What is Peyronie’s disease?
Peyronie’s disease is a condition of the penis where it becomes bent at an angle. It is quite common, affecting 3% – or nearly one in twenty men over the age of 50 years old. Fibrous tissue – similar to scar tissue – is deposited in the penis which causes it to bend, particularly when erect. It is also associated with erectile dysfunction – an inability to get an erection that is hard enough for intercourse.
What are the Symptoms of Peyronie’s disease?
There are two distinct “phases” of Peyronie’s disease – these are called the Acute Phase and the Chronic Phase.
The Acute Phase
During the acute phase there is a progressive curvature of the penis on erection. Sometimes there is also pain as the penis becomes erect. Patients sometimes notice a thickening of the tissue under the skin of the penis. This is the development of the plaque and it can be painful when touched. The Acute Phase lasts somewhere between six and twelve months and during this phase the penis becomes progressively more bent, particularly during erection. Once the curvature has stabilised, the Chronic Phase sets in.
The Chronic Phase
The chronic phase is characterised by a stable penile deformity on erection which can cause the penis to bend upwards, downwards or to the side. More complex deformities include an ‘hour glass’ or waist deformity where the penis has a concave in-drawing like an egg timer or hour glass. This can cause buckling or bending of the penis during intercourse.
It is only during the chronic phase of the disease that surgical treatment is performed.
What are the Causes of Peyronie’s disease
The cause of Peyronie’s disease is still not fully understood. There are a number of theories though and the most accepted one is that during intercourse the small blood vessels of the penis can tear and bleed in the tissue of the penis. As this heals too much scar tissue is deposited and the fibrous plaque develops as a result.
There are various “risk factors for the development of Peyronie’s disease and these include:
- High blood pressure
- Certain medicines such as beta-blockers
Can Peyronie’s disease be treated?
A lot of men with the condition are understandably embarrassed to seek advice and treatment, but they really needn’t be. On the contrary, leaving it untreated can have a serious impact on your own feelings of self-worth as well as harming your relationships. The good news is that in almost all cases treatments are available which will help with the condition – and it doesn’t always require an operation.
Why should I see a specialist?
Peyronie’s disease is a condition that really requires a specialist to treat it. Although many urologists can offer treatment, for the best results using the most modern techniques and procedures it is important that you see a surgeon who treats this condition regularly.
I am proud to say that over the years I have helped my hundreds of men with Peyronie’s disease.
What treatments are available for Peyronie’s disease?
The treatment for Peyronie’s disease may be divided into two groups: medical treatment and surgical treatment. Although the bend in the penis may look very severe, the treatment options for this condition do not always have to involve surgery. Less severe curvatures often do not require treatment at all, or may be treated with injections in the area of the bend. More severe curvatures can be straightened by undergoing penile surgery to either remove a small amount of tissue form the opposite side to the bend or by using a graft to lengthen the side with the curvature.
Medical Treatment of Peyronie’s Disease
There have been a number of medical treatments which have been tried over the years for Peyronie’s Disease. These are generally given during the “Acute Phase” of the disease when surgical treatment is not an option. The common types of medication which have been used are anti-oxidants such as vitamin E or potassium aminobenzoate. However the benefit of these medicines is still unclear as there have been very few good clinical trials which have assessed the response. Alternative treatments include injecting the fibrous plaque with calcium channel blockers or steroids or more recently collagenase (Xiapex ®).
Recently there have become available a number of oral treatments that can be used to treat men during the acute phase of the disease, the idea being to limit the pain and curvature stabilise the disease more quickly.
In the acute phase I often recommend a series of injections with collagenase (Xiapex). This acts by helping to dissolve the scar in the penis that is causing the bend and can be effective, especially if used also with a vacuum device to help straighten the penis.
For less severe curvatures this option avoids the need for surgery and can be performed as a daycase procedure – there is no need for you to stay in the hospital overnight.
Surgical Treatment of Peyronie’s disease
Surgery is still the preferred option to manage the penile curvature when it is severe and prevents penetration, because it provides the best results. The aim of the operation is to correct the bend in the penis and maintain the ability to achieve an erection. There are two main operations that I perform, the Nesbit Procedure and the plaque incision and grafting procedure.
The Nesbit Procedure
The Nesbit procedure involves removing an ellipse of tissue from the convex (bulging) side of the penis. The aim is to shorten the convex side slightly and so ultimately straighten the penis. Clearly this means the penis after the operation is slightly shorter but most patients are generally still satisfied with the outcome of the surgery and can return to a full sex life with their partners.
What to expect after surgery
You will need to stay in hospital overnight and may require a catheter to allow you to pass urine. There is often some bruising and swelling for a few days but this settles fairly quickly. The incision is just below the end of the penis (the “glans”). I almost always use dissolvable stitches which helps with your comfort after the operation. You should avoid soaking the wound in a bath for the first week but after that a shower is fine with gentle drying of the wound afterwards. I advise avoiding sexual activity for 6 weeks after the operation to allow everything to heal properly. Occasionally I will give you a prescription for a medicine called a PDE-5 inhibitor for two weeks after surgery.
Plaque Incision and Grafting (Lue Procedure)
This procedure was developed in order to reduce the degree of penile shortening. The operation involves incising the Peyronie’s plaque and then filling the resulting defect with a graft. Various graft materials can be used – these have included using the saphenous vein from the leg as well as synthetic materials. This procedure is not suitable for all patients with Peyronie’s disease as there is a higher risk of erectile dysfunction, particularly if there are underlying risk factors for erectile dysfunction already present. It is mainly used for patients with very severe penile curvatures or those which are associated with a waist or hour-glass deformity.
What to expect after surgery
Patients are hospitalised overnight and may require a catheter. There is likely to be bruising and swelling for a few days. The incision is just below the glans penis and the sutures are dissolvable. Patients should avoid soaking the wound in a bath for the first week but they can shower and keep the wound dry after showering. We advise no sexual activity for 6 weeks. Patients may also be commenced on a PDE-5 inhibitors following the operation after 2 weeks. Vacuum therapy to encourage penile stretching is recommended before and after surgery in order to maintain penile length and stretch the graft.
In patients with very extensive Peyronie’s disease and erectile dysfunction, the option of a penile prosthesis addresses both problems. The use of an inflatable penile prosthesis gradually corrects the deformity over a period of months as the prosthesis is used.
What to expect after surgery
Patients are admitted overnight with a catheter and drain and the implant is partially inflated. The catheter and drain is removed the following day and the implant is deflated. There may be bruising in the scrotum after the procedure. Patients should avoid soaking the wound in a bath for the first week but they can shower and keep the wound dry after showering. The device is checked after 2 weeks and the pump can be used to inflate and deflate the device (cycling) however sexual activity can only resume after 6 weeks.
Why see a specialist
Mr Muneer is an expert in managing Peyronie’s Disease both medically and surgically. As he performs the surgical procedures on a regular basis, patients can expect a thorough assessment before the procedure and advise on the best procedure to be undertaken. Most men can be helped overcome this problem without the fear of embarrassment and have the confidence that they are seeing an expert to deal with Peyronie’s disease.
A 57 year old banker had developed a penile curvature which was preventing sexual intercourse. Having lived with it for 2 years he underwent a consultation and assessment. The curvature was so severe that it was almost touching his abdomen. He underwent a penile Doppler scan to check the blood flow to the penis and opted for a plaque incision and grafting procedure. Following the procedure the penis was straight and he was able to resume intercourse with good erections.