Peyronie's Disease

Peyronie’s disease is a condition of the connective tissue of the penis that causes the abnormal growth of plaques, or scar tissue in the tissues that encases the corpora caverosa, the two long cylinders that run the length of the penis.
This may cause pain, abnormal curvature, loss of girth and/or shortening of the penis, as well as erectile dysfunction or indentation.

Plaque on the top side of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. In many cases, men with Peyronie’s disease find it difficult or impossible to have sexual intercourse because of pain or due to the curvature of the penis.

Treating Peyronie’s Disease

Some men who present with the symptoms of Peyronie’s disease experience improvement without treatment, while other men have lived with the condition for months or longer and require more interventional treatment. If the curvature of the penis does not correct itself over time, it’s important to discuss treatment options with a urologist. Surgery is considered the gold standard therapy, but other treatment options may help.

Surgery

Surgery, specifically penile prosthesis, remains the gold standard treatment for Peyronie’s disease. There are several surgical options including:

• Excision – this procedure involves removing or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length. Risks of the procedure include numbness of the tip of the penis and decreased rigidity of erections in a small number of patients.
• Plication – this procedure involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, to straighten out the penis. This method is less likely to cause numbness or erectile dysfunction, but it is associated with a decrease in penile length.
• Penile Prosthesis – for patients with Peyronie’s disease and erectile dysfunction, placement of an inflatable penile prosthesis (penile implant) is used to increase the rigidity and straighten the penis adequately. Penile prosthesis remains the gold-standard treatment for patients with ED and Peyronie’s disease.

Medical Management

Medical therapy, or injection therapy, is often used to decrease pain and inflammation, or soften plaque. The goal of medication injected directly into the area of the plaque formation is to reduce the plaque as well as diminish pain and curvature of the penis.

• Xiaflex – The first FDA approved nonsurgical treatment for Peyronie’s disease, approved for use in men with a palpable lump from plaque in the penis that causes a curvature of at least 30 degrees during erection. This medicine works by decreasing the plaque that causes the curvature of the penis and involves a series of injections. The injections are given in your doctor’s office and most men receive as many as four treatments, each of which is two injections of the drug. The treatment does have side effects that should be discussed with your urologist.