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List of All Topics
Peyronie's Disease
Introduction
Peyronie's (pa-ro-NEEZ) disease causes a bent penis during erection. A hard, fibrous layer of scar tissue (plaque) 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 soft tissue in the penis is noncancerous (benign). The condition can cause pain and make sexual intercourse difficult.
Sometimes Peyronie's disease improves without treatment, so your doctor may initially recommend a wait-and-see approach. Treatments of Peyronie's disease involve nonsurgical and surgical approaches.
Signs and symptoms
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.
- A thick band of hard tissue on one or more sides of your penis.
- Indentation, or an "hourglass-shaped" penis during erection.
- Impaired ability to obtain an erection (erectile dysfunction, or ED).
- Shrinking or shortening of your penis.
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.
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 may cause small tears in the tissue, and small blood vessels in the penis can rupture and bleed internally. Penile injuries can be caused by vigorous sexual intercourse or an accident. 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.
- Inherited collagen abnormality. Peyronie's disease may be caused by an inherited abnormality in the genes that regulate the growth fibrous connective tissue proteins (collagen).
- Medications. Some drugs may cause 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 stopping or changing any prescribed drug.
Treatment
Because the course of Peyronie's disease differs from man to man and some men experience improvement without treatment, doctors often initially recommend a wait-and-see approach. Your doctor may suggest monitoring the progression of the disease for nine to 12 months by assessing plaque formation, penile curvature and erectile function before attempting treatment. Some treatments — nonsurgical and surgical — can increase a man's risk of ED.
Oral medications
If Peyronie's disease doesn't improve on its own, your doctor may suggest trying an oral medication. This treatment appears to be effective only for the first 12 to 18 months when plaque is still forming. Oral treatments for Peyronie's include:
- Colchicine. This medication inhibits growth of collagen and may improve symptoms of Peyronie's disease. However, common side effects include digestive problems and diarrhea.
- Potassium aminobenzoate (Potaba). Taken orally, this prescription medication may help treat Peyronie's disease. However, like vitamin E, more research is needed to determine the medication's effectiveness. The medication is expensive, requiring taking up to 24 tablets daily, and side effects include digestive problems.
- Vitamin E. Researchers have reported that vitamin E may improve Peyronie's disease when taken orally, although more controlled studies are needed to verify the effectiveness of vitamin E therapy. Talk to your doctor before taking vitamin E, as it may not be safe in high doses.
Your doctor can inject drugs such as collagenase, calcium channel blockers (such as verapamil) or interferons directly into the plaque in your penis. These drugs are intended to break down scar tissue deposits and return the tissue-building process to normal. You'll receive multiple injections over a period of months. The success of intralesional injections varies, and more studies are needed to find out which treatments are most effective.
Surgery
If other methods of treatment don't help and your penis is still curved or bent when erect, surgery may be an option. Doctors usually suggest surgery when unacceptable appearance, pain during intercourse and poor erection quality persist for at least a year. Surgery is generally effective at restoring normal erections, although each surgical method can cause unwelcome side effects such as partial loss of erection or shortening of an erect penis.
Common surgical methods include:
- Nesbit plication. Tissue on the unaffected side of the penis is shortened, canceling the bending effect. This type of surgery can shorten the penis. It is generally used in men who have adequate penis length and a curve of less than 45 degrees.
- 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. This procedure is generally used in men who have a shorter penis, a curve of more than 45 degrees or an hourglass-shaped deformity.
- Penile prosthesis. An implanted device is used to straighten and increase the rigidity of the penis. This type of surgery is for men who have trouble maintaining an erection (erectile dysfunction).
There's no known prevention for Peyronie's disease. It's possible that the problem may begin with trauma to the penis from being hit or bent abnormally when erect or during sexual intercourse. Avoiding injury to your penis when erect may prevent the development of Peyronie's disease. However, trauma to the penis doesn't explain all cases of the disorder.
Information obtained from National Institute of Health