Peyronie’s disease causes an uncommon sexual dysfunction that results from a bent penis during erection. The disease is characterized by a hard, fibrous layer of scar tissue (plaque) that usually develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of erectile tissue, is noncancerous (benign). Francois de la Peyronie, a French surgeon, first described Peyronie’s disease in 1743.
The signs and symptoms of Peyronie’s disease may appear overnight or develop more slowly. These may include:
- Painful erection
- A bend or curve in your penis during erection
- Inflammation under the skin of your penis that develops into hardened scar tissue
- A thick band of hard tissue on one or more sides of your penis
- Narrowing of the diameter of your penis during erection
- Impaired ability to obtain an erection (erectile dysfunction)
Scar tissue that develops on the top of the penis will cause the penis to bend upward. Plaque on the underside of your penis will cause it to bend downward. More rarely, hardening may occur on both sides of the penis, causing indentation and shortening. In many cases, pain caused by Peyronie’s disease may decrease after a short period of time. However, the curvature may persist even if the pain subsides. In some men with a milder form of the disease, inflammation may improve without causing a lot of pain or permanent bending. Peyronie’s disease can make intercourse painful, difficult or even impossible. Emotional distress can put a strain on your marriage or relationship and make attempts at sexual activity with your partner stressful and frustrating.
What are the Causes
Doctors and researchers don’t completely understand what causes Peyronie’s disease. A number of theories exist, including:
- Injury to the penis. Trauma to the penis from being hit or bent abnormally while erect or during intercourse may cause small tears in the tissue. It may also cause small blood vessels in the penis to rupture and bleed internally. Abnormal healing can result in the development of hard, thickened scar tissue (plaque) under the skin of the penis. With repetitive trauma, the plaque may develop tough fibrous tissue (fibrosis) or calcium deposits (calcification) and result in the deformity.
- Autoimmune disorder. Some studies suggest that Peyronie’s disease may be an autoimmune disorder. A man’s immune system may respond abnormally and cause plaque to form in the penis. However, Peyronie’s disease isn’t related to other autoimmune diseases, such as rheumatoid arthritis or lupus.
- Collagen abnormality. Peyronie’s disease may be caused by an abnormality in the substance that builds and remodels connective tissue (collagen).
- Medications. Some drugs list Peyronie’s disease as a possible side effect. Most of these drugs belong to a class of blood pressure and heart medications called beta blockers. These drugs are also used to treat glaucoma, multiple sclerosis and seizures. Developing Peyronie’s disease as a side effect of these drugs is rare. Check with your doctor before discontinuing any prescribed drug.
Although injury to the penis may explain sudden (acute) cases of Peyronie’s disease, cases that develop slowly or disappear quickly with no apparent trauma to the penis remain unexplained. Age, heredity and other conditions involving hardened tissues may increase your risk.
Hattat Clinic Peyronie’s Disease Screening and diagnosis
Your Hattat Cinic Physician diagnoses Peyronie’s disease by a physical examination. Hard plaque can be felt in your penis with or without an erection. It may be necessary to inject medication into your penis to induce an erection for proper evaluation. Ultrasound of the penis also may reveal fibrous tissue in the penis.
Hattat Clinic Treatment Protocols
For many patients, Peyronie’s disease results in sexual problems because there is difficulty in attaining and/or maintaining erections. Treatment options for Peyronie’s disease include pharmacological interventions, radiation and surgery. They are designed to alleviate the symptoms rather than to cure the disease. A number of surgical techniques have been developed for patients with more severe symptoms and for patients who have been refractory to conservative treatment.
Assessing the course of Peyronie’s disease if your physician may decide shock wave theraphy as your treatment protocol . If these other methods of treatment don’t help and your penis is still curved or bent when erect, surgery may be an option.
Common surgical methods include:
- Plaque excision. The plaque is removed and replaced with a patch of skin from the pubic area.
- Nesbit plication. Tissue on the opposite side of the penis is removed or pinched, canceling the bending effect.
- Plaque incision with saphenous vein graft. Several linear cuts are made in the plaque, which allows straightening. The cut plaque is then covered with a grafted vein.
- Penile prosthesis. An implanted device is used to straighten and increase the rigidity of the penis
ESWT (Extra-corporeal Shock Wave Treatment)
ESWT has gained some popularity in recent years. The procedure involves the use of shockwave lithotripsy technology. Extracorporeal shockwaves are high-pressure, low-frequency sound waves, generated by a device outside the body and applied to the affected tissue in a site-specific manner. In Peyronie’s disease, the penile plaque is the target of the shockwaves, and it is generally localised using an ultrasound scanner. The procedure can be performed with or without sedation. Multiple shock waves are fired at the lumps within the penis, breaking them up. Six treatments are usually given over a period of a few weeks. ESWT seems to be most beneficial to men who have a lot of pain with their erections. From comparative studies, the main benefits of ESWT were the alleviation of pain and reduction of angulation of the penis. Case series evidence also suggested some improvement of sexual performance.
Prof. Dr. Halim Hattat
