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Conditions Treated

Peyronie's Disease

What is Peyronie’s Disease?

Overview. Peyronie’s disease is a disorder in which a benign fibrous layer of scar tissue (plaque) develops under the skin in the upper or lower part of the penis, affecting the erectile tissue. This inflammation of what is known as the tunica albuginea tends to result in a bent or curved penis during erection that can cause pain and lead to difficulties during sexual intercourse. Beyond the pain it can cause, Peyronie’s disease often affects intimacy in relationships and can have a psychological impact on the man. In the most severe cases it is treated with surgery; in many more mild cases, the symptoms will improve without any treatment.

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Incidence and Risk Factors. Peyronie’s disease has been found to occur in about 1 percent of men, although that may be a low estimate given that many men, particularly those with mild symptoms, don’t report the problem to their doctor. It most commonly begins in middle age, but it can develop in older or younger men. It is unclear what causes the disease. Certain conditions have been associated with increased risk, including an inherited abnormality of human leukocyte antigen B7 and a connective tissue disorder such as lupus; diabetes; vascular inflammation; and vitamin E deficiency. Trauma to the penis, either through injury or an invasive penile procedure, can cause a sudden onset.

Symptoms. Symptoms of Peyronie’s disease may include painful erection, an upward or downward bend or curve in the penis during erection, and a thick layer of hardened tissue on at least one side of the penis. Men may also experience indentation in the penis and a reduction in diameter or length. These symptoms can range from mild to severe and can appear suddenly or develop slowly. In many cases, the disease is associated with a degree of erectile dysfunction, though usually not complete impotence. Other times, there may be no significant pain or the pain may subside, but the curvature can impair intercourse. In about one in five patients, hardened tissue also develops in other parts of the body, such as the hands or feet.

Diagnosis. The plaques characteristic of Peyronie’s disease can usually be diagnosed by a doctor’s physical examination even when the penis is flaccid, although an examination during erection (which can be induced by injection or self-stimulation) may be required to determine its severity. Often, photographs taken at home by the patient are sufficient for the diagnostic process.

Treatment. Treatment aims to reduce any pain and maintain sexual function. In many cases, particularly those that are mild, patients are advised to wait at least 1-2 years to see if the symptoms will resolve themselves. Non-surgical techniques tend to be unproven, although some patients have reported benefits. These treatments include vitamin E supplementation; B-complex vitamins; and injections of calcium channel blockers, collagenase, steroids such as cortisone, and interferon alpha-2b. Surgery can be effective. Surgical approaches include correcting the bending by either gathering tissue opposite the plaque to reduce the curvature, replacing the scarred tissue with grafts made of pieces of vein, dermis, tissues from other parts of the body, or synthetic materials, or by implanting biocompatible plastic cylinders to produce a functional erection. Again, surgery is usually reserved for the most severe and persistent cases; for others, education and time are often enough.

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