Peyronie's Disease
Peyronie’s is a disease where scar tissue into the penis causes it to bend, curve or lose length or girth. Patients may be able to feel the scar tissue (plaque) through the skin or they may have pain in a specific part of their penis as the scar tissue forms. During an erection, the penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition don’t have a curve, but might have an area of indentation or “hourglass” appearance.
Most men don’t have perfectly straight erections. Just because there is a little curve in their penis, that doesn’t mean they have Peyronie’s disease. In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. However, in some cases, the scar develops on both the top and bottom of the shaft, which can cause the penis to become shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the center of an hourglass. About one in three men with this condition may have calcium in the scar tissue that can make it feel like bone.
It has ben accepted by several authors that Peyronie’s disease has two stages namely acute and chronic.
⦁ Acute phase: This stage lasts between six and 12 months. During this period the scar forms under the skin of tyhe penis, causing a curvature or other change in its shape. Patients may feel pain when their penis is erect or when it is soft.
⦁ Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections. Also, erectile dysfunction (ED) or problems getting or keeping the penis hard may develop.
Peyronie’s disease is one type of penile curvature that happens to adults. Some men can be born with penile curvature and this is called congenital curvature or chordee. It is not caused by scar tissue, and the condition does not change over time. It might not be noticeable until after puberty when a man begins having more regular erections.
Experts estimate that about 6% to 10% of men between ages 40 and 70 have Peyronie’s disease. It’s been observed in other ages, but it’s less common. There’s a theory that the actual number may be higher since some men choose not to talk about the disease with their healthcare provider, and others may not be bothered enough to seek medical care.
SYMPTOMS AND CAUSES
The cause of Peyronie’s disease is undetermined. There is a believe that the scar occurs after the erect penis has been injured or abnormally bent, typically during sexual intercourse. However, 80% of men don’t remember a specific event that led to the changes in their penis. These changes probably happen due to small unrecognized microtraumas which happen during regular sexual relations. Men with Peyronie’s disease may be at risk of having too much scar tissue form in response to these small injuries compared to men who don’t develop this condition.
Symptoms of Peyronie’s disease may develop slowly or acutely. The pain of Peyronie’s disease is usually mild and often does not require treatment, but medications like ibuprofen can be used if needed. In most cases, the pain decreases over time, but the bend in the penis related to the scar can remain a problem. If the bend is bad enough, such as greater than 30 degrees, the curve can interfere with sex. Changes in the penis can cause body image issues, anxiety or even depression. It can cause strain in a relationship and in other aspects of life.
Although, there is no cure for Peyronie’s disease, but there are always ways that the changes in the penis can be improved. Many different treatments exist including stretch therapy (traction), medications and even surgeries.
Traction (or stretch) therapy uses a device to stretch the penis and sometimes even bend the penis in the opposite direction of the curvature. This encourages the scar tissue to be recycled into more normal tissue and can improve curvature, restore length lost due to Peyronie’s disease, and even improve the hardness of erections.
There are medications taken by mouth and medications injected into the penis. The oral medications show little effectiveness compared to the injections. Injections that go right into the scar tissue are able to break down the scar and improve the curvature in the penis. Medications can be used in the acute phase, or in men who aren’t sure if they want surgery. Medications rarely result in a straight penis.
Mild curvature of the penis caused by Peyronie’s disease usually does not need treatment. Men in the chronic phase who desire the most rapid results or those who desire a straight penis may be better served with surgery to correct the problem. Surgery is only performed on men whose Peyronie’s disease makes it hard to have sex. As an important issue, surgery should only be performed in the chronic phase.
There are three surgical options to possibly fix your Peyronie’s disease. These surgeries are:
⦁ Shorthening the long side (Different types of plication thechniques)
⦁ Lengthening the short side (Grafting after incision of the plaque)
⦁ Inserting a prosthetic device inside the penis (Preferred in the men with Peyronie's Disease and Erectile dysfunction who do not respond to medical therapy)
