By Sergey Kravchick, M.D.
Peyronie’s disease (PD) is a curvature of the penis that is usually associated with a palpable area of fibrosis. The curvature is usually obvious when the penis is erect but is occasionally noticeable even when the penis is flaccid.
The penile curvature is often preceded by painful erections and may be associated with erectile disfunctions.
The rate of PD is reported to be 0.39 to 3 percent. However, that is probably an underestimation because of the embarrassment most men feel about having this condition. The etiology of PD is still unclear. More recently, PD has been thought to result from vascular trauma or injury to the penis. The injury may be insignificant or involve only microscopic vessels and tissues.
Presentation and Initial Treatment
Men with PD may present with any combination of the following: penile pain, which is more pronounced during erections; penile angulation; an indentation in the shaft, typically at the site of the plaque (causing an hour-glass deformity in the shaft); decreased erectile function.
If the disease is diagnosed within the first six months of the onset, an attempt of nonsurgical therapy is worthwhile. It can be oral non-steroidal anti-inflammatory medications (pain management), colchicine, pentoxifylline, or potassium aminobenzoate. Even if it is not initially successful, such therapy should be maintained for about six months. If the plaque and/or penile angulation have remained unchanged for six months, the condition can be assumed to be stable and treatment modalities could be considered. Typically, PD lesions become stable at 12 to 18 months after symptom onset.
• Intralesional collagenase clostridium histolyticum in combination with modeling (elongation and stretching of the plaque) when penile curvature is between 30 and 90 degrees. This treatment includes eight injections of 10,000 U over 24 weeks. The adverse events include penile ecchymosis, swelling, pain and corporal rupture.
• Intralesional interferon -2b (potential adverse events: sinusitis, flu-like symptoms, and minor penile swelling).
• Intralesional verapamil (potential adverse events: penile bruising, dizziness, nausea, and pain at the injection site).
• Tunica plication is the most common surgical strategy used to treat PD patients. The most commonly reported curvature improvement post-surgery occurred in more than 90 percent of patients. This surgery is not a treatment for erectile dysfunction (ED) and the most appropriate candidates for plication surgery are patients with intact erectile function or with ED responsive to oral medications, vacuum pump therapy or intracavernosal injections.
• Plaque incision or excision and/or grafting results in curvature correction in the setting of a relatively low risk of serious adverse events. The success rate reported for this surgery is more than 80 percent. The best candidates for this procedure are patients with intact erectile function or ED responsive to oral medications or vacuum pump therapy.
For the patients with erectile dysfunction and Peyronie’s disease, penile prosthesis surgery might be the most appropriate option. Adjunctive intraoperative procedures, such as modeling, plication or incision/grafting, can be performed during this surgery.
Upstate Urology offers these treatment modalities to patients with Peyronie’s disease.
Physician Sergey Kravchick specializes in general urology, endourology, male health: chronic prostatitis/chronic pelvic pain syndrome and testicular pain and practices at Upstate Urology at UHS and Wilson Hospital in Binghamton.