While rare and not always painful, Peyronie's disease tends to cause most patients plenty of mental anguish. The good news? This is a treatable condition.
Below, Dr. Michael J. Curran discusses Peyronie's disease, including symptoms and treatments.
Bottom line: If you or someone you love suspects Peyronie's disease, don't wait: make an appointment with your doctor. If you're in the greater Boston area, consider using one of our urologists.
What is Peyronie's Disease?
DR. CURRAN: Peyronie's disease is the development of scar tissue along the tunica albuginea, which is the fiber sheath that surrounds the erectile tissue of the male penis. For reasons sometimes known, sometimes unknown, scar tissues (called plaque) can develop in this tissue. It can occur due to injurious sexual activity, injurious non-sexual activity, or normal sexual activity without injury.
As the scar tissue develops, it creates a rigid area of this tissue that should be elastic. The consequence of developing significant scar tissue along the tunica is that it can cause the penis during an erection to bend and curve to a degree that either makes erection difficult or sexual activity difficult.
The scar tissue development isn't always painful, but many, many times, it will affect a patient's whole view of himself, and, as such, it significantly affects the quality of life.
How old are most patients?
DR. CURRAN: There appears to be no real age peaks of this disease. We have certainly seen it in men in their 20s and 30s. We've also seen it in men in their 70s and 80s. The incidence of the disease is probably going to be a little bit higher as men get older because some of the causes and factors are just specific to repetitive sexual activity and obviously as people age, the number of sexual encounters that the patient has will increase over time. It tends to occur more in older patients, but we do see young patients with this problem as well.
For the younger patient, it tends to be more psychologically devastating. Younger patients often avoid seeking treatment because they don't have a regular doctor or they simply don't have the information that what they have is a correctable problem.
For many men, the biggest problem they have with Peyronie's disease is they're either embarrassed or afraid that they have this condition in the first place and don't know where to get help. The good news is that there's definitely help available for these men.
What treatments are available?
DR. CURRAN: Let's start with the least invasive first, which is counseling. When we have a patient who has come to us in the disease's early stage (i.e. the patient has begun to notice a hard lump on the penis or some curvature to the penis), we can manage these patients by showing them how to perform simple, manual maneuvers to their erect penis. The maneuvers stretch the area where the scar tissue is trying to deposit. Although the patient's penis may develop some curvature, it may not be to the extent that it affects his ability to get an erection or have intercourse.
If we don't have the opportunity to intervene at the very early stages, which is the typical case, the patient usually comes to us feeling a knot or a lump on the shaft of the penis associated with curvature at that point. This is the true definition of Peyronie's disease.
The patient could still try physical therapy maneuvers, but they'll be much less successful at that juncture. At this point, we can consider surgical corrections or medical corrections.
OK, let's start with medical corrections first.
DR. CURRAN: In regards to medical corrections, there's a new drug that many of the Greater Boston Urology doctors are approved in giving called Xiaflex.
We inject Xiaflex into the scar tissue. Xiaflex is a substance called collagenase. Collagenase has the ability, over time, to dissolve some of the collagen deposits in the plaque. We believe in combining a series of these injections with what I term "penis remodeling"—physical therapy that helps to reduce abnormal curvature of the penis.
This treatment usually doesn't completely get rid of the plaque and usually doesn't completely get rid of the curvature, but in many cases, it can restore the patient's penis to a state where he can again comfortably have erections and resume sexual intercourse.
If the patient is unsuccessful with the conservative measures, two surgical corrections are available.
Tell us about the surgical options.
DR. CURRAN: The lesser invasive of the two surgeries is a procedure called penile plication (doctors can use many methods/techniques in regards to plication). Essentially, what we do is acknowledge that the plaque or scar tissue is present and causing the curvature to the penis. We attempt to counterbalance this with a series of sutures and sometimes some small excisions in the tunica on the opposite side of the plaque to correct the bend.
The downside of this procedure is that it does not get rid of the underlying cause of the problem, which is the plaque itself. The upside of the procedure is that there are fewer side effects with this surgery than an excision and grafting procedure. It will straighten the penis and the risk of impotence or losing sensation to the head of the penis is minimized versus the more invasive procedure.
Patients with slight curvature that's not amenable to medical therapies could benefit from this procedure. We also sometimes use it in conjunction with an excision and grafting to give an optimal result for a patient.
The more invasive procedure is a procedure that I've performed myself and prefer to use with my patients with Peyronie's disease because it can correct and cure the problem. This is called an excision and grafting. In the operating room, we expose the area of the scar tissue and literally remove that scar tissue and the damaged tunica from the patient's penis. Obviously, this will leave a defect that needs to be filled. There are new tissue-engineering technologies that have allowed us to successfully use tissue-engineered pericardium to be placed as a graft over the removal of the diseased tunicas. We've been doing this procedure at Greater Boston Urology for many years now. We have a series of patients and our satisfaction rate is over 90%.
The excision and grafting works very well because it not only corrects the curvature, but it also removes the diseased tissue that is the root of the problem.
The downside of the grafting technique is that it is more invasive. We do keep the patients in the hospital for a one-night stay. The patients do run the risk of potential nerve injury to the penis. In my experience, I have not had this problem with my patients personally, but there is a risk of having numbness to the tip of the penis, which can affect orgasm and sexual function down the road.
At GBU, we understand the potential risk and we take every measure to avoid that. In doing so, we use microsurgical techniques to identify the nerves to the head of the penis and isolate them from the surgical fields so that in excising the graft, we do not injure these nerves. That's a very technical aspect of the surgery. Because of this aspect, surgeons who have wide experience in doing this operation are hard to find. However, at Greater Boston Urology and in my practice, we can certainly offer this option to patients and have done so successfully many times in the past.
After the surgery, our goal is to restore a patient's ability to both get an erection and have sexual function to the point where they can have intercourse to the point of orgasm without pain, without discomfort, and without causing their partner any discomfort. Many men aren't necessarily bothered by the curvature, but it's causing their significant other to have discomfort with intercourse due to the abnormal curvature.
If you do surgical interventions, can the plaque come back? Can they develop this problem again?
DR. CURRAN: The plaque can always come back with surgical interventions. We usually wait until the patient has stability of the scar tissue for over one year because then we believe the acute inflammatory process has stopped. At that point, the chance of recurrence, especially with excision and grafting, is much, much less. If the patient is going to have a plication procedure and we've seen stability of the degree of curvature, we would not expect that curvature to get much worse in the future.
Are there any oral medications that can treat this disease?
DR. CURRAN: At this time, there are no oral medications that have ever been proven to counteract Peyronie's disease. In the initial phases of the disease, we often encourage patients to try basic anti-inflammatories, such as ibuprofen or sometimes even vitamin E, although in full disclosure, neither has ever been shown in clinical studies to significantly affect the progression of the disease.
Do you suffer from Peyronie's disease? Schedule a consult with one of our urologists.