Peyronie’s Disease (penile curvature)

What is Peyronie’s disease?

Peyronie’s disease is a condition characterized by the development of fibrous scar tissue, or plaques, within the penis. These plaques can cause penile curvature, pain, and erectile dysfunction.

What causes Peyronie’s disease?

The exact cause of Peyronie’s disease is not fully understood. It is believed to involve a combination of genetic factors, trauma or injury to the penis, and abnormal wound healing processes. Peyronie’s disease is believed to be more fairly common, with an incidence of about 10%. There is a known association between Peyronie’s disease and Dupuytren’s contracture of the hand, a condition characterized by one or more fingers bending towards the palm.

What are the two phases of Peyronie’s disease?

Peyronie’s disease typically progresses through two distinct phases: the acute phase and the chronic phase.

Acute phase

This is the initial phase of Peyronie’s disease. It is characterized by the active onset of symptoms and typically lasts for several months to a year. During this phase, patient’s may experience penile pain, the formation of fibrous plaques on the shaft of their penis, and the development of penile curvature.

Chronic phase

The chronic (or stable) phase is characterized by the resolution of pain, and the stabilization of plaques and curvature. When a patient reaches the chronic phase, typically the curvature does not worsen any further.

What are the treatments for Peyronie’s disease?

Treatment for Peyronie’s disease is dependent on the stage of the disease the patient is currently in, as well as the severity of the curvature, and concurrent erectile dysfunction.

Active phase

During the active phase, treatment is focused on managing the pain of the patient. There is some evidence that providing low-intensity shockwaves to the penis can help alleviate pain associated with Peyronie’s disease. Non-steroidal analgesics such as ibuprofen can be very effective for treating pain as well. It is not recommended to treat the curvature of the penis during the active phase as the curvature can continue to worsen during this phase, and is best addressed once the condition has reached the chronic phase.

Chronic phase

Traction therapy

This treatment involves using a mechanical device (“a penis splint”) that applies gentle and continuous stretching to the penis to potentially reduce curvature and improve penile straightening. It is typically used for several hours per day over a period of months, and carries very little risks.

There are several traction devices on the market, including RestoreX. Most patients are asked to wear this device 30 minutes, twice a day, for 12 weeks. The device costs approximately $500. A trial of RestoreX can help improve the curvature by about 30-40 degrees, and can also mildly help increase penile length.

Injections

Xiaflex is an FDA approved medication that is specifically approved for the treatment of Peyronie’s disease. Injections are given in the office, and a series of injections are provided to help soften the plaques and improve the curvature. Risks of injections include pain/discomfort, swelling, and very rarely penile fracture (~1%).

Xiaflex is typically administered on a strict scheduled. Patient’s are typically given 2 injections over a 7 day period, and over 4 weeks they are given stretching exercises to do at home. At the end of the 6 weeks, this concludes 1 cycle of Xiaflex. Patients are able to do a total of 4 cycles.

It is important for patients to know that they cannot have sex for 4 weeks after any Xiaflex injection. The average improvement with Xiaflex is expected to be 30-40%.

Penile plication

Plication is an operative option for patients who desire the correction of their curvature. During this outpatient procedure, a small incision is made on one side of the penis, and a series of stitches are applied to the unaffected side of the penis, to help straighten out the curvature. Although patients are typically able to resume most activities fairly quickly following surgery, they are not able to masturbate or have sex for 5 weeks after the operation. The majority of the curvature associated with Peyronie’s disease is expected to improve with this operation.

Risks of this procedure include shortening of the penis, and discomfort from the stitches. If a patient is not satisfied with the results, the stitches can be removed in a subsequent procedure. Additionally, this process does not affect the scar tissue associated with Peyronie’s disease.

Plaque Incision/Excision and Grafting

In cases of severe deformity, a synthetic graft can be placed in the operating room to remove the scarring and restore normal penile curvature. This is a highly complex operation, and can potentially cause loss of sensation to the penis.

Penile implant

For patients with severe erectile dysfunction, a penile implant may be recommended. The implant can help reduce the curvature, and adjunct procedures during the implant operation can also be undertaken to help reduce any residual curvature.