The Progression of Peyronie’s Disease and When It Should Be Treated
Peyronie’s Disease, an abnormal penile curvature, is a disease that can cause significant physical as well as psychological distress. Peyronie’s Disease is a disease of abnormal scar tissue in the penis, leading to a palpable bump or lump as well as curvature. This can cause pain with intercourse, pain for their partners, or distress that the penis does not look normal. Men can also be concerned that this may turn into cancer or progress uncontrollably. It’s important to understand, first and foremost, that this is a benign condition that will never turn into cancer and is not life-threatening. There are two phases to Peyronie’s disease – an acute phase where the scar tissue occurs and a chronic phase where the scar tissue is stable. For men in the acute phase, approximately 15% will see remodeling and improvement of their Peyronie’s. About 60% will see no change over time, and approximately 25% will experience worsening curvature. The acute phase can last 3-6 months and can be accompanied by pain with erections as well as penile shortening. Invasive treatment is typically deferred during the acute phase, although penile traction can be helpful. We typically prefer to treat Peyronie’s disease when the curve has been stable for approximately 3-6 months.
When It’s Time for Treatment
After the disease has stabilized, it is time to consider treatment. To qualify for treatment, patients should have a 30-degree or greater curvature and pain or difficulty during intercourse for them or their partner. Certain curvatures may be more likely to cause trouble with sex. For example, upward curvature is typically well tolerated, while downward or lateral curvature may cause a significant geometry problem for men trying to have sex.
Treatment options vary depending on the degree of curvature. Patients with moderate curvature may still benefit from penile traction at this point. Other patients desiring noninvasive treatment would be candidates for Xiaflex, a collagenase injection. This involves cycles of 2 injections into the scar tissue every six weeks over six months, with stretching exercises in between. This can lead to a 50% or better improvement in curvature.
There are also multiple surgical treatments for Peyronie’s disease. For curvature less than 90 degrees, a penile plication is a good option. This involves using permanent stitches to straighten the penis. More severe curvatures will do better with plaque incision and grafting, where the scar tissue is opened, and a graft is placed to straighten the penis.
Significant Peyronie’s and Concurrent Erectile Dysfunction
Some Peyronie’s patients will also have erectile dysfunction (ED), which no longer responds to medication like Viagra and Cialis or injections known as Tri-mix. At this point, a solution to both problems is an inflatable penile prosthesis (penile implant). The three-piece penile implant addresses both the curvature of the penis and the severe erectile dysfunction. All parts of the device are implanted entirely within the body, making it very discreet. Using a pump placed in the scrotum, patients can easily and quickly generate an erection on demand. Per Dr. Kemper, a Georgia Urology Men’s Health specialist, “A penile implant can be an ideal way to treat both diseases in one straightforward surgery.”
With or without erectile dysfunction, PD patients have a multitude of options to help them return to their former sex life. The most critical first step is to set aside any worries or embarrassment and visit a knowledgeable male health and urologic specialist at Georgia Urology for an appropriate diagnosis and treatment plan.
This allows the patient to make the best choice for them.
