Peyronie’s Disease

Crooked Male Anatomy (The Doctors)

Urologist Dr. Aaron Spitz provides easy solutions for a bent or crooked penis.

*Video:urologist dr. aaron spitz provides easy solutions for a bent or crooked penis.

What is Peyronie’s disease? Scar like tissue, or plaques, build up inside of the penis in the smooth casing called the “tunica albuginea.” This casing is what surrounds the blood vessels and spongy musle tissue of the penis and it creates the long pair of cylinders that make up the shaft of the penis. Normally this casing expands and then holds its size as more and more blood is pumped into the penis, making it hard like a pumped up bicycle tire. When peryronies disease occurs, the abnormal “scar” does not stretch normally and it creates a kink or bend in the erection due to shortening on the side it is on, much like if you pinched the side of a long thin inflated balloon. Curvature may be to the left, to the right, upwards or downwards. Sometimes the “scar” is evenly distributed across the shaft of the penis and it makes and “hourglass” shape deformity. Often some degree of shortening occurs. In many cases the penis can still maintain an erection but in some cases the peryonies disease also causes erectile dysfunction due to poor trapping of blood in the penis.Erections can become painful for those with Peyronie’s disease but the pain usually subsides within the first 4 to 6 months. The amount of curvature may make sex painful for the man or his partner, but in many cases intercourse may continue without pain to either. The degree of curvature or deformity and the size of the “scar” tissue can progress for up to a year and a half. In many cases the condition worsens during this time frame, but in a small number, about 10 % to 15% it spontaneously improves. The “scar” tissue may be felt as a lump in the shaft of the penis, but it is not always able to be felt.

What causes Peyronie’s disease?

This is the first question that men generally have, and unfortunately, there is no solid answer. The causes are largely unknown, though it is believed that injury or trauma to the penis may cause the condition. Injury doesn’t have to be severe, and it is possible to not even be aware of these “micro injuries,” which can occur through sexual intercourse, accidents, or sports. It is likely that when the injury occurs, it damages the elastic tissue that surrounds the corpus cavernosa, which are the erection chambers in the penis. If the tissues, called tunica albuginea, heal properly, men will likely have no long-term issues. If the healing process is interrupted in some way, permanent scarring can occur. The region in which the scar tissue forms is no longer elastic and can’t stretch. This causes the disfigurations common in those with Peyronie’s disease.

If you have Peyronie’s disease, does this mean you also have ED?

Not necessarily. In some men, the disease never progresses to the point that it interferes with sexual intercourse. Because of the progressive nature of the disease, doctors mayadvise waiting for one to two years to see if the condition worsens or stagnates. If there is no pain, the curvature is not severe and/or worsening, and if you can engage in satisfying intercourse, no treatment is generally needed. If you do have these issues, however, there are some options to consider:

  • Oral medications: There has been little convincing evidence that oral medications and nutritional supplements provide significant relief for peyronie’s disease. Because there have been case by case improvements and because the side effects are minimal, most doctors recommend trying these. They may serve a protective effect against the process worsening early in its course. They include include potaba, vitamin E, colchicine, phosphodiesterase inhibitors (Viagra, levitra, Cialis) and L-arginine. Oral medications or supplements are usually taken for at least 3 to 6 months.
  • Penile injections: Verapamil, a drug used for treating hypertension, can be injected directly into a peryonie’s plaque and in some men may reduce the degree of curvature of the penis. The injections are usually given every 2 to 3 weeks for at least 6 rounds of treatment. A medication that has been approved for contractures of the palm (Dubrytren’s (please check spelling) contractures) is being studied in clinical trials for treatment of Peyronie’s disease. This drug, known as collagenase, will be available to clinical trial participant’s through Dr. Spitz’s practice. Please inquire if you are interested.
  • Surgery: can be performed to shorten the unaffected side or lengthen the affected side of penis so as to straighten out the penis Surgery is usually reserved until after the disease process has stabilized. There can be a risk of developing erectile dysfunction with some corrective surgeries. If a man has both significant curvature and severe erectile dysfunction, a penile prosthesis surgery will usually be the best solution for him. The prosthesis will straighten the penis significantly and provide on demand, reliable, rigid erections.
  • Traction devices: External penile traction can help reduce curvature. The device provides constant pull several hours each day that loosens the tunica albuginea “scar” tissues and helps straighten the penis. The process requires time-4 to 6 months because the tissue that is being straightened is very dense. It is much like wearing a brace to straigten a bone or the spine. Many men report success with this method when other medical interventions have failed.