I would like to take a few moments to talk to you about a common condition in men called Peyronie’s disease. In this article, I will define Peyronie’s disease, discuss the evaluation, and offer some treatment solution for this common condition that affects millions of American men.
The definition of Peyronie’s disease is an acquired condition associated with the curvature of the penis. It usually occurs in men between the ages of 45 and 60 years of age, and it’s usually progressive with more bending and angulation of the penis with the passage of time. Fortunately, some cases subside spontaneously without any treatment at all. It usually results from an inelastic scar resulting in the bending at the time of an erection. There is usually pain associated with the erection and in severe cases, where there is significant angulation of the penis, it may cause discomfort to the man’s partner. If there is a significant restriction of the blood flow in the penis, it may result at the end of the penis not becoming erect and remaining flaccid when the part of the penis closest to the body fills with blood.
Most of these cases present with pain at the time of an erection, and there is noted angulation or bending of the penis at the time of an erection. With severe cases, there can be a palpable non-tender movable mass in the penis that is not associated with any pain or discomfort when the man is examined. Because the scar formation in the penis only affects the blood supply to the erection part of the penis, it is usually not associated with any restriction of the passage of urine from the bladder to the outside of the body.
The clinical course of Peyronie’s disease is usually progressive pain with intercourse causing distortion of the penis and bending of the penis with an erection. With progressive Peyronie’s disease, the scar can become calcified and become very hard and very firm. With more angulation, there is more discomfort to the man and also to the partner as well.
The diagnosis is easily made from the history, and on the physical exam, the palpation of the nodule in the shaft of the penis is easily accomplished. It is often helpful if the man takes photographs of the penis in the erect position as this will become very helpful in plotting or following the progress associated with treatment. Occasionally and x-ray will pick up a calcification in the penis.
The treatment of Peyronie’s disease has multiple options. One treatment option is certainly watchful waiting. If there is not severe pain or there is not enough angulation that prevents penetration or discomfort to the partner, often no treatment is recommended. There are pills that can be taken called Potaba, which requires approximately eight to twelve tablets a day. Also, vitamin E has been reported to occasionally being helpful, and Verapamil cream applied topically to the plaque may result in softening of the plaque. There are also injections that can be applied or inserted into the plaque with injections of steroids, interferon, and also verapamil injections often can be effective in reducing the size of the plaque.
If these conservative approaches are not helpful, then surgical management is required, which it consists of surgically removing the plaque or surgically suturing the opposite side of the bend in order to straighten the penis. And in severe cases, where this is not possible, it requires the insertion of a penile prosthesis either an inflatable penile prosthesis or a semi-rigid rod.
In summary Peyronie’s disease is a common urologic condition affecting millions of American men. It is associated with angulation or bending of the penis and pain at the time of erection. The discomfort or the condition can be disabling both to the man and his partner at the time of sexual intimacy. Treatment is available and most men with Peyronie’s disease can be helped and can return to their previous normal sexual intimacy.