What is Peyronie’s Disease?
Peyronie’s disease is an unusual and sometimes painful form of erectile dysfunction that causes penile curvature. Mostly found in middle aged men, the disease may occur in those younger and older. Estimates show that more than 80,000 men in the UK may have Peyronie’s disease, with one study suggesting that as many as one percent of the nation’s male population may be effected.(1)
Peyronie’s disease is characterised by damage to penile tissue that results in scar tissue also known as plaque. The size and location of the plaque can cause the penis to bend upward or downward or be indented. The curvature can happen gradually starting with lumps and soreness that go on to develop into a hardened scar, or it can appear suddenly - almost overnight.
It is hard to pin-point what actually causes the scar tissue to develop in Peyronie’s disease, with many different theories having been put forward for this mysterious disorder. While trauma might explain some acute cases of Peyronie's Disease, it does not explain why most cases develop slowly and with no apparent traumatic event.
Some researchers theorise that Peyronie's disease may be an autoimmune disorder. Schiavino et al studied(2) 66 patients with Peyronie’s disease and compared them with 20 controls of the same age. They found that 75.8 per cent of the patients with Peyronie’s disease had at least one abnormal immunologic test, compared with only 10 per cent in the control group.
This may explain why there are some recognised systemic disorders that are associated with the disease, such as Dupuytren's contracture, a condition of the hands and fingers, which can cause the affected fingers to bend towards the palm and won’t allow patients to straighten fingers fully.(3) Peyronie’s disease is present in up to 20 per cent of patients with Dupuytren contracture.
Another condition that is thought to be associated with Peyronie’s disease is Paget’s disease, which is a chronic skeletal disorder that may result in enlarged or deformed bones in one or more regions of the skeleton.(4)
Despite extensive basic scientific research, the cause of Peyronie’s disease and its development are not actually that well understood. Symptoms have been known to improve or worsen over time; but it is usual for the sufferer to experience pain during an erection, making sexual intercourse very difficult. In addition to the physical scarring Peyronie’s disease can leave its emotional mark on the sufferer.
There is a risk that without good communication and understanding in a relationship, Peyronie’s disease can take its toll and cause huge amounts of distress. Even in a loving relationship it can wreak havoc, disrupting a couple's physical and emotional relationship and lead to lowered self-esteem in the man.
First Stop Diagnosis
Quick and accurate diagnosis is the fist step in effectively treating Peyronie’s disease. However, many men are reluctant to visit the doctor when they first notice an unusual curvature or pain in their erect penis. Occasionally their reluctance leads to self-misdiagnosis resulting in further anguish and distress by thinking they have cancerdefine or a sexually transmitted disease. However, when intercourse becomes an agonising struggle, men with Peyronie's disease finally seek medical help - often as a result of their partner’s encouragement.
For those patients who are reluctant to initially go to the doctor for diagnosis and treatment, information about Peyronie’s disease on the Internet can be the first step towards getting help. Online interactive sites such as www.MensHealthPD.com provide discussion forums that allow sufferers and their partners to interact with doctors and other patients about the disease and learn more about the treatments available.
Even after the diagnosis of Peyronie’s disease is confirmed, the course for healing can take many directions.
Treatments Available
The early stage, also known as the acute inflammatory stage of Peyronie’s disease, lasts from approximately six to 18 months. The stage is characterised by painful and weak erections or difficult ejaculations caused by an inflammation, which can then develop into hardened scar tissue (plaque). Sufferers may experience pain; varying degrees of penile curvature, shortening or indentation; and the formation of a lump of scar tissue.
The second phase, the chronic stage of Peyronie’s disease, is when a stable scar (plaque) forms and the deformity stabilises which may result in erectile dysfunction or loss of penile length. Many surgeons prefer to wait at least one year to surgically correct the curvature to help keep it from returning.(5)
Doctors often first try a “wait and watch” approach since Peyronie’s disease symptoms may improve on their own with no treatment necessary in correcting the curvature(6) - mostly within the first year.
There are also a number of non-surgical treatment options available including oral medications, injections, topical treatments shock wave and energy therapies, traction devices, and vacuum therapy. Other therapies are under investigation.
Surgery is a good option when non-surgical treatments are not working and may be the only effective treatment for severe cases. To minimise the reoccurrence of the disease, physicians recommend that the patient’s disease be in a stable, inactive phase for at least six months.
Generally, there are three types of surgical treatments: the Nesbit procedure; plaque incision and grafting; and prosthesis implantation. The Nesbit procedure is used to excise and plicate the penile tissue directly opposite the plaque to straighten the penis.
The second type of procedure is plaque incision and grafting. This surgical method involves excision of some of the plaque followed by placement of a graft of either an autologous (human) tissue, synthetic material or a biologically designed material such as Cook Medical’s Surgisis® Biodesign™. The graft material helps keep blood trapped within the penis to achieve erection.(7)
A third surgical option is the implantation of a prosthesis. This procedure is used for men with Peyronie’s disease and severe erectile dysfunction. During the surgical procedure, an inflatable penile device is implanted.
In conclusion
As Peyronie’s disease can vary extensively in how it affects each sufferer, it is important to identify the best and most suitable course of action for each individual. The goal of treatment is to safeguard sexual function so in some cases all that is needed is education on the condition. Prompt and accurate diagnosis will not only lead to a quicker resolution of the problem but will give peace of mind. So for those reluctant to visit the doctor as a first point of call, social online medical networks provide a good source of information and support for sufferers.
Remember that there is life after Peyronie’s disease; and that the day-to-day living with this disease should not be let to get the better of you. Having the right resources at hand, understanding the numerous options for treatment and discussing them with a physician are the first and effective steps in treating Peyronie’s disease. As a result, you can often stop the disease from turning into a crisis.
By Dr. Raj Persad, Consultant Urologist at United Bristol Healthcare NHS
References:
1 http://www.malehealth.co.uk/userpage1.cfm?item_id=127#peyronie
2 Schiavino D et al. (1997) Immunologic findings in Peyronie’s disease: a controlled study. Urology 50: 764-768
3 http://www.patient.co.uk/showdoc/23068725/
4 http://www.pagetsdisease.com/info/about/what-is-pagets.jsp
5 Tomehl CK. Carson CC, Peyronie’s disease surgery; Which technique for which patients. Cont. Urol, 2004; Vol 16 No. 6.
6 http://www.netdoctor.co.uk/menshealth/facts/peyronies.htm
7 Levine LA. Understanding Peyronie’s disease A Treatment Guide for Curvature of the Penis. Omaha, Nebraska: Addicus Books; 2007.
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