Part II Peyronie’s Disease

What are the signs and symptoms of Peyronie’s disease?

The signs and symptoms of Peyronie’s disease may include:

hard lumps on one or more sides of the penis
pain during sexual intercourse or during an erection
a curve in the penis either with or without an erection
narrowing or shortening of the penis

Symptoms of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear quickly. In many cases, the pain decreases over time, although the curve in the penis may remain. In milder cases, symptoms may go away without causing a permanent curve.

What are the complications of Peyronie’s disease?

Complications of Peyronie’s disease may include

the inability to have sexual intercourse

-Anxiety, or stress about sexual abilities or the appearance of the penis
-stress on a relationship with a sexual partner
-problems fathering a child because intercourse is difficult

How is Peyronie’s disease diagnosed?

A urologist diagnoses Peyronie’s disease based on:

  1. a medical and family history
  2. a physical exam
  3. imaging tests

1. Medical and Family History

Taking a medical and family history is one of the first things a urologist may do to help diagnose Peyronie’s disease. He or she will ask the man to provide a medical and family history, which may include the following questions:

What is the man’s ability to have an erection?
What are the problems with sexual intercourse?
When did the symptoms begin?
What is the family medical history?
What medications is the man taking?
What other symptoms is the man experiencing?
What other medical conditions does the man have?

2. Physical Exam

A physical exam may help diagnose Peyronie’s disease. During a physical exam, a urologist usually examines the man’s body, including the penis.

A urologist can usually feel the plaque in the penis with or without an erection. Sometimes the urologist will need to examine the penis during an erection. The urologist will give the man an injectable medication to cause an erection.

3. Imaging Tests

To help pinpoint the location of the plaque buildup inside the penis, a urologist may perform

ultrasound of the penis
an x-ray of the penis

For both tests, a specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. The patient does not need anesthesia.

Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.

X-ray. An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. The man will lie on a table or stand during the x-ray, and the technician may ask the man to change positions for additional pictures.

How is Peyronie’s disease treated?

A urologist may treat Peyronie’s disease with nonsurgical treatments or surgery.

The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronie’s disease often resolves on its own without treatment.

A urologist may recommend changes in a man’s lifestyle to reduce the risk of ED associated with Peyronie’s disease.

Nonsurgical Treatments:

Nonsurgical treatments include medications and medical therapies.

Medications. A urologist may prescribe medications aimed at decreasing a man’s penile curvature, plaque size, and inflammation. A man may take prescribed medications to treat Peyronie’s disease orally––by mouth––or a urologist may inject medications directly into the plaque. Verapamil is one type of topical medication that a man may apply to the skin over the plaque.

Oral medications. Oral medications may include
vitamin E
potassium para-aminobenzoate (Potaba)
tamoxifen
colchicine
acetyl-L-carnitine
pentoxifylline
Injections. Medications injected directly into plaques may include
verapamil
interferon alpha 2b
steroids
collagenase (Xiaflex)

To date, collagenase is the first and only medication specifically approved for Peyronie’s disease.

Medical therapies. A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include:

-high-intensity, focused ultrasound directed at the plaque
-radiation therapy––high-energy rays, such as x-rays, aimed at the plaque
-shockwave therapy––focused, low-intensity electroshock waves directed at the plaque

A urologist may use iontophoresis––painless, low-level electric current that delivers medications through the skin over the plaque––to decrease plaque size and curvature.

A urologist may use mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.
Surgery

A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when symptoms have not improved erections, intercourse, or both are painful
the curve or bend in the penis does not allow the man to have sexual intercourse

Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronie’s disease––such as shortening of the penis. Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms before having surgery because the course of Peyronie’s disease is different in each man.

A urologist may recommend the following surgeries:

grafting. A urologist will cut or remove the plaque and attach a patch of skin, a vein, or material made from animal organs in its place. This procedure may straighten the penis and restore some lost length from Peyronie’s disease. However, some men may experience numbness of the penis and ED after the procedure.

Plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. Plication cannot restore length or girth of the penis and may cause shortening of the penis.
device implantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronie’s disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.

A urologist performs these surgeries in a hospital.

Lifestyle Changes:

A man can make healthy lifestyle changes to reduce the chance of ED associated with Peyronie’s disease by

Lifestyle Changes

A man can make healthy lifestyle changes to reduce the chance of ED associated with Peyronie’s disease by

quitting smoking
reducing alcohol consumption
exercising regularly
avoiding illegal drugs

How can Peyronie’s disease be prevented?

Researchers do not know how to prevent Peyronie’s disease.
Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Peyronie’s disease. quitting smoking
reducing alcohol consumption
exercising regularly
avoiding illegal drugs

How can Peyronie’s disease be prevented?

Researchers do not know how to prevent Peyronie’s disease.
Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Peyronie’s disease.

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