31 March 2017
Peyronie’s Disease is a condition which leads to the build-up of abnormal scar tissue in the penis. This scar tissue has a similar effect to putting a piece of sticky tape on a sausage balloon and then trying to blow it up. The sticky tape prevents expansion and the balloon curves and/or narrows at that point.
How common is it?
It affects around one in thirty men with two thirds of those affected between the ages of 40 and 60
How does it develop?
It is thought to arise due to injury to the penis.
Are any men particularly affected or does it appear to be a totally random condition?
Men with diabetes and those with peripheral vascular disease (poor circulation to their limbs) are more likely to be affected, but anyone can get it. I find that there is often an almost forgotten sexual injury that patients recall when you specifically quiz them, that set everything off.
What affects can it have upon a patient?
It can initially cause pain or discomfort with an erection, which is the inflammatory phase. Later the patient may find a Peyronie’s plaque which can feel like a lump of gristle in the penis which is followed by the development of a curvature or a narrowing (‘waist’) or even a shortening of the penis.
Fifty percent of men with Peyronie’s will develop erectile dysfunction.
The milder cases will have discomfort with erections and during sexual intercourse and later they will have a curve which may or may not affect sexual activity.
The worst cases will have pain that can go on for months, shortening of the penis, a curve that completely prevents penetrative intercourse accompanied by erectile dysfunction. This is devastating to patients.
Can it affect fertility?
There is no effect on fertility. As long as the man can ejaculate then fertility remains unchanged.
What treatments would you advise or carry out?
In the early (inflammatory phase) there are no medications that have been proven to have a great effect. Vitamin E, tamoxifen (a breast cancer drug) and pentoxifylline (a drug for poor circulation) are amongst those that have all been used and, for a minority of men, they can work well. However, you would only take these for three months.
I think it is better to purchase either a penile vacuum developer or penile traction device, both of which have been shown to rectify the curve and increase penile length.
Viagra can be important to maintain erections and allow sexual intimacy to continue even when penetration is not possible due to the curve.
Once the curve has been unchanged for six months the disease is regarded as stable and you could then consider surgery.
The vast majority of men are dealt with by a ‘shortening’ procedure such as the Nesbit Procedure with the intention forming a functionally straight penis that will allow sexual intercourse.
Many men seek a ‘grafting’ procedure (Lue procedure) as this operation aims to restore length through the use of grafts but not all men are suitable. The grafting procedure is performed by only a few surgeons as it is much more technically demanding than the Nesbit procedure which is widely available.
Have there been any advances in treatments over the past few years?
Recently a medication called Xiapex has become available and this is an injection that is given into the Peyronie’s plaque to dissolve the scar tissue. It is not yet widely available but it has a role in the milder cases.
If someone thinks they may be developing Peyronie’s what action should they take?
They should see their GP to confirm the diagnosis. For many men it would be reasonable to let the disease run its course and see how the penis is at the end of it.
The whole process of pain, plaque, deformity and stabilisation can take a year and, in the end, not everyone needs surgery.
However for those men who want to be more proactive, they should ask to be referred to a urologist who has an interest in Peyronie’s Disease and who regularly operates on the condition, rather than a general urologist or a urologist who specialises in cancer or stones.