Peyronie's Disease

The P-Shot is increasingly used to treat Peyronie's Disease. I hope the following information about the condition is helpful..

 

Peyronie's Disease is a condition that is due to development of scar tissue inside the penis that causes curved, painful erections.

Having a curved erection is common and isn't in itself a cause for concern. Unfortunately, in some men, Peyronie's disease causes a significant bend or pain resulting in difficulty having sex or getting/maintaining an erection (erectile dysfunction). Obviously, in many men, this causes stress and anxiety.

There are characteristically two phases of the disease; An acute phase lasts 3-6 months followed by a chronic phase lasting around a year during which the disease usually stabilises.

While it is possible for Peyronie's Disease to go away on its own, it usually remains stable or worsens. Treatment is advisable if the curvature is severe enough that it prevents successful sexual intercourse.

 

What are the symptoms (and signs)?

  • Symptoms may develop gradually or appear suddenly.
  • Scar tissue - Felt under the skin of the penis as flat lumps or a band of hard tissue.
  • A significant bend to the penis - The erect penis might also have narrowing or indentations.
  • Erection problems.
  • Shortening of the penis.
  • Pain - With or without an erection

 

What are the causes?

While we don’t know for sure, we believe that Peyronie's disease results from repeated injury to the penis. For example, during sex  or sport. Most often, men don’t recall episodes of trauma. During  healing, scar tissue forms which can result in a lump or change in penis shape. This is particularly obvious when the penis becomes erect as the scarred part is unable to stretch.

A number of factors can contribute to poor wound healing and excess scar tissue:

  •  Heredity - If your father or brother has Peyronie's disease, you have an increased risk
  • Connective tissue disorders - Some  men who have Peyronie's Disease also have a condition known as Dupuytren's contracture where a cord-like thickening across the palm causes the fingers to pull inward
  •  Age - The prevalence of Peyronie's Disease increases with age
  • Diabetes
  • Cigarette smoking may be linked to Peyronie's disease

 

How might Peyronie's Disease affect me?

  • Inability to have sexual intercourse
  • Difficulty achieving or maintaining an erection (erectile dysfunction)
  • Anxiety or stress about sexual abilities or the appearance of your penis
  • Stresses on the relationship with your sexual partner
  • Difficulty fathering a child, because intercourse is difficult or impossible

 

When should I see a Doctor?

If you have pain or a curvature of your penis that prevents you from having sex, you should see your general practitioner (GP) who will probably suggest a referral to a specialist in male sexual disorders (urologist).

 

What might the doctor ask?

  • When did you first notice a curve in your penis or scar tissue under the skin of your penis?
  • Has the curvature worsened over time?
  • Are  erections painful, and if so, is it worsening or improving over time?
  • Do you recall having an injury to your penis?
  • Do you have difficulty having sex?

Your doctor may ask you to complete a survey, such as the International Index of Erectile Function, to gauge the effect of the condition on your sexual function. You may also be asked to take photographs of your penis when erect to detect the degree of curvature and location of scar tissue.

 

What might the doctor do?

Diagnosis of Peyronie's disease  is usually based on a physical examination to identify scar tissue in the penis. Measurements may be taken to monitor progress.

You may also be referred for an ultrasound scan. This test uses sound waves to produce images of soft tissues, allowing assessment of blood flow and checking for presence of scarring.

 

And treatment options?

If symptoms are mild, you may be advised to “wait-and-see” (watchful waiting).

If your symptoms are severe or are worsening over time, your doctor might recommend treatment to address the pain or curvature.

Some treatments used with variable success include Vitamin E, Potaba, Colchicine and Verapamil.

Surgery is not used frequently but will be considered when penetration is impossible, particularly when the bend is 45 degrees or greater. Surgery usually isn't recommended until the curvature of the penis stops increasing.

Surgery, particularly the simplest 'plication' procedure, unfortunately can be associated with further shortening of the penis and increasing the risk of erectile dysfunction. Newer procedures include insertion of semi-rigid or inflatable implants which can be particularly helpful if there is also erectile dysfunction.

Drugs called 'collagenases' (including Xiapex) can be injected to help dissolve collagen in the scar tissue and are available when there is a curvature greater than 30 degrees.

Platelet Rich Plasma (PRP) is used in a treatment called the P-Shot which holds potential as a natural approach, using the patients own blood to treat the scarring and deformity while improving size and erectile dysfunction.