Peyronie's Disease

Peyronie’s disease causes curved, painful erections due to the development of fibrous scar tissue inside the penis. While a curved penis can be perfectly normal, Peyronie’s disease causes a significant bend that tends to be painful when the penis is erect.

The condition can also cause erectile dysfunction or prevent sexual activity, which can in turn lead to stress and anxiety.

Common Signs and Symptoms

Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common include:

• Flat lumps or palpable bands under the skin of the penis caused by scar tissue
• A significant bend to the penis, especially if it hasn’t always been present (may be curved or bent, or the penis may appear to be indented)
• Problems getting or maintaining an erection (erectile dysfunction)
• Sudden or gradual shortening of the penis
• Pain in the penis, with or without an erection

Causes and Risk Factors

The cause of Peyronie’s disease isn't completely understood, but it’s generally thought to be the result of repeated injury to the penis, which can occur during sex or physical activity, or from an accident.

While the penis heals, the scar tissue grows unevenly, leading to lumps and/or curvature of the penis. Pain can occur when the penis becomes erect because the scar tissue can’t stretch with the rest of the skin.

Peyronie’s disease doesn’t always involve injury to the penis, however. Some possible risk factors include:

• Heredity. You’re at increased risk of developing Peyronie’s disease if your father or brother has had it.
• Connective tissue disorders. There does seem to be a greater risk of developing Peyronie’s disease in men who have a connective tissue disorder.
• Age. The chance of developing Peyronie’s disease increases with age, especially in men over 55.
• Other factors. Smoking and other factors may contribute to Peyronie’s disease.

How It’s Treated

If the curvature of your penis isn’t severe and isn’t getting worse, and if you can still have erections without pain, your doctor may recommend watching and waiting to see if the Peyronie’s disease resolves on its own.

If your symptoms are severe or worsening, or if you’re experiencing erectile dysfunction or pain during sex, your doctor will likely prescribe medication or surgery.

Medications commonly used to treat Peyronie’s disease include:

• Pentoxifylline – This oral medication may reduce the amount of scar tissue in Peyronie’s disease.
• Collagenase – The only FDA-approved medication for Peyronie's disease, Collagenase is approved for use in adult men with moderate to severe curvatures and a palpable lump and has been shown to help lessen the curvature by breaking down the buildup of collagen that causes it.
• Verapamil – A drug normally used to treat high blood pressure, Verapamil has been shown to help disrupt the production of collagen and reduce pain.
• Interferon – This protein has shown promise in helping to disrupt the production of fibrous tissue

In some cases, medication is injected directly into the penis, with multiple injections given over several months.

Your doctor may also recommend surgery if the penile deformity is severe or the pain is extreme. Note that surgery isn’t usually recommended until you’ve had Peyronie’s disease for at least a year.

Common surgical methods include:

• Suturing the side of the penis that’s been unaffected by scar tissue, which straightens the penis. One form of this procedure is called Nesbit plication. This type of surgery can cause erectile dysfunction.
• Incision or excision and grafting, during which your surgeon makes one or more cuts in the scar tissue, allows the sheath to stretch out and the penis to straighten. The surgeon might remove some of the scar tissue. Then a piece of tissue is grafted into place to cover the cuts. This surgery can also cause erectile dysfunction.
• Penile implants which can replace the spongy tissue that fills with blood during an erection. If the implants are semirigid, you will have to manually manipulate the penis to bend down or become erect. If they are inflatable implants, you can manipulate the penis with a pump.
• If you're uncircumcised, your doctor might recommend a circumcision during surgery.

After surgery for Peyronie's disease, you'll be required to wait four to eight weeks before resuming sexual activity.

If you’ve noticed a curvature of your penis or have felt possible scar tissue under the skin, the Urology specialists at Kelsey-Seybold Clinic in Houston can determine if you have Peyronie’s disease and provide the best treatment plan for your case.