Peyronie's Disease

By Allen A. Farsaii, MD

Peyronies disease is a rare, but not uncommon, disease that involves only the male population. It is the formation of hard plaque in the dorsum shaft of the penis, which causes curvature of the penis during erection, therefore making intercourse difficult and painful and ultimately can cause erectile dysfunction and the inability to have a full erection.
The average age of patients suffering from Peyronies disease is 50 years and older. The cause of this disease is unknown, however conditions sometimes associated with Peyronies disease can include diabetes mellitus, arteriosclerosis and trauma. Repeated trauma during sexual practice over a long period of time that goes unnoticed could cause formation of this hard plaque in the penis and ultimately curvature, which is mostly located in the dorsum of the penis and the back of the penis.
There is an associated hereditary condition of this disease called Dupuytren disease, which is seen in up to 30-40% of victims of Peyronies disease. Prevalence of Peyronies disease is 1%, however, the true number or prevalence is not clear and may be much higher due to the fact that this disease is assigned to the genital area of the man and embarrassment of the patient may prevent him from discussing this issue with the physician until the pain really gets worse.
Painful erection and penile deformity is the hallmark of this condition. In some patients, the disease disappears without any treatment after up to one year, but ultimately pain and curvature brings the patient to their physician to complain and seek treatment.
Shortening of the penis, with or without erectile problems, and notice of plaque (or the hard area) in the dorsum or back of the penis is again the hallmark of the disease. Some patients feel pain when they wake up in the morning and it is clear that they might have had an erection during their sleep. Pain shows itself when they wake up or the pain will wake them up; they then notice the curvature and hard plaque.
Medical treatments have been used, including vitamin E, Potaba, tamoxifen, colchicine, and nonsteroidal anti-inflammatories, but the results are not impressive, and only 20% of cases may get resolved or the disease may disappear by itself. It is often not clear whether the medical treatment worked, or if the disease disappeared spontaneously, based on the duration of the disease. If the disease lasts longer than a year, the possibility of regression is very low.
Verapamil injection in the plaque along with a traction device is somewhat promising, but there is no complete resolution of the disease. However, there are more and more studies going on at the present time for combination therapy (verapamil injection and traction device).
Surgery, the last resort, consists of incision or excision of the plaque with or without graft, and may create some good results if done by an experienced surgeon.
In severe cases, when all other methods fail, the implantation of a penile implant, which is semi-flex or penile implants with incision of plaques, has created excellent results. The curvature and pain disappears, although this patient may have pain after implant for a short period of time, which ultimately disappears.