Early treatment critical for Peyronie's disease

Peyronie's disease is a common yet poorly understood condition. Between 8% and 10% of men in their mid-teens to their 80s have signs or symptoms of Peyronie's disease.

It is a noncancerous condition that is a result of scar tissue developing on the penis. This causes curved and painful erections. It can prevent sexual intercourse, lead to penile shortening, and could make it difficult to get or maintain an erection. Peyronie's disease can cause significant stress and anxiety.

Early evaluation and treatment is important, as Peyronie's disease rarely goes away on its own. Without treatment, only about 10% to 15% of men experience symptom relief in one year, while symptoms worsen for about 45% of men.

Causes

In some cases, Peyronie's disease is caused by an injury to the penis during sex, athletic activity or an accident. During the healing process, scar tissue forms in a disorganized way. When the penis becomes erect, the scar tissue doesn't stretch, and the penis curves, bends or becomes disfigured. This can cause pain, as well.

Often, men cannot recall a specific episode of trauma. In those cases, it could be a result of excessive pressure creating microtrauma or a genetic predisposition to abnormal scar tissue formation or connective tissue disorders.

Early treatment

Peyronie's disease begins in the acute phase, which can last three months to one year. This is often associated with pain with erections and the initial development of curvature. Early diagnosis and treatment may be able to halt or treat the curvature with nonsurgical means. This is why it's important to seek treatment early.

Most often, treatment in the acute phase may include:

• Penile traction therapy
  This involves stretching the penis with a self-applied device to improve penile length and curve while correcting any deformity. It is worn for as little as 30 minutes to as much as eight hours a day. It's the only treatment shown to improve penile length.
• Injection therapy
  Some medications can be injected directly in the penile scar tissue. One example is collagenase, the only medication that the Food and Drug Administration has approved for the disease. This medication breaks down the buildup of collagen. Verapamil and interferon are other injection options. They disrupt the production of fibrous tissues and are shown to reduce pain.

Oral medications aren't recommended during the acute phase, as they haven't been shown to be effective.

Treatment for chronic symptoms

The chronic phase happens later in the disease and generally occurs around three months to one year after symptoms begin. It is when the curvature stabilizes, and pain typically resolves.

While penile traction and injection therapy are a part of the treatment plan during the chronic phase, surgery is another option and is the most definitive treatment. Surgery, however, is not recommended until symptoms have stabilized for at least three months.

Some common surgical options include:

• Suturing the unaffected side (penile plication)
  A surgical procedure can be performed on the side of the penis with no scar tissue. The surgeon cinches together the excess tissue on what had been the outer side of the curve by placing a series of stitches or "tucks." The final penile length will depend on the length of the shorter side — the side with the scarring from Peyronie's disease. It's usually for men with less severe curvatures.
• Grafting (plaque incision and grafting)
  During this procedure, the scar tissue is cut, and a piece of tissue called a graft is sewn into place to cover the gaps. This procedure is generally for men with more severe curvature or deformities and excellent erectile function.
• Penile implants
  Often, men with Peyronie's disease also are affected by erectile dysfunction. The best treatment to correct both conditions is placement of an inflatable penile prosthesis. This device is implanted within the erectile bodies of the penis with a small pump in the scrotum. With inflation of the device, the man can have a firm, long-lasting erection, with minimal to no curve, hinge or indentation deformity.

A urologist can explain the benefits and risks of all treatment options and recommend a treatment plan based on your current erectile function, duration of symptoms and personal preferences.

David Yang, M.D., is a urologist in Mankato, Minnesota.