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Peyronie’s Disease or penile curvature is a build up of fibrous “plaque” or scar within the elastic covering (tunica albuginea) of the erectile tissue of the penis. The penis is a highly vascularized organ that is divided into three compartments. The paired copra cavernosa are the structures that contain the erectile tissue. They corpus spongiosum contains the urethra (urine channel) located on the undersurface of the penis. When a man becomes “excited,” the erectile tissue fills with blood and the penis elongates and becomes rigid. If a scar forms in the lining of this tissue, it may cause a restriction and prevent the penis from expanding in that area. This can result in a curvature at the point of restriction.
The symptoms of Peyronie’s Disease include penile curvature, penile pain that may increase upon erection, and difficulties achieving or maintaining an erection. The penis may become rigid up to the area of the scar and remain flaccid past that point. A narrowing or “waist-line” may develop giving the penis an “hour glass” appearance. Often a hard plaque can be felt along the penile shaft. Occasionally the penis may become so severely curved that intercourse is painful to both parties and penetration may become mechanically impossible.
The exact cause of Peyronie’s Disease is unknown but several theories have been proposed. Many patients recall a history of seemingly insignificant penile trauma during an episode of vigorous sexual activity. The penis was accidentally injured against the partner’s pelvic bone. Repeated minor trauma may also lead to scar formation. An inherited form of Peyronie’s disease also exists. Ten percent of men with Peyronie’s Disease have a condition called Dupuytren’s contracture which is similar to a trigger finger. The same scar process occurs in both the penis and the 4th finger of the hand. An association between these conditions and the HLA-B27 histocompatibility antigen has been discovered and points toward a genetic or autoimmune process. Reports of Peyronie’s Disease following radical pelvic or urologic surgery are becoming more frequent.
The clinical course of Peyronie’s Disease is variable. In up to 50% cases the disease process is self-limited and does not worsen. A review of 97 patients published in The Journal of Urology in 1990 (Vol. 144) found that 40% of patients felt the disease worsened over time and 15% thought it improved. The disease process takes approximately 12 months to stabilize and it is during this period that it may resolve without treatment.
The treatments for Peyronie’s Disease can be categorized as medical or surgical. Oral medications such as vitamin E (which can also be applied topically), Potaba and colchicine have been studied and beneficial effects have yet to be proven. These medications may be tried during the first 12 month period of plaque stabilization, but can be associated with some side effects. Intralesional injections (into the scar) of steroids, collagenase, interferon, and verapamil have been attempted and are also of questionable benefit. Injecting any of these agents into the penis may make the plaque worse and we do not advocate this form of therapy. Radiation and ultrasound treatments have been utilized in patients with significant amounts of pain. While these treatments are successful in relieving the pain they do little to correct the curvature. Reconstructive surgery has proven to be the only therapy that corrects the curvature and eliminates the pain on a consistent basis. Several types of reconstructive procedures have been developed and are tailored to the individual problem. The simplest surgical procedure is the corpral plication. Sutures are placed in the lining of the penis opposite the curvature to straighten the penis. This procedure is reserved for patients with mild curvatures, no pain and where penile shortening is not a major concern. Patch corporoplasty was developed to correct curvature and reduce the pain while maintaining penile length. During this procedure the plaque is incised and covered or “patched” with a piece of vein (taken from the ankle), skin graft or synthetic material such as Gortex. A circumcision is typically performed at the same time in uncircumcised men. This is the procedure of choice for most men who wish reconstruction and is highly successful. Men who experience severe erectile dysfunction associated with Peyronie’s Disease may opt to have a penile implant inserted as this will correct both problems. Most surgical procedures are done on an outpatient basis or as a short 23 hour hospital stay. Surgery can be performed with a general or regional anesthetic.
Effective treatments are available to correct penile curvature and relieve the pain associated with Peyronie’s Disease