PEYRONIE’S DISEASE?
Peyronie’s disease is thought to happen in about 6 out of 100 men between the ages of 40 and 70. It’s rare in young men, but has been seen in men in their 30s. The number of cases may be higher than the estimates because many men may be embarrassed and choose not to see their health care provider.
Interestingly, more Peyronie’s disease cases have been noted in recent years. This may be because new meds for erectile dysfunction (ED) have come to market, and health care providers may notice Peyronie’s disease in men seeking help for erectile dysfunction. For this reason, the number of Peyronie’s disease cases reported will likely keep growing.
PEYRONIE’S DISEASE TREATMENT OPTIONS
You can click here to download the latest AUA guidelines on Peyronie’s Disease.
In very few cases (about 13 out of 100), Peyronie’s disease goes away without being treated. Many health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed.
Men with small plaques, not much curving of the penis, no pain, and no problems with sex may not need to be treated. If you need Peyronie’s disease treatment, there are many choices:
ORAL DRUGS
Drug therapy may help men who are badly affected by the disease during the acute phase. However, there haven’t been enough studies to tell exactly how well these drugs work.
ORAL VITAMIN E
Vitamin E is an antioxidant that’s popular because of its mild side effects and low cost. Studies as far back as 1948 show that taking vitamin E may make plaques smaller and help straighten the penis.
But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn’t work better than placebo. (A placebo is a pill with no drugs in it – a “sugar pill.”)
POTASSIUM AMINO-BENZOATE (“POTABA”)
Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It can also upset your stomach, so many men stop taking it.
TAMOXIFEN
This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie’s disease. There are only a few controlled studies of this drug and they haven’t shown that tamoxifen works better than placebo.
COLCHICINE
Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn’t been proven to work better than placebo.
CARNITINE
Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn’t show it to work better than placebo.
PENILE INJECTIONS
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren’t sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
VERAPAMIL INJECTIONS
Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection also works for penile pain and curving. Verapamil appears to be a good, low-cost option for Peyronie’s disease. More controlled studies are needed to prove how well it works.
INTERFERON INJECTIONS
Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue. A large-scale test of interferon injection for Peyronie’s disease showed that this treatment can help. But more studies are needed.
COLLAGENASE INJECTIONS
Collagenase is made in the body and breaks down certain tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie’s disease. This drug (Xiaflex®) is now approved in the U.S. for treatment of men with penises curving more than 30 degrees.
OTHER PEYRONIE’S DISEASE TREATMENTS
Other ways to treat Peyronie’s disease are being studied. But there isn’t enough data on them yet to prove they work.
Some small studies have shown that stretching the penis for 2 to 8 hours a day for at least 6 months may help restore length and curving. Treating the penis with ultrasound, radiation, shock-waves, heat, and verapamil on the skin are also being studied. These, for the most part, are not proven and are not recommended by experts in the field.
SURGERY FOR PEYRONIE’S DISEASE
Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex. Most health care providers suggest putting off surgery until the plaque and curving have stopped getting worse, and the patient has been pain-free for at least 9 to 12 months.
Before surgery, your health care provider may check the blood flow in the penis by injecting a drug that will make it stiff, and may also look inside the penis using ultrasound. These tests help show what is going on inside your penis (such as whether there is also erectile dysfunction) so your health care provider can decide which type of surgery is best for you.
There are 3 basic ways to fix Peyronie’s disease with surgery:
- Making the side of the penis opposite the plaque shorter
- Making the side of the penis that curves longer
- Placing a prosthetic device inside the penis
SURGERY TO SHORTEN THE SIDE OF THE PENIS OPPOSITE THE PLAQUE/CURVE
This type of surgery can be done either by cutting out small pieces of tissue on the outside of the curve and sewing it closed or by folding the tissue and pulling it together with surgical thread. The surgery is most often safe, easy for the surgeon to do, and has a low risk of problems (such as bleeding or making ED worse). A drawback is that this type of surgery can make the penis shorter. This surgery is better for men with mild or no ED, mild-to-moderate penile curving, and a long penis.
SURGERY TO MAKE THE SIDE OF THE PENIS THAT IS CURVED LONGER
This type of surgery is used when the penile curve is severe or the shaft has become very narrow. The surgeon cuts the plaque to ease tension, and may remove some of the plaque. The space that’s left is then filled with a graft.
In most cases, this surgery won’t make the penis much shorter. But it’s harder for the surgeon to do and there is a risk it could make ED worse. This surgery is often only recommended for cases of severe deformity in men who are able to get erections hard enough for sex.
TYPES OF GRAFTS
Grafting surgery moves tissue from one place on the body to another. It can also replace missing tissue on your body with donor tissue or a laboratory-made replacement. Your surgeon will help you decide which type of graft should be used to fill the space left by taking out the plaque.
There are 2 types of grafts that are most often used for Peyronie’s disease:
Autologous tissue grafts: These are grafts made of tissue taken from another part of your body during surgery. Some sources of grafts used for Peyronie’s disease are a vein from your leg (saphenous vein) or skin from behind your ear (temporalis fascia). Since autologous grafts are living tissue, they often grow into the surgical site much better than some other materials. A drawback to using an autologous graft is that the surgeon must make a second cut to harvest the graft.
Non-autologous allografts: These are sheets of tissue that are commercially made from human or animal sources. Before use, they are sterilized and treated to remove anything that could cause infection. These grafts act as supports for your body to grow fresh, healthy tissue on while they are slowly absorbed by your body. Allografts are strong, easy to work with, and well tolerated by most patients. Man-made materials such as Dacron® mesh or GORE-TEX® aren’t often used for Peyronie’s surgeries now. These materials can cause fibrosis that can make the deformity worse.
PENILE PROSTHETIC DEVICES
An inflatable pump or moldable silicone rods placed inside the penis are good options for men with Peyronie’s disease and moderate-to-severe ED. In most cases, this will straighten the penis and allow it to get stiff enough for sex. If the device doesn’t straighten the penis enough, the surgeon may straighten it more by modeling the plaque against the stiff prosthesis or by cutting the plaque and using a graft to cover the opening.