Peyronie's Disease

Definition

Peyronie’s disease indicates the presence of scar tissue in the fibrous wall of the corpora cavernosa- the paired cylindrical chambers that fill with blood at the time of erection. When scar occurs, the site of scar fails to expand in length or girth at the time of erection. If the scar develops around the entire penis, a circumferential constriction is noted with erections (i.e. hour glass deformity). However, more commonly the scar is located on either side or the “top” (dorsal) area of the penis. In this situation, the lack of elasticity of the scar causes a curvature of the erect penis that can progress and result in inability to achieve vaginal penetration. The presence of a Peyronie’s plaque (scar) is sometimes painful, and with extension of the scar tissue into the erectile bodies it can lead to impotence.

Cause of Peyronie’s Disease

The cause of Peyronie’s disease cannot be determined in all cases. The condition is associated in some cases with previous penile trauma which may include fracture of the erectile bodies during intercourse. Occasionally, the disease is thought to be familial.

Top

Evaluation and Diagnosis

The evaluation includes careful history regarding the onset of painful erections or deformity, prior episodes of penile injury or surgery, quality (rigidity) of erections, and impact upon sexual activity for the patient and his partner. The degree of curvature can be assessed with digital photos of the erect penis from the side and from above. Occasionally, injection of the erectile bodies with medication causing erection can be performed in the office so that the urologist can measure the angle of curvature.

Top

Treatments Available

Treatment is based upon severity of the condition. While pain is common in the early stages of disease, discomfort during erection resolves in the majority of men. In cases of curvature that is less than 30 degrees, no treatment may be needed.

Non-operative therapies have been used with some success. Vitamin E has provided stabilization of the scar with occasional regression of scar tissue. Colchicine, an anti-arthritis (anti-inflammatory) medication has been used with reported response. Scar injection with verapamil, a calcium channel blocker or interferon alpha 2B has also been reported to stop progression of the scar tissue with some reversal. Delivery of medication through the skin rather than injection can be obtained by use of an electric field to promote absorption at the site of the scar, a method known as “iontophoresis”. Use of a vacuum erection device with one or more of these therapies has also been used to promote straightening of the erect penis. Unfortunately, response to any of these therapies is unpredictable.

Operative treatments are reserved for severe (greater than 30 degrees) curvature.
In cases of moderate angulation, a Nesbit procedure is performed. This entails plication or pleating of the erectile body on the side opposite the Peyronie’s plaque, thus shortening but at the same time straightening the penis during erection. The loss of length during erection may be unacceptable to some patients.

Removal or incision of the scar tissue combined with placement of a biologic graft material offers another approach that spares the shortening which occurs with the Nesbit procedure.

In men with decreasing erectile function (decreased rigidity) these reconstructive procedures may ultimately fail. When erectile failure is imminent, insertion of an inflatable penile prosthesis provides treatment of impotence and, with incision and molding of the Peyronie’s plaque, straightening of the penis.

Top

The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.