Peyronie's Disease
Peyronie's Disease is a benign condition of the penis characterized by curvature of the penile shaft. It is most frequently seen in men aged 40 to 70. It is often associated with a painful erections and erectile dysfunction. It is caused by the development of scar tissue within the penile shaft.
This scar tissue prevents the normal expansion of the elastic tissue inside the penis resulting in curvature. The tension on the scar tissue during expansion can result in pain and also an irregular filling of penis with blood during the erectile process.
The cause of Peyronie's Disease is unclear. In the past, it has been associated with vitamin E deficiency, use of beta-blocker drugs such as metoprolol, and elevated serotonin levels. More recently, it has been theorized to result from minor vascular trauma or injury to the penis. The injury causes release of molecules that produce collagen, a protein that forms the scar also known as the Peyronie plaque.
Several symptoms are common in Peyronie's Disease. Symptoms include penile pain, which is more pronounced during erection; penile angulation, which may be present only during erection; a palpable plaque at the site of angulation; and decreased erectile fuction.
Radiologic studies may be used in Peyronie's Disease to identify calcification of the plaque, which indicates that the plaque is mature and angulation is complete. Simple x-ray of the penis may be used to identify calcification. Penile ultrasound may also be used to delineate the extent of the plaque.
The natural history of the disease is variable. In some men the process is reversible. In others, progression may occur over several years. If the fibrotic plaque becomes calcified, the penile angulation becomes permanent and spontaneous is unlikely.
In treatment of Peyronie's Disease, medical therapy is the first line option. Oral vitamin E has been show to reduce pain in patients with Peyronie's, though it does not reduce penile curvature in most patients. Oral potassium aminobenzoate has been used extensively with very minimal results and many patients find the adverse gastrointestinal side effects to be intolerable. The anti-inflammatory agent colchicine reduces collagen formation and has been shown to decrease plaque size and curvature; however, it too is associated with gastrointestinal side effects.
Combination therapy with oral medication and intrapenile injection has also been effective. Injection of prostaglandin E1 into the penis helps to reduce pain, curvature, and plaque size. Intralesional injection with the steroid dexamethasone has been shown to reduce pain and plaque size, especially in men with small lesions. More recently, intralesional injection with verapamil, a calcium channel blocker also used in the treatment of hypertension, has been effective in reducing pain, plaque size, and penile curvature, and in improving erectile function.
Another treatment approach has been to use electromotive drug administration in combination with topical preparations of drugs such as dexamethasone, lidocaine, and verapamil. An electrical current is pulsed through the topically applied drugs.
When medical therapies fail, and the sexual side effects of Peyronie's Disease become debilitating, surgery may be indicated. Surgery may involve incision or excision of the plaque. It is important to note that surgery may be complicated by loss of penile length or loss of penile sensation. At the time of surgery to correct the Peyronie's plaque, some men may opt to have a penile prosthesis as well to correct any associated erectile dysfunction.
