While some cases of penile curvature are congenital in nature, the majority of men who present with penile deformity (often with other changes to their erection) are found to have Peyronie’s disease. Much is still to be learnt about this condition which is thought to occur in certain predisposed men to repeated minor trauma during sexual activity. Men are naturally alarmed by the development of this condition and need access to reliable information about their condition, its prognosis and options for treatment.
Peyronie’s disease typically presents with a lump or “plaque” within the tissues of the penis. There is an initial phase of inflammation, which may be associated with pain, but many cases spontaneously resolve within a year to 18 months without treatment. In some patients however, the plaque causes the erect penis to bend and make intercourse difficult. Some men additionally find their erections to be less firm, and a combination of factors including emotional stress may contribute to overall sexual difficulty.
Not all men need treatment, and for many providing information and reassurance about the disease process and its likely outcomes is all that is required. It is important to keep men sexually active despite their condition. Many doctors recommend a variety of medical treatments (tablets, injections etc.) for Peyronie’s disease but there is no convincing evidence that any of the agents used produce any benefit. A small proportion of men with stabilised disease may require surgery if issues with the shape or rigidity of the penis cannot be overcome by other means. Other treatments such as radiation or shock wave therapy are not generally regarded as standard options.
It is important to recognise that surgery should only ever be performed when Peyronie’s disease appears to be stable (i.e. there are no signs of progression). Surgery may be required if a deformity persists which prevents satisfactory sexual activity for the patients or when the penis is too soft, despite medication, to allow penetration. Surgery may take different forms:
Results and patient satisfaction from all of these procedures are shown to be superior when carried out by a specialist in this field. Certain complications such as penile shortening, may be seen with some procedures and it is vital that all men contemplating surgery have access to the best possible information and advice in this area.
Not all men will wish to undergo surgery, nor will they all need to. Many men adapt to having a penis which looks and behaves differently without concern and without the risks of potential changes related to surgery which they would find more distressing in some cases. These observations have led to the development of other options which can be considered.
Collagenase injections: a bacterium called Clostridium produces an enzyme named Collagenase which it uses to break down tissues. This effect has been harnessed to produce a pharmaceutical preparation which can be injected into a Peyronie’s plaque (Xiapex) to allow reduction in curvature when used with stretching or “modelling” of the penis. I have placed a brochure here to explain further its use. This is a newly licenced treatment in Europe, and as such experience and results are in the early stages. This treatment may however be of interest to men who wish to avoid surgery.
Traction & vacuum devices: I have posted here some information available on devices which can be used to mechanically stretch the penis in Peyronie’s disease. These have limited available clinical data, but are safe, free of adverse effects as far as we know and again do not involve surgery.