1Peyronie's disease is a disorder in which scar tissue, called a plaque, forms in the penis—the male organ used for urination and sex. The plaque builds up inside the tissues of a thick, elastic membrane called the tunica albuginea. The most common area for the plaque is on the top or bottom of the penis. As the plaque builds up, the penis will curve or bend, which can cause painful erections. Curves in the penis can make sexual intercourse painful, difficult, or impossible. Peyronie's disease begins with inflammation, or swelling, which can become a hard scar.
The plaque that develops in Peyronie's disease is not the same plaque that can develop in a person's arteries. The plaque seen in Peyronie's disease is benign, or noncancerous, and is not a tumor. Peyronie's disease is not contagious or caused by any known transmittable disease.
Early researchers thought Peyronie's disease was a form of impotence, now called erectile dysfunction (ED). ED happens when a man is unable to achieve or keep an erection firm enough for sexual intercourse. Some men with Peyronie's disease may have ED. Usually men with Peyronie's disease are referred to a urologist—a doctor who specializes in sexual and urinary problems.
Medical experts do not know the exact cause of Peyronie's disease. Many believe that Peyronie's disease may be the result of
acute injury to the penis
chronic, or repeated, injury to the penis
autoimmune disease—a disorder in which the body's immune system attacks the body's own cells and organs
The signs and symptoms of Peyronie's disease may include
hard lumps on one or more sides of the penis
pain during sexual intercourse or during an erection
a curve in the penis either with or without an erection
narrowing or shortening of the penis
Symptoms of Peyronie's disease range from mild to severe. Symptoms may develop slowly or appear quickly. In many cases, the pain decreases over time, although the curve in the penis may remain. In milder cases, symptoms may go away without causing a permanent curve.
Cross section of a curved penis during erection
Complications of Peyronie's disease may include
the inability to have sexual intercourse
anxiety, or stress, about sexual abilities or the appearance of the penis
stress on a relationship with a sexual partner
problems fathering a child because intercourse is difficult
A urologist may treat Peyronie's disease with nonsurgical treatments or surgery.
The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronie's disease often resolves on its own without treatment.
A urologist may recommend changes in a man's lifestyle to reduce the risk of ED associated with Peyronie's disease.
Nonsurgical treatments include medications and medical therapies.
Medications. A urologist may prescribe medications aimed at decreasing a man's penile curvature, plaque size, and inflammation. A man may take prescribed medications to treat Peyronie's disease orally—by mouth—or a urologist may inject medications directly into the plaque. Verapamil is one type of topical medication that a man may apply to the skin over the plaque.
Oral medications. Oral medications may include
potassium para-aminobenzoate (Potaba)
Injections. Medications injected directly into plaques may include
interferon alpha 2b
To date, collagenase is the first and only medication specifically approved for Peyronie's disease.
Medical therapies. A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include
high-intensity, focused ultrasound directed at the plaque
radiation therapy—high-energy rays, such as X-rays, aimed at the plaque
shockwave therapy—focused, low-intensity electroshock waves directed at the plaque
A urologist may use iontophoresis—painless, low-level electric current that delivers medications through the skin over the plaque—to decrease plaque size and curvature.
A urologist may use mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.
A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when
symptoms have not improved
erections, intercourse, or both are painful
the curve or bend in the penis does not allow the man to have sexual intercourse
Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronie's disease—such as shortening of the penis. Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms before having surgery because the course of Peyronie's disease is different in each man.
A urologist may recommend the following surgeries:
grafting. A urologist will cut or remove the plaque and attach a patch of skin, a vein, or material made from animal organs in its place. This procedure may straighten the penis and restore some lost length from Peyronie's disease. However, some men may experience numbness of the penis and ED after the procedure.
plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. Plication cannot restore length or girth of the penis and may cause shortening of the penis.
device implantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants maybe considered if a man has both Peyronie's disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.
A urologist performs these surgeries in a hospital.
About This Chapter: Information in this chapter is excerpted from “Peyronie's Disease,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), June 2014.
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