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Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons
Peyronie's Disease is a condition that often affects the curvature and length of the penis, caused by fibrous scar tissues called plaque that form inside of the penis.
This scar tissue can be easily palpated as a lump and tends to be tender for a few months during the initial phase of the disease.
Peyronie's Disease plaques cause loss of elasticity of the tunica of the penis and this reduces the capacity of the penis to stretch during erections. Patients therefore frequently report penile shortening and deformity such as curvature and narrowing of the shaft penis, which become visible during erections. In flaccidity, the lumps can still be palpated, but the deformity is not visible.
Most men who suffer from Peyronie's Disease are still able to have sex, although for some men it can become painful or cause further erectile dysfunction. Depending on the symptoms you have, you may opt for medical or surgical treatments. The disease rarely goes away by itself and often gets worse. However the curvature and penile shortening associated with the condition often stabilizes within three to 12 months.
If treated early, Peyronie's Disease can be stopped from progressing and you may even notice an improvement in your symptoms.
Peyronie's Disease can be a challenging condition to live with and may be harming your mental and emotional wellbeing and impacting on your romantic relationships. Peyronie's Disease treatment can help with the mental and emotional impact as well as easing the physical symptoms of the condition.
The lumps that form in Peyronie's Disease are noncancerous.
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There are a number of symptoms which may indicate Peyronie's Disease. Sometimes symptoms appear suddenly but sometimes they develop very gradually over an extended period of time. You may be experiencing some or all of the following:
Peyronie’s Disease diagnosis is based on history taking and on the examination of the patient. Frequently patients report that the disease has started following a trauma to the penis during sexual activity. Examination of the penis will demonstrate the presence of a lump, which can be elastic or indurated in texture.
Penile deformity can be assessed only during erections, when the tunica albuginea of the penis is stretched to its maximum capacity. Self-photography of the erect penis can be a useful tool to identify the nature of the deformity, but this has its limitations. A photo taken at home may not fully demonstrate the extent of the curvature and a semi-erection will make the deformity appear less pronounced. If required, the doctor will be able to administer vasoactive medication to induce an erection at the clinic for assessment.
As patients with Peyronie’s Disease frequently have cardiovascular disease, which might have produced a degree of obstruction of the arteries feeding the penis, a thorough assessment of the penile blood supply will be carried out using an Eco Colour Doppler Ultrasound Scan. This will provide the doctor with information that will also help to better decide which is the most appropriate treatment option for each specific patient.
There are various treatment options for Peyronie’s Disease depending on the progression of the disease:
There is very little evidence that this type of treatment is effective during the beginning phase of the disease. Treatment options such as oral medication, topical treatments and supplements such as oral Viitamin E, Tamoxifen, Pentoxyphilline, Potassium Paraaminobenzoate, Colchicine and Verapamil have been offered to patients with no proven success on reducing penile curvature or plaque size, however, they may help with pain management and potentially slowing the progression of the disease.
Traction therapy (penile stretching)
There may be rationale for penile stretching and straightening exercises during the acute phase of the disease. This can be achieved either by enhancing natural erections with the administration of Phosphodiesterase Type 5 Inhibitors such as Sildenafil, Tadalafil and Vardenafil, or mechanically, with the use of a vacuum or stretching device. Either treatment on its own is unlikely to show an enormous benefit and should be performed together to get any result. The evidence of the effectiveness of the use of the vacuum pump or penile stretching device in isolation to mechanically straighten the penis is minimal. In the best-case scenario, the regular use of these devices may just slightly reduce penile curvature, which would be beneficial only in very selected patients (under 10%).
Injections of the Collagenase of the Clostridium Histolyticum (Xiapex®) is one of the latest treatment options available for Peyronie’s and the first non-surgical therapy that has proved effective in treating Peyronie’s plaque. These injections treat the curvature by “chemically” softening the plaque and restoring some of the length lost due to the scarring process. Xiapex® injections provide better results if combined with the regular use of a vacuum pump or of the penile stretching device in order to provide an extra stretch of the plaque softened by the Collagenase of the Clostridium Histolyticum. These should be performed at four weekly intervals and the residual curvature should be assessed after the third injection, once the healing process at the level of the plaque is likely to be complete. If significant deformity persists, the cycle injection/stretching can be repeated. In expert hands, Xiapex® injections are a simple and safe procedure and can be performed in the outpatients’ clinic and would typically be the first line of treatment (subject to consultant’s diagnosis).
Surgery represents the gold standard treatment for Peyronie’s Disease and its aim is to guarantee a penis straight and hard enough to allow the patient to engage in penetrative sexual intercourse without pain or discomfort. The choice of the best surgical approach, apart from patients’ preference, should take into consideration the quality of an erection and the degree of deformity and shortening. In patients with preserved erections, the curvature can be corrected either by shortening the longer side of the penis, which has not been affected by Peyronie’s Disease or lengthening the shorter side incising the plaque and interposing a graft. Both procedures can be performed as a day case.
