Peyronie’s disease is an acquired inflammatory condition of the penis where a plaque develops under the skin of the penis leading to penile curvature, painful erections, and erectile dysfunction. The plaque consists of scar tissue that forms within the wall of the tissue called the tunica albuginea that surrounds the corpus cavernosum, which is the structure that fills with blood to create a normal erection. When the plaque is large enough, it causes painful curvature of the penis that may prevent intercourse. Also, the plaque may cause erections to be less rigid or difficult to maintain. Peyronie’s disease is common and may run in families, with an estimated 3-9% of all men having some degree of Peyronie’s disease.
The exact cause of Peyronie’s disease is unknown, and although a genetic predisposition to abnormal scar tissue formation is likely, trauma to the penis (for example, sudden and painful bending during intercourse) is the cause in some men. Peyronie’s disease can be associated with abnormal scar tissue formation in the plantar fascia of the foot, the eardrum, or the palm of the hand (Dupuytren’s contracture). Low testosterone, or hypogonadism, is also commonly seen in men with Peyronie’s disease, which may predispose to poor wound healing and inflammation.
Peyronie’s disease often begins with a new curvature to the erect penis, which may be painful initially. Peyronie’s disease may only present with new onset of erectile dysfunction. You or your doctor may notice an abnormal hardening or calcification of the tissue below the skin along the shaft of your penis. The plaque commonly occurs on the upper side of the penis near the base, but can also form on the bottom or side of the penis. In some men, the plaque occurs around the entire penis. The condition is usually asymptomatic in the flaccid state.
During erection, there may be:
- A bend in the penis, which usually begins at the area where you feel the scar tissue or hardening
- Narrowing of the penile shaft or “hourglass deformity”
- Penile pain with erection
- Difficulty with penetration
- Pain with intercourse for the patient or his sexual partner
- Shortening of the penis
- Inability to maintain the erection
Ultrasound is used to evaluate the degree of curvature and severity of associated erectile dysfunction. Medicine is injected into the penis to produce an erection. A painless ultrasound probe is used to determine the degree of curvature, the arterial blood flow into the penis, and the ability of the veins to keep this blood from exiting the penis. This information is used to develop an individualized treatment plan.
A combination of oral medications and/or penile injections may improve symptoms. For some men, the curvature can improve over time with or without treatment.
Injections of medication directly into the plaque are an option for some men because it allows for higher doses of medication to be directed to the plaque. It is an option following oral medication and prior to surgery, and best for men in the initial stage of the disease who have not yet suffered significant erectile dysfunction.
Surgical treatment is typically reserved for men with a severe penile curvature or erectile dysfunction that prevents intercourse. The main goal of surgery is to straighten the penis enough to restore satisfactory sexual function. Surgical procedures for men with severe curvature but preserved erection function may include:
- Plication: This procedure involves placement of non-absorbable sutures into the tissues of the penis opposite the curve. Although it causes shortening of the erection, it has the lowest risk of subsequent erectile dysfunction.
- Incision and grafting: In this procedure, the Peyronie’s plaque is incised and replaced with a graft.
- Penile Prosthesis: For men with Peyronie’s disease and erectile dysfunction not responsive to conservative treatment options, implantation of a 3-piece inflatable penile prosthesis (IPP) is the best option. An IPP completely cures the disorder by restoring sexual function and confidence. Performed through a small hidden scrotal incision, a penile implant is invisible in your body while producing a completely natural erection and sexual experience. Sensation, orgasm, ejaculation, and urination are unaffected. The IPP has the highest success rate of all the treatments for Peyronie’s disease and erectile dysfunction, and over 90% of men and their partners are satisfied after the procedure.