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Peyronie's Disease

Peyronie’s disease is a curvature to the penis due to the presence of scar tissue.  The exact reason why a curve to the penis began is often difficult to determine.  Some patients will report the curve after a rough sexual event.  Other patients find that it starts after beginning injection of medication in the penis for erectile dysfunction.  A genetic component is also possible especially in combination with Dupuytren’s contracture of the hand.  In most cases of penis curvature, scar tissue does not let the penis enlarge with erection.  This might stop the ability for sex to happen.

How many men have this problem?

The number of men presenting with symptomatic Peyronie’s disease is about 1%, but many experts feel the full number of men with a curve to the penis is likely closer to 5%.  Fortunately, most men do not have pain or trouble with sex because of the curve.

Will it get worse?

Most cases of Peyronie’s disease have an early time when pain is present with erection.  This then stops and the curve stays stable.  Nearly 33% of men may never have pain.  In general, most patients see the penis curve stay stable or improve after the pain goes away.

Many men have trouble with erections (erectile dysfunction) with the penis curving.  It is important to treat both problems for the best success.  Treatments for Peyronie’s disease are now often successful in reducing the curve and permitting sexual activity.
 

Peyronie’s disease is an abnormal scar tissue formation on the portion of the penis that should stretch with an erection.  This scar tissue forms on the tunica albuginea of the corpus cavernosum.  This scar will not stretch when a patient does get an erection, but the remainder of the cavernosum does stretch.  

There are a number of causes for this abnormal scar tissue to form.  Causes include:

  1. Buckling trauma to the penis- this can be during sex and is not always painful enough to stop sexual activity
  2. Non-sexual trauma to the penis
  3. Urethral instrumentation including transurethral surgery
  4. Post-prostatectomy
  5. Genetic/Hereditary causes
  6. Associated with Dupuytren’s contracture
  7. Possibly medication related
  8. Spontaneous without a clear cause
 

The scar tissue formation can lead to multiple problems.  There are times when the scar tissue will not cause pain or curvature.

  1. Curvature with an erection
    • Most common curvature is dorsal, up toward the belly button
    • Lateral curvature
    • Ventral curvature, such as downward curvature
  2. Hourglass narrowing of the penis
  3. Pain in the penis, particularly with an erection
  4. Pain for a partner during sexual activity
  5. Weaker erections
  6. Cosmetic bother

 

There are two phases of Peyronie’s disease.  The acute or early phase is typically associated with pain when patients have an erection.  During this phase, the curvature may continue to worsen, or even improve in a small number of patients.  The second phase is a chronic phase.  During this phase, there is not a change in curvature or pain.  It may take up to 12-18 months to reach the chronic phase.    

Work-up of a patient with Peyronie’s disease needs to focus on multiple issues.  It is important to assess the erectile strength/risk of erectile dysfunction, bother created by the Peyronie’s plaque and curvature present.  Bringing a picture to the office of an erection at home can help in determining the best course of action.  Having the pictures from above the penis and to the side of the penis is most useful.  At times it is useful to perform an in-office assessment of the erection, typically done with a medication to cause an erection.  This is at times combined with a penile doppler ultrasound to evaluate blood flow more formally.  Occasionally imaging is performed with ultrasound or plain x-ray to evaluate for calcification of the scar.  

Thankfully there are treatments to assist the patient bothered by Peyronie’s disease.  Some treatments do not have sufficient success in research studies but may still be tried to improve the discomfort or curvature.  

Stretch therapy:

  • Traction therapy with a stretching device
  • Vacuum erection device

Oral medications:

  • Vitamin E
  • Pentoxifylline
  • Colchicine
  • Potaba (potassium aminobenzoate)
  • Terfenadine
  • Acetyl-l-carnitine
  • Viagra, Cialis, Levitra, Stendra, Staxyn

Topical therapies:

  • Verapamil cream
  • Steroid cream
  • Aminopropionitrile

Intralesional therapy (injection therapy into the scar tissue):

  • Verapamil injections
  • Interferon
  • Collagenase (Xiaflex)- the only FDA approved therapy for Peyronie’s disease
    • performed as 2 injections performed over 24-72 hrs typically as one cycle
    • 2 weeks then of no sexual activity following each injection
    • The injections are repeated every 6 weeks

Surgical therapy:

  • Penile plication
    • May cause shortening of the penis
    • Less effect to weaken erections
  • Excision of the penile plaque with grafting
    • Increased risks of erectile dysfunction and numbness of the penis
    • In some cases, possibility to regain some lost length caused by the scar tissue
  • Penile prosthesis
    • Improves both erections/erectile dysfunction and Peyronie’s disease

For more information:

http://www.urologyhealth.org/urologic-conditions/peyronies-disease

http://www.sexhealthmatters.org/peyronies-disease


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Post Op: Peyronie's Disease

Home Care after Peyronie's repair

Follow these guidelines for your care after your surgery to help your recovery.

Activity

      • Limit your activity for the first 5 days after surgery to light activity.

      • You may return to work in a day or so.

      • Limit lifting, pushing or pulling to less than 20 pounds for the next 2 weeks. Also limit running and long walks. 

Swelling

Scrotal and penile swelling from the surgery may take weeks to get better. You should call your doctor if the swelling is severe and the scrotum is larger than an orange.

      • Use ice packs to the scrotum and penis for 15 minutes every hour for the first 48 hours when you are awake to limit swelling. Use a plastic bag with ice or a bag of frozen peas for the ice pack. Wrap a cloth or towel around the ice pack so the ice does not directly touch your skin.

      • Wear a jock strap or tight underwear for the next week to support your scrotum and reduce swelling. 

Incision care

      • Stitches will dissolve and do not need to be removed.

      • Expect a small amount of blood may stain the dressings for up to 72 hours after surgery.

      • For the first few days, apply two or three gauze pads to the site each day and as needed to keep the dressing dry. This will protect the incision and help keep your clothes clean.

      • When you are no longer having any drainage, stop using the gauze pads over the site. 

Bathing or showering

      • You may shower 48 to 72 hours after surgery. Allow the water to wash over the incision but do not scrub the incision. Dry the site gently by patting it with a clean towel.

      • Tub baths should be avoided for 14 days after surgery.

      • Sitz baths can be used 10 days after surgery to help reduce swelling.

      • Swimming or hot tubs should be avoided for 21 days after surgery. 

Pain control

You will likely be sent home with a prescription for a few days of pain medicine. Use this only as needed. After 48 hours, most patients can take extra strength Tylenol (acetaminophen) or Advil (ibuprofen) for pain, following the label directions. Pain most often is eased after 5 to 7 days.

Sexual activity

None for 4-5 weeks.

Follow up

You will need to schedule a follow up visit 6 weeks after surgery.

When to call your doctor

Call your surgeon’s office at 614-788-2870 right away if you have:

      • Severe swelling, larger than the size of an orange

      • A large amount of fluid drainage that soaks several pads per day

      • Pain that is not controlled with pain medicine and use of ice packs or worsens after 48 hours

      • Any signs of infection such as: 

      • Increased redness or tenderness around the incision site

      • Pus type drainage from the incision

      • Fever of greater than 101 degrees F 

Also call the office if you have any questions or concerns about your care.

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OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center
500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177
 
 

OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center

500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177