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Peyronie's Disease

A man’s penis is one of the most important parts of his anatomy. Apart from being a critical part of the urinary system, the penis also acts as a sexual organ. Penis, just as any other part of the body, is vulnerable to disease and damage which can affect the sexual capability of the man. Peyronie’s Disease is one such medical disorder which causes deformity in the penis and affects urinary and sexual functioning of the penis.


How does the penis work as a sexual organ?
 

The penis is cylindrical in shape and has three distinct parts. The upper (dorsal) part consists of two large blood vessels (called ‘corpora cavernosa’). These are supported by layer of tough yet elastic tissue (called ‘tunica albuginea’). The third part is located in the underside of the penis, just below the corpora cavernosa (called ‘corpus spongiosum’). This is also supported by connective tissues which form a sheath around it. This has the urethra inside it which allows the passage of urine and semen out of the penis.

Normally, the numerous small blood capillaries in these penile parts get filled with blood and the penis becomes rigid from the pressure. This allows the man to enjoy sexual intercourse.


What is Peyronie's disease? 

Peyronie’s disease (or ‘induratio plastic penis’) is an acquired medical disease which results in the formation of plaque (hardened scar tissue) in the underside of the penis. This can be mostly felt under the skin with a touch. Although not tumorous, the plaque can result in the penis to bend down when in the erect position. This deformity results in loss of sexual pleasure and other problems.

What are the symptoms of Peyronie's disease?

The most commonly seen symptom of Peyronie’s disease is the formation of plaque which can be easily felt. The plaque formation is not distinct in the underside (dorsal) side of the penis, and can occur anywhere along the length of the penis.
Other symptoms that often accompany the formation of plaque are:

  • Penile curvature

  • Lumps in penis

  • Painful erections

  • Soft erections

  • Difficult penetration during sexual intercourse

 

It is advised to seek expert medical consultation in case any of these symptoms are noticed.


What causes Peyronie's disease?

There are several causes attributed to the development of Peyronie’s disease in men, including trauma to the penis (from aggressive sexual intercourse, sports injury, accidents, etc).
However, there are cases where the exact cause of acquiring this disease is not yet known.  


How is Peyronie's disease diagnosed?

The ideal way to diagnose Peyronie’s disease is a physical examination by an experienced physician. This allows determining the location and size of the plaque on the penis.
In addition, imaging tests such as x-ray or ultrasound imaging are also advised to get a better view of the plaque and also check for signs of calcification.  


How is Peyronie's disease treated?

In a few cases, Peyronie’s disease goes away on its own and does not require any treatment. Initially, non-surgical treatment methods are used for treating the symptoms for the first 12 months.

These are the treatment methods for Peyronie’s disease:

Oral medications
These include mainly Vitamin E, potassium amino-benzoate, anti-estrogen medications and anti-inflammatory drugs.

Penile injections
Injections to the plaque may be advised by the physician in case the oral medications fail to address the problem. This is a minimally invasive treatment method which is usually performed under local anesthesia to the penis. It acts as an attractive alternative to surgical treatment for Peyronie’s disease.

Other treatments
There are several other treatment methods also under use in some parts of the world for treatment of Peyronie’s disease, such as high-powered focused ultrasound therapy, shock-wave treatment, radiation therapy, topical treatments, hyperthermia, etc.

Surgical Treatment
In case the penile curvature is severe and affects the sex life and urination process, the physician might suggest surgical correction in case other (non-surgical) treatment methods fail to address the problem. These are the three main types of surgical treatments used for Peyronie’s disease:

Shortening the penile length
In this, the surgeon will shorten the side of the penis from opposite the formation of the plaque. This is a considerably safe surgical treatment and incurs less bleeding and risk of erective dysfunction.  

Lengthening the penis
This surgery aims to cut the plaque to release the tension which is causing the curvature. The physician may also decide to remove the plaque completely. After this, the space in the tunica chamber will be filled with a tissue graft, either from the patient’s body (autologous grafts), artificially harvested grafts and synthetic graft alternatives.

Penile implants
This surgery aims to implant artificial inflatable penile pump or a malleable silicone rod inside the corpora to treat moderate to severe erectile dysfunction. 


What can be expected after surgery for Peyronie's disease? 

A light pressure dressing is typically left on the penis for 24 to 72 hours after the surgery to prevent bleeding and hold the repair in place. In some cases, patients will wake up with a catheter in the bladder but this is usually removed in the recovery room.

In most cases surgeons recommend not engaging in sexual activity for at least 4-6 weeks after surgery, longer in some cases of complex repairs. 

 

Frequently asked questions: 

What happens at the molecular level following penile trauma?

Following any penile trauma, injured cells release a veritable stew of chemical messengers that have a number of important effects, including the activation of fibroblasts, cells that produce connective tissue. Normally these cells produce organized collagen sheets that restore the normal architecture of the penis. Some fibroblasts transform into cells called myofibroblasts, cells that not only produce collagen but also contract to help bring wound edges together. Myofibroblasts are designed to do their job and then die off. However, in some cases, fibroblasts produce abnormal, disorganized collagen and myofibroblasts do not die, leading to persistent wound contraction and inflammation. These two processes lead to overgrowth of dense scar tissue, which in some cases becomes the plaque of Peyronie's disease. 


Are men with Peyronie's disease prone to any other conditions? 

About 30 percent of men with Peyronie's disease develop fibrosis in other areas of the body. The most common sites are the hands and feet. Dupuytren's contracture is a condition classically associated with Peyronie's disease in which fibrosis occurs in the tissue of the palm. Dupuytren's contracture may lead to progressive permanent bending of the fingers. While the fibrotic process in Peyronie's disease and Dupuytren's contracture is similar, it is not clear at this time what causes either plaque to develop and why men with Peyronie's disease are more likely to develop Dupuytren's contracture. 


What are the most important things to know about Peyronie's disease?

Peyronie's disease is a poorly understood urological condition characterized by penile deformity and pain. Treatment for this condition needs to be individualized to each patient based on the timing and severity of the disease. The objective of any treatment should be to reduce pain, normalize penile anatomy so that intercourse is comfortable, and restore erectile function in patients who suffer from concomitant erectile dysfunction. The early phase of the disease is treated with either oral medications and/or plaque injections approaches. Traction therapy is emerging as a potential valuable non-surgical treatment. The late phase of the disease is usually managed with surgery if penile deformity is preventing a man from enjoying sex. As medical researchers continue to develop basic and clinical research for a better understanding of this disease, more therapies and targets for intervention will become available.

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