Peyronie's disease

What is Peyronie's disease?

Although Peyronie's disease is quite common - it's thought to affect about one in 100 men - few have heard of it.

It usually appears in middle age but younger and older men can also develop it. In Peyronie's, a plaque, or hard lump, forms on the upper or lower side of the penis in the layers containing erectile tissue. It begins as a localised inflammation and can develop into a hardened scar. It isn't cancerous.

Symptoms

Usually the plaque forms on the top of the shaft, making the penis bend upward. But if the plaque is on the underside it will bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis.

In the worst cases, the hardened plaque reduces flexibility and causes so much pain, bending and emotional distress that sex becomes impossible.

Causes and risk factors

The cause of Peyronie's disease isn't certain. There's a link to fibrosis or scarring of other tissues in the body such as a condition known as Dupuytren's contracture of the hand. There's also a mild family tendency to the disease.

Many researchers now think the plaque or lump in Peyronie's disease develops following trauma such as hitting or bending that causes localised bleeding inside the penis. This leads to injury of the elastic lining of chambers inside the penis.

Ageing increases the risk as a general reduction in elasticity of the body's tissues increases the chances of injury. If the damaged area heals slowly, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification (formation of calcium deposits) resulting in a long-term problem.

But this theory doesn't explain those cases which develop slowly, or why similar conditions such as Dupuytren's contracture don't seem to result from severe trauma.

Treatment and recovery

Peyronie's disease often occurs in a mild form that stops progressing without treatment after six to 18 months. However, for some men the problem is severe and disabling with regards to erections.

The main aim of treatment is to help the man stay sexually active, but doctors try to avoid intervening as far as possible because there's no strong evidence to show that any treatment other than surgery is effective. So information and reassurance is usually the first step and for many men that is enough.

Surgery is usually performed after several years when the disease is stabilised and the deformity prevents intercourse. Because the symptoms of Peyronie's disease can improve without treatment, medical experts suggest waiting one to two years or longer before attempting to correct it surgically. Other currently unproven treatments include:

• Vitamin E tablets.
• Para-aminobenzoate tablets.
• Injections of chemical agents such as collagenase, dimethyl sulfoxide, steroids and calcium channel blockers directly into the plaques (the most promising being collagenase, an enzyme that attacks collagen, the major component of Peyronie's plaques).
• Radiation therapy has also been used but, while it can reduce pain, it has no effect on the plaque itself and can cause unwelcome side effects.

Surgery

The three most common operations are:

• Removal or expansion of the plaque followed by placement of a patch of skin or artificial material (‘Lue’ procedure). This can involve partial loss of erectile function, especially rigidity, and has a higher rate of complications than the Nesbit operation (see below).
• Removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect (‘Nesbit’ procedure). This causes a shortening of the erect penis.
• Implantation of a device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin).