Peyronie’s disease (penile curvature) is one of the important diseases that causes erectile dysfunction. While it is seen in different age groups, it is more common in the middle and older age groups during sexually active periods.
A structural disorder and anatomical defect develops in the penis. It is a disease that is mostly seen with hard palpable plaques in the penile tunica and subsequently curvatures in the penis.
In this article, explanations from A to Z about Peyronie’s disease have been provided primarily in the form of answers to frequently asked questions. The topics in the article are a compilation of curious subjects and questions most commonly asked to us.
What Is Peyronie’s Penile Curvature?
Peyronie’s disease is a penile disease named after the famous French Surgeon who first described it. It is a disease characterized by structural changes occurring in the layer (tunica albuginea) that surrounds the spongy tissue that provides penile erection.
As a result of this structural change, hardening in the sheath surrounding the spongy tissue and shape deformities (penile curvature) in the penis are observed. The calcification that occurs on the sheath can also prevent the penis from becoming erect.
What Are the Causes of Peyronie’s Penile Curvature?
- Microtraumas
The most commonly blamed factor for Peyronie’s Disease is microtraumas applied to the penis. Straining of the penis during sexual intercourse, bending or kinking of the penis at the moment of erection due to an unwanted movement, and vigorous penile movements during intercourse form the basis of these microtraumas.
- Strains due to penile curvatures
Peyronie’s disease can be seen due to strain during intercourse in those with congenital or acquired penile curvature. It also appears after certain positions applied for prolonged and repetitive periods during sexual intercourse.
- Systemic diseases
Among systemic diseases, it is most commonly seen in association with Diabetes Mellitus. In addition, Peyronie’s can also be seen after other systemic diseases (such as hypertension, chronic kidney failure) and medications used for these diseases. Alcohol and smoking are also among other blamed factors.
What Is a Plaque in Penile Curvature Disease?
Small hard areas that form in the penis during Peyronie’s Disease are called Peyronie’s plaques. Since these plaques mostly prevent the penis from stretching and becoming erect, they lead to palpable hardnesses in the penis and consequently cause various symptoms such as loss of erection, shape deformity, shortening of penile length, and penile curvatures.
At What Ages Does Penile Curvature Disease Occur?
The disease is commonly seen in the 40-60 age group, and cases where the disease resolves spontaneously without any treatment have also been reported. On the other hand, it can also be seen at earlier sexually active ages or at later ages.
What Is the Course of Peyronie’s Disease?
From the moment symptoms first appear, the disease is active and progressive for a period of 1 year. During this period, various oral medications are tried in treatment.
It is important to closely monitor and control this 1-year period. Surgical intervention is usually not planned until 1 year has passed since the onset of the disease.
How Is Peyronie’s Disease Diagnosed?
The diagnosis of Peyronie’s disease is made through the patient’s history and physical examination. Necessary laboratory and radiological imaging are requested when needed.
This group of patients presents with the following complaints:
- Palpable hardness in the penis
- Pain in the penis
- Erectile dysfunction
- Shortening of penile length
- Curvature in the penis
- Difficulty during sexual intercourse
- Pain in the penis during sexual intercourse
Through manual examination of the plaques described by the patient:
- Plaque presence
- Plaque number
- Plaque location
- Plaque size is determined.
When needed, penile color Doppler ultrasonography is utilized.
In Which Department Is Curved Penis Treatment Performed?
In all fully equipped health units, physicians in the Andrology department if available, or the Urology department, deal with the treatment of this disease. All types of diagnostic and treatment procedures for Peyronie’s disease are planned at our clinic located in the Ankara Trade Center (ATM) Plaza in the Cukurambar area of Ankara.
How Is Curved Penis Peyronie’s Treatment Performed?
The time since the onset of disease symptoms is very important in determining treatment options. Patient complaints are also taken into consideration. Especially in cases accompanied by pain, more careful treatment aimed at pain reduction is planned.
In the early stages of the disease, treatment is performed with medications, while in more advanced stages, particularly in conditions causing shape deformity in the penis (penile curvature), surgical treatment options come into consideration.
During the first 1-year period since the onset of disease symptoms, the disease is mostly attempted to be controlled with oral medication therapies.
Peyronie’s Medical Treatment and Other Treatment Methods
- Oral medications:
Vitamin E, Colchicine, POTABA, and Nonsteroidal anti-inflammatory drugs are used.