Before the introduction of Xiapex, surgery was the only effective treatment for penile curvature caused by Peyronie’s and still remains the most successful for most patients. Surgery should only be performed after the disease progress has stopped which usually occurs 12 months from onset (chronic phase).
You will be considered suitable for treatment for Peyronie’s Disease if you experiencing one or more of the following:
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What causes Peyronie's Disease?
Although doctors are not entirely sure exactly why this disease happens, researchers do believe that those fibrous plaques could start to form after a trauma to the penis - such as blunt force trauma, bending or hitting - that would result in bleeding inside the penis. Unfortunately, you may not notice the injury, and the plaques would begin to build over time.
There have also been studies that show Peyronie's Disease can be inherited, so for some men family history could be a factor. Some medications have been known to list Peyronie's Disease as a possible rare side effect. However, there is no evidence that medications cause the condition to occur.
Peyronie's disease is frequently associated with other known cardiovascular risk factors, such as diabetes, high blood pressure, high cholesterol levels, obesity and tobacco smoke. It is now established that more than 60 percent of patients have at least one known cardiovascular risk factor.
How to distinguish congenital curvature and Peyronie’s Disease?
Both Peyronie’s Disease and congenital penile curvature can be found in adolescents and young adults and therefore the age of onset is not a good criterion to distinguish between the two conditions. However, in patients with congenital penile curvature there is no palpable lump, which is instead indicative of Peyronie’s Disease. Also, while most congenital curvatures are ventral, in most patients with Peyronie’s Disease the penis bends upward. Waist deformities are also absent in patients with congenital curvature, which tend to be more gentle and harmonic than the one of patients with Peyronie’s Disease.
While erectile dysfunction is a common finding in patients with Peyronie’s Disease, most patients with congenital penile curvature have adequate erections, as there is no association between cardiovascular risk factors and congenital penile curvature. To render the situation more confusing, some of the patients with congenital penile curvature may eventually develop Peyronie’s Disease later in life and therefore both conditions may coexist.
Who is more likely to get Peyronie’s Disease?
Peyronie’s Disease is a quite common condition as it affects around 10% of men. Although it is typically a condition that affects men in their 50s and 60s, Peyronie’s Disease can occur at any age. Usually in the adolescent the condition tends to be more aggressive in terms of size of the plaque and degree of deformity produced.
Due to the strong link between Peyronie’s Disease and cardiovascular disease, patients presenting with this condition should always be actively screened for the known cardiovascular risk factors such as high blood pressure, diabetes and high cholesterol levels.
Men who have certain connective tissue disorders also appear to be at a greater risk of developing Peyronie’s Disease.
Can I get treatment for Peyronie's Disease on the NHS?
Collagenase injections to treat Peyronie's Disease are not available on the NHS. You may be entitled to surgery on the NHS if your Peyronie's Disease is particularly severe and your symptoms are seriously affecting your quality of life.
However the NHS has been, and continues to be, hit hard by the Covid-19 pandemic. High levels of staff sickness have had an impact on waiting times across the board. These waiting times vary from hospital to hospital. And any new waves of Covid-19 infections may result in this wait getting even longer. Because of this, many people choose to go to a private clinic for their Peyronie's Disease treatment. At the Cadogan Clinic, there is no waiting list, so you can have the procedure promptly.
Is Peyronie's Disease permanent?
Peyronie's Disease is usually a permanent condition. The condition usually progresses before stabilizing at around three to 12 months.
Men who experience painful erections as a result of Peyronie's Disease usually find that this improves over a year or two. However the scar tissue, curvature and penile shortening remain.
Occasionally, both the curvature and pain associated with Peyronie's disease improve without treatment. But the disease does not go away on its own and if you are experiencing symptoms that are having a negative impact on your overall health and wellbeing then you should seek treatment.
The most common side effects from hydrocortisone injections is pain or swelling in the joint where the injection was given. This is temporary and usually resolves in one to two days. There may also be some mild bruising at the injection site.
As hydrocortisone shots are injected straight into the joint, the medicine does not travel around your body. However sometimes hydrocortisone may get into your blood and as a result there is a very slim chance you may experience a serious side effect. Potential side effects include: depression, mood changes, infection, deep vein thrombosis (DVT), eyesight changes, diabetes or complications of diabetes, and Cushing’s syndrome. Some of these side effects may happen after a few days while others may not present until months after treatment. These are all very rare side effects.
It is extremely rare to have an allergic reaction (anaphylaxis) to a hydrocortisone shot.
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