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Tuesday, April 24, 2007

Peyronies Disease


Peyronies disease is a not-to-infrequent disorder of the penis that is associated with penile curvature and sexual dysfunction. The actual etiology of the disorder is a mystery, though it is thought to be due, in part, to tiny, micro-traumas to the inner lining of the penis, though most men with Peyronies are unable to recall such traumatic events. Peyronies is also associated with certain autoimmune disorders, such as Dupytrens contractures of the wrist.


Men with Peyronies Disease complain of 3 things: pain, curvature, or sexual problems, or all three. Peyronies Disease has 2 phases: the acute and chronic phase. The acute phase occurs early on in the disease process and is when the man first experiences his symptoms. The acute phase can last up to 2 years and is the only time period in which non-surgical therapy may be effective. The chronic phase is associated with a stable, hard, and calcified plaque that is palpable in the penis and stable (non-worsening) curvature for 18 to 24 months.


Medical therapy is indicated for men still in the acute phase of the disease process. Medical therapies include:


  • Vitamin E

  • Potaba

  • Colchicine and Vitamin

  • Intra-lesional Verapamil (injected directly into the lesion)

All of the above medical therapies have side-effects and have never been demonstrated to be effective in good, randomized, placebo controlled studies. I have had good, anecdotal experience with Vitamin E.


Men with Peyronies should be evaluated with a good history, including sexual history, and physical examination. Often, the plaque is palpable. When curvature is not visible with the flaccid penis, I will ask the man to take a digital picture or Polaroid of the erect penis when he is at home and bring it to me on the next visit. This way, I can see the degree of the curvature. If he is unable to get an erection at home, I will give him an injection with caverject or trimix in the office and assess the curvature that way, and take a digital photograph. Men that opt for invasive forms of treatment, such as the incision and patch of the plaque, will need to undergo objective tests of erectile function, such as a penile doppler.


Men in the acute phase are offered Vitamin or Potaba, or if the curvature is mild or after informed consent, reassurance. Treatment in the chronic phase depends on the degree of curvature and the presence or absence of ED. Treatment options include:



  • Reassurance

  • Tunica albuginea plication

  • Incision and patch

  • Penile implant insertion

Surgical intervention must not be performed during the acute phase, or failure will occur. Failure is defined as worsening or progressive curvature after the operation. ED after Peyronies surgery is uncommon and if it occurs, it typically means it was present pre-op. If ED is present pre-op, the treatment option of first choice is the penile implant.


Thanks,


The IU.