- Medications injected into the Peyronie’s plaque:
The aim with these medications is to dissolve the hardness. Various groups of medications are used for this purpose. There is a considerable amount of scientific literature regarding the medication called Verapamil, and it has been reported that when injected into the plaque, it shows a plaque-dissolving effect in a significant portion of patients.
How Is Peyronie’s Surgery Performed?
- Surgeries aimed at correcting penile curvature:
Many surgical techniques have been described and successfully applied to correct shortening, curvature, or various deformities caused by shape deformity in the penis.
- Penile Prosthesis:
In patients with advanced erectile dysfunction accompanying Peyronie’s, penile prostheses are applied with the aim of both correcting the curvature and providing rigidity.
Is Peyronie’s Surgery Difficult?
It is incomparably easier compared to surgeries involving other vital organs (such as coronary bypass or brain surgeries performed for the heart). However, when penile surgeries are evaluated within themselves, it is one of the significant, specialized, and serious surgeries requiring experience and knowledge.
Risks of Peyronie’s Surgery
While depending on the type of surgery to be performed for Peyronie’s, there is a risk of bleeding and infection in the early period. Erectile problems can occasionally be seen in surgeries where plaque excision is performed and grafting is applied.
Does Peyronie’s Curved Penis Coexist with Erectile Dysfunction?
This disease is seen together with erectile problems, especially in advanced stages and when the curvature is prominent. In addition to penile curvature creating difficulty for sexual intercourse, erectile dysfunction may also accompany it.
Is Happiness Rod (Penile Prosthesis) Surgery Performed in Peyronie’s Disease?
If erectile dysfunction also accompanies Peyronie’s disease, happiness rod surgery (penile prosthesis) can be applied when necessary. However, this does not apply to every patient. It is planned in accordance with your doctor’s recommendation, when needed, and as a last resort.
Is Surgery the Definitive Solution for Penile Curvature?
Curvatures are corrected with surgery. However, there are other treatment methods to be applied before reaching surgery. If no results are obtained after these treatments are applied, then the surgical option comes into consideration.
How Long After Peyronie’s Disease Surgery Can Sexual Intercourse Begin?
Sexual intercourse is permitted on average 4-6 weeks after surgery. However, this period may be extended depending on the condition of the disease.
Does Peyronie’s Disease Resolve on Its Own?
Since the mechanisms of formation of Peyronie’s disease are not definitively known, the course of treatment cannot be precisely predicted in advance. Therefore, there is no clear consensus on how the disease will progress in which patient. In some patients, there is a possibility of spontaneous recovery.
What Difficulties Does Penile Curvature Cause During Sexual Intercourse?
Fundamentally, 3 difficulties are experienced during sexual intercourse due to the disease:
- Erectile dysfunction and consequent inability to have intercourse
- Penile curvature and consequent inability to have sexual intercourse
- Pain during erection and sexual intercourse
Is Peyronie’s Disease Permanent?
No. There are cases that are successfully resolved with treatment. However, due to the long treatment process and permanent penile curvatures seen in some patients, it is mistakenly thought to be a permanent disease.
Which Hospitals in Ankara Perform Peyronie’s Surgery and Treatment?
Peyronie’s surgeries are successfully treated at many public and private healthcare institutions in Ankara.
Is There an Age Limit for Peyronie’s Surgery?
There is no specific age limit for Peyronie’s surgery. It can be applied to all patients of sexually active age. In elderly patients who also have erectile dysfunction, manual dexterity is required if a happiness rod (penile prosthesis) is to be used.
Can Peyronie’s Be Treated with ESWT Shock Waves?
ESWT shock wave has started to be used with increasing frequency in urology in recent years. The aim is to increase new vessel formation and to provide renewal and repair of penile tissue through regeneration.
While there are studies reporting that it is beneficial for Peyronie’s disease, it is an area that requires a larger number of clinical studies.
Does Penile Curvature Progress? Is It a Progressive Disease?
The progressive nature of the disease depends on the individual patient, their constitution, immune system, accompanying systemic diseases and the medications used in their treatment, and the duration of exposure to the disease. Therefore, while it is progressive in some patients, improvement with treatment can be achieved in others.
Does Peyronie’s Cause Hourglass Deformity?
