Peyronie’s Diseasee

Curvature of the penis is an abnormal bend in the penis that occurs during erection. It is also called Peyronie’s disease.

Causes, incidence, and risk factors

In Peyronie’s disease, fibrous scar tissue develops under the skin of the penis. The cause of this fibrous tissue is not known. Fracture of the penis can lead to this condition. Patients have a higher risk after surgery or radiation treatment for prostate cancer. Peyronie’s disease is uncommon and affects men ages 40 – 60 and older. Curvature of the penis can occur with Dupuytren’s contracture, a cord-like thickening across the palm of one or both hands. It is a fairly common disorder in white men over age 50. However, only a very small number of people with Dupuytren’s contracture develop curvature of the penis.

Other risk factors have not been found. However, people with this condition have a certain type of immune cell marker, which indicates that it may be inherited. Newborns may have a curvature of the penis, which may be part of an abnormality called hypospadias (this is different from Peyronie’s disease).

Symptoms

You or your doctor may notice an abnormal hardening of the tissue below the skin, in one area along the shaft of the penis. 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 penis
  • Pain
  • Problems with penetration or pain during intercourse
  • Shortening of the penis

Treatment

Vitamin E supplementation:

Vitamin E is found naturally in some food but it is also available as dietary supplement. It is maybe best known for its antioxidant properties, it helps protecting cells from potential damage caused by free radicals, like pollution, in the environment. Vitamin E may also help with scar prevention and that is why it has been recommended for Peyronie’s patients. Vitamin E may be able to hinder scar tissue building up and to reduce inflammation.

Newer agents of interest:

Some newer agents targeting the basic mechanisms of inflammation have been studied in larger clinical trials. These include potassium para-aminobenzoate (Potaba), pentoxifylline (acting through TGFβ1 inhibition) and Coenzyme Q10. Other newer agents of interest include acetyl L-carnitine, propionyl L-carnitine, L-arginine, and sildenafil (acting through phosphodiesterase-5 inhibition). The efficacy of Interferon-alpha-2b in the early stages of the disease has been reported in recent publications but it was found to be less effective in cases where calcification of the plaque had occurred in common with many treatments.

Excision of the Plaque & insertion of Fascia lata patch and Penile prosthesis:

The two most common surgeries used to treat Peyronie’s disease are:

  • Removal of the plaque followed by placement of a tissue patch.
  • Removal or altering the tissue from the side of the penis opposite the plaque, which counters the disease’s bending effect.

Unfortunately, the surgeries do not guarantee normal penis function. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis. Another surgery for Peyronie’s disease is penile prosthesis implantation. This treatment is reserved for men who have both Peyronie’s disease and significant erectile dysfunction (inability to obtain or maintain an erection suitable for intercourse). Most types of surgery produce positive results. But because complications can occur, and because many of the complications associated with Peyronie’s disease (for example, shortening of the penis) cannot be corrected, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.