Peyronie’s is a non-malignant condition, in which penis is not straight while erect. There is a significant bend upwards, downwards, or to the sides. It can often be painful, particularly in the acute phase. Most men with this condition can have sexual intercourse but somewhat more difficult. Other cases, the penis has such a severe bend that it does not allow normal intercourse.
This condition is more common in middle age adults, but it can happen at any age. It does not resolve on its own and it may even get worse with time. Therefore, early treatment can have better outcome.
Cause and Pathology:
Penis is composed of two sponge like chambers, one on each side. This is called Corpus Cavernosum. It contains blood arteries and veins and it is filled with blood during erection. Corpus cavernosum is wrapped by an elastic tissue called Tunica Albuginea. On top of the Tunica is the skin. Tunica Albuginea’s function is to keep a straight erection when the corpus cavernosum is filled with blood.
Usually a scar under the skin prevents the stretching of the Tunica Albuginea in that particular site, leading to a bend and pain during erection. The scar is called a plaque or Peyronie’s plaque. The scar is usually formed due to a trauma or over stretching of the penis, which is usually not even noticed by patient. It usually happens during sexual relations. Overusing a penile pump or applying too much pressure, thus over stretching the penis during a penile pump session can also be a cause of the trauma.
There has been some suggestion that Peyronie’s may be a genetic problem but there has been no evidence to support this theory. The most accepted theory is the one of trauma.
Signs and Symptoms:
Signs and symptoms of Peyronie’s disease might appear suddenly or develop gradually. The most common signs and symptoms include:
- Palpable Scar tissue. The scar tissue, Peyronie’s plaque, can be felt under the skin of the penis as flat lumps or a band of hard tissue.
- A significant bend to the penis. The penis might curve upward or downward or bend to one side.
- Erection problems. Peyronie’s might cause problems getting or maintaining an erection (erectile dysfunction).
- Shortening of the penis. The penis might become shorter as a result of Peyronie’s disease.
- Pain. Possible penile pain, with or without an erection.
- Other penile deformity. In some men with Peyronie’s disease, the erect penis might have narrowing, indentations or even an hourglass-like appearance, with a tight, narrow band around the shaft. This depends on the severity of the plaque.
The curvature and penile shortening associated with Peyronie’s disease might gradually worsen. At some point, however, the condition typically stabilizes after three to 12 months or so.
Pain during erections usually improves within one to two years, but the scar tissue, penile shortening and curvature often remain.
Treatment:
Traditionally there aren’t many treatment options available for Peyronie’s disease. Many patients are recommended to live with it. Surgery is an option, but the results are not impressive. Therefore, surgery is reserved for severe cases.
Biologic treatment, however, has offered great results for Peyronie’s disease. This is a completely natural and noninvasive procedure. It has no side effects because patient’s own body is used to treat the issue.
First: Ultrasound is used to diagnose the problem and visualize the plaque. This assures us that we are not dealing with any other problems.
Second: Several sessions of Shock wave therapy is done to break up the scar/plaque.
Third: patient’s own platelet rich plasma is injected into the plaque. This will remodel the scar and replace it with more of a normal tissue.
Depending on the severity of the plaque and subsequently the condition, patient may need one treatment or a few sessions to absorb majority or all of the Peyronie’s plaque.