Peyronie’s Disease
Peyronie’s disease is a physical deformity of the penis, typically caused by scar tissue or plaque inside the penis. Patients with Peyronie’s disease may have a pronounced bend, curve, or narrowing of the penis during erection. Symptoms include painful erection, inability to have sex, and serious psychological issues.
Causes and Symptoms of Peyronie’s Disease
There isn’t one specific cause of Peyronie’s disease. The condition may develop as a result of injury to the penis during sexual or athletic activity. The scar tissue that forms after injury may produce a curvature.
Patients with Peyronie’s disease may have:
- Bumps or a band of hard tissue that can be felt through the skin of the penis
- An hourglass appearance or bent appearance of the penis during erection
- Difficulty with erection
- Discomfort with or without an erection
Treatment for Peyronie’s Disease
Effective treatment for the condition include stretching devices placed on the penis, injections into the plaque or scar in the penis, and surgery to straighten the penis by placing sutures on the opposite side of the curvature.
Xiaflex
Xiaflex injections are a series of eight injections administered in four cycles. The first two injections are done within one week, followed by a break of four to six weeks. The cycle repeats until all eight injections are done.
Patients should avoid sexual intercourse for two weeks after each injection. After each procedure, patients are able to return to work and continue regular activities. About 70% of patients are satisfied with Xiaflex and don’t require additional interventions. The average improvement in curvature with Xiaflex is 40% to 50%
Penile Traction Therapy
Peyronie’s Disease Surgery
Surgery for Peyronie’s disease may be recommended if:
- The curvature of the penis has been stable for at least three to six months
- Patients have had symptoms for at least one year
The physician will perform an exam when the penis is flaccid to identify penile plaque, indentation, and other abnormalities. The physician will also evaluate the penis when it is erect to measure curvature degree and direction.
During plication surgery, sutures are placed on the opposite side of the curvature. This type of surgery is only recommended if the curvature of the penis is less than 60 degrees. Plication is not an option for patients with hourglass deformities or indentations.
The outpatient procedure is performed under sedation or general anesthesia. Patients are typically able to recover at home after the surgery. They will need to regularly change dressings for five days after plication surgery. Most patients can go back to work one or two days later.
Potential risks or complications of plication surgery for Peyronie’s disease include:
- Decreased sensation in the penis
- Persistent pain after surgery
- Bumps or lumps in the penis
- Less-rigid erections
- Remaining indentations in the penis
- The penis can become curved again
Another option is plaque excision and grafting. During this type of surgery, plaque is removed and the remaining hole is filled with a graft. This option is recommended when penile curvature is greater than 60 to 70 degrees. Surgery is performed under general anesthesia or with an epidural. Patients will need to stay in the hospital overnight because the procedure is more invasive and may require multiple incisions.
Patients with Peyronie’s disease and severe erectile dysfunction may benefit from an inflatable penile prosthesis. During surgery, inflatable cylinders are placed inside the penis and controlled by a pump in the scrotum. The patient will be placed under general anesthesia and will need to stay in the hospital overnight. The recovery process can last a few weeks.
