Peyronie's Disease

Peyronie’s disease is a scarring condition beneath the skin of the penis that leads to a curved erection, and can make sexual intercourse difficult and painful
Peyronie's disease
It can also manifest with a lump or indentation in the penis, difficulty getting an erection (ED), penile shortening or deformity. ​Its cause is unclear, but it might be related to minor trauma.


First described by Francois de la Peyronie in 1743, Peyronie’s disease affects up to 10% of men during their lifetime, and is often linked to ‘vascular’ risk factors such as diabetes, high blood pressure and high cholesterol. It is also more common in men with a low testosterone, or those with a history of pelvic surgery including radical prostatectomy for prostate cancer.

A small proportion of patients may improve spontaneously, but the majority either remain stable or progress to a more severe deformity.

Unfortunately no treatment can get rid of the scar tissue, and treatment is aimed at alleviating symptoms, correcting the deformity and restoring sexual function.

Treatment Options: (all available at Wessex Andrology)

Tablet Therapy:

No tablet treatment has been shown to reverse penile curvature, but some medications can be of use in Peyronie’s disease. 

Vitamin E or Pentoxyifylline can improve the inflammatory pain during the acute (inflammatory) phase, which is sually in the first 6 months. 

The use of Potaba®  (Para-amino-benzoate) has been to shown to limit worsening of the curvature, but requires 4 times a day treatment, and it can cause gastro-intestinal side-effects.

Mechanical Therapy:

There is emerging evidence for the benefit of vacuum therapy device exercises, and this involves a daily stretching exercise for 5-10 minutes for 3-4 months. A trial is currently underway to study this in more detail, but initial data suggests that half of men achieve a sustained improvement in penile curvature. 

Surgery:

A significant proportion of men with Peyronie’s disease require surgery to correct their deformity and restore sexual function. Mr Rees performs over 50 procedures a year for Peyronie’s disease.

There are 3 broad types of operations for Peyronie’s disease:
    

  1. Nesbit (or Yachia / Lemberger / Essed plication) – these procedures are aimed at shortening the long (healthy) side of the penis – they are simple, have a low complication rate and high success rate (less than 5% require further treatment). 

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  2. Incision and Grafting (Lue) procedure: this is a procedure is aimed at cutting into the scar tissue to create a gap, and inserting a graft (such as a piece of vein, or bovine collagen) into that gap. It has the potential advantage of causing less penile shortening, but due to the complexity carries a 30% complication rate in the medium term – such as erectile dysfunction recurrent scar tissue etc. 

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  3. Penile prostheses: Where there is a combination of penile curvature and erectile dysfunction, often the best and most durable solution is to insert a penile prosthesis or implant.

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Injection Therapy:

The use of collagenase (Xiapex) has recently been shown to be effective in reducing the penile curvature related to Peyronie’s disease, and approximately 50% of patients derive benefit. It involves a series of injections  

Into the scarred area of the penis, followed by stretching exercises. 

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