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Peyronie's Disease

In certain conditions a layer of benign fibrous tissue develops under the skin of the penis. When erection occurs, this layer of tissue cannot stretch as well as the normal penile tissue, thus causing the penis to curve. Thiis can can make erection painful and sexual intercourse difficult. This is known as Peyronie's disease.

The side and degree to which the penis curves on erection would depend on the area and extent of the fibrous tissue formation. If the scar tissue forms on the upper side of the penis, on erection the penis will curve upwards. Similarly, if the fibrous tissue is on the lower side, the curvature will be downward. If there is fibrous tissue formation on both sides, the penis will appear irregular or indented on erection.
The signs and symptoms of Peyronie's disease include :
  • Thickened fibrous tissue on one or more sides of the penis
  • Pain during erection
  • Bending ( curving ) of the penis on erection
  • Impaired ability to obtain an erection (erectile dysfunction, or ED)
  • Shrinking or shortening of the penis

Conditions that are thought to cause Peyronie's disease are :
  • Injury to the penis. Injury to the penis can be caused by trauma or even by vigorous sexual intercourse. This injury can lead to tears in the tissue of the penis with small bleeds internally. When this injured tissue heals it forms thickened fibrous tissue. With repeated trauma and healing, this fibrous tissue can become significant.
  • Inherited collagen abnormality. One theory is that Peyronie's disease may be caused by an inherited abnormality in the genes that control the proteins that form connective tissue (collagen).
  • Medications. Peyronie's disease may develop as a possible rare side effect of certain medications like those to treat high blood pressure, glaucoma, multiple sclerosis and seizures. It is not a common side effect and one should always take doctors advice before changing any medication.
  • Autoimmune disorder. Though Peyronie's disease is not known to be related to other autoimmune disorders, some still believe that it may be cause by an autoimmune disorder. This autoimmune dysfunction may cause fibrous tissue to form in the penis.

Diagnosis of this condition is made on physical examination of the penis. In some cases the hard fibrous tissue may be felt without an erection, but in others in may be necessary to induce an erection ( by injecting medication into the penis ) for proper examination. Ultrasound of the penis may also be helpful in diagnosis.

Peyronie's disease can make sexual intercourse painful, difficult or even impossible. This leads to anxiety and stress which can have an effect on the relationship between the two partners. It is important to be aware of this disease and its course so that its symptoms can be managed effectively. The course of this disease varies from man to man and in some cases there may be some resolution of the symptoms without treatment. In mild cases, the doctor may advice monitoring the disease by serial examinations to see the progression of the fibrous tissue formation, penile curvature and erectile function.

Treatment options available are surgical or nonsurgical.
Oral medications
Oral medications may be useful in the early stages of the disease.
  • Colchicine. This works by inhibiting growth of collagen and may improve symptoms of Peyronie's disease. Common side effects include digestive problems and diarrhea.
  • Vitamin E. It has been reported to improve Peyronie's disease but its effectiveness has not been verified. It should not be taken without medical advice.
Intralesional injections
Drugs such as collagenase, calcium channel blockers or interferons can be injected into into the fibrous tissue lesion on the penis.. This works by breaking down the fibrous tissue and promoting healing with normal tissue. Multiple injections may be needed over a period of months. The success of these injections varies from person to person and may depend on the extent of the lesion.
Surgery
Surgical treatment may needed if other options do not help and symptoms have persisted for more than a year. Surgery may help restore normal erection, though it may cause partial loss of erection or shortening of an erect penis.

Common surgical methods include :
  • Nesbit plication. Tissue on the unaffected side of the penis is shortened, thereby nullifying the curving effect of the fibrous tissue on the affected side. This technique is used in men with mild curvature of the erect penis and who have good penis length, as it may shorten the penis.
  • Plaque incision with saphenous vein graft. The fibrous tissue band is weakend by making several linear cuts through it. This stops the bending effect of the band during erections. The cut fibrous tissue is then covered with a grafted vein. This procedure is generally used in men who have a shorter penis, a curve of more than 45 degrees or an hourglass-shaped deformity.
  • Penile prosthesis. A penile implant is used to straighten and increase the rigidity of the penis. This would be useful for men who have erectile dysfunction.