We previously mentioned that penile curvatures can be seen in Peyronie’s disease. Plaques that involve the middle of the penis cause thinning in this area, which can create a shape deformity called “hourglass deformity,” a form of penile curvature.
Does Peyronie’s Disease Cause Penile Shortening?
In Peyronie’s disease with advanced plaque formation, both penile shortening and erectile dysfunction can occur.
Does Peyronie’s Plaque Progressively Increase?
Plaque progression may occur as long as the triggering factor, the initiating factor, persists. Many factors such as the patient’s age, systemic diseases, medications used, and immune system resistance are determining factors. However, the expectation that plaque size will necessarily increase in every patient is unnecessary.
How Is Peyronie’s Plaque Treated?
Plaques are palpable hardnesses in the penis. First, medical treatments are tried. In cases that do not respond, non-surgical solutions are employed. In situations that cannot be managed with these either, plaques are removed surgically.
What Should Be Considered While Using Peyronie’s Medical Treatment Medications?
During the use of medications such as Colchicine and POTABA, attention should be paid to potential toxic effects on the liver, and during the use of nonsteroidal anti-inflammatory drugs, attention should be paid to stomach problems, kidney functions, and bleeding diatheses.
Long-term use must be done under doctor supervision. Patients should never start these group of medication treatments on their own.
What Are the Harmful Effects of Peyronie’s Disease?
Peyronie’s disease generally causes 3 fundamental harms:
- Functional harm:
It creates functional disorders such as inability to have sexual intercourse due to penile curvature, difficulty during sexual intercourse and inability to maintain intercourse, pain during sexual intercourse, and impairment of erection.
- Aesthetic harm:
It causes aesthetic deformities in the penis by forming curvatures at different degrees and angles to the right, left, up, or down, and sometimes occurring at the exact midline of the penis creating an hourglass deformity.
- Psychological harm:
Both aesthetic and functional consequences negatively affect the individual’s psychological state. Sometimes this negative interaction also reflects on the individual’s partner, and negative effects related to Peyronie’s disease arise between partners.
What are the points to PAY ATTENTION to in Peyronie’s disease?
- Early diagnosis and treatment are important.
- Consult a doctor if you have clinical suspicion.
- Keep in mind that the disease can heal but that it will take time.
- If you can identify the triggering or sustaining factor of the disease, distancing yourself from it will help your disease heal in a shorter time.
- Be aware of the effects and side effects of medications your doctor will prescribe, and do not neglect follow-up appointments at the time recommended by your doctor.
- It is important to know the approximate onset time of your disease well. Because not rushing into surgery and waiting approximately one year from this onset time is the generally accepted view for the treatment of this disease.
Conclusion:
- Peyronie’s disease is an important disease that causes pain and curvature in the penis.
- Pain and penile curvatures can be at a level that prevents sexual intercourse.
- Peyronie’s plaques are formed due to structural disorders in the penis.
- Peyronie’s plaques should be considered for palpable hardnesses in the penis.
- It can be treated with medications, non-medication methods, and surgeries.
- New medications injected into the penis require a greater number of relevant clinical studies with different options.
References:
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- Objective Assessments of Peyronie’s Chen JY, Hockenberry MS, Lipshultz LI. Sex Med Rev. 2018 Jul;6(3):438-445.
- Recent surgical advances in Peyronie’s Gaspar S, Santos Dias J, Martins F, Lopes T. Acta Med Port. 2016 Feb;29(2):131-8.
- Nonsurgical management of Peyronie’s Tsambarlis P, Levine LA. Nat Rev Urol. 2019 Mar;16(3):172-186.
- Peyronie’sDisease: Intralesional Therapy and Surgical Intervention. Aliperti LA, Mehta A. Curr Urol Rep. 2016 Sep;17(9):60.
- All about Peyronie’s Hussein AA, Alwaal A, Lue TF. Asian J Urol. 2015 Apr;2(2):70-78.
- A review of the epidemiology and treatment of Peyronie’s Ostrowski KA, Gannon JR, Walsh TJ. Res Rep Urol. 2016 Apr 29;8:61-70.
- Lengthening strategies for Peyronie’sdisease. Gaffney CD, Pagano MJ, Weinberg AC, Small AC, Kuehas FE, Egydio PH, Valenzuela RJ. Transl Androl Urol. 2016 Jun;5(3):351-62.