Erectile dysfunction no more
Men with Peyronie's disease are often surprised to hear it affects one in thirty males, as it is not a condition that receives much publicity nor is it something that men discuss amongst themselves. Peyronie's disease affects the penis, usually causing painful erections, lumps in the penis and a bend in the erection.
The condition is caused by damage to the penile tissue creating a scarring under the skin, known as a plaque. Depending upon the size and location of the plaque, it can cause the penis to bend upwards, downwards or become indented. Its affect upon an individual should not be underestimated however, with painful and often poorer quality erections greatly interfering with sexual intercourse and the resultant negative effect on quality of life and self esteem. Relationships suffer.
Who is at risk?
Smokers and diabetics are at higher risk and it is believed that the repeated trauma of intercourse leads to the deposition of scar tissue which develops into the lumps within the penis, medically known as Peyronie's plaque.
How do doctors assess Peyronie's disease?
When assessing someone with Peyronie's, it is helpful to inquire whether there has been any injury to the penis, but it is most important to enquire about pain on erection, degree of curvature and associated erectile difficulties. In the early or inflammatory phase of the disease, pain will be present and curvature to a lesser extent. This phase can last up to a year.
Curvature is a later feature and typically occurs upwards, but can bend in any direction and occasionally cause 'hour-glass' deformities which make the erection unstable. Photographs of the curve are useful, but the best way to accurately measure curvature is to give an injection into the penis to produce an erection that the clinician and patient can examine together. GPs should refer to a specialist any patients who are having difficulty with intercourse, whether that is due to pain or the angle of the curvature.
Men who are suitable for corrective surgery are those whose curve has been static for six months and are unable to have penetrative sex. An upward curve of up 30 degrees often does not need correcting as it is unlikely to interfere with vaginal sex. For those men in the inflammatory phase who are not yet suitable for surgery, there are unfortunately no well proven medical therapies. The use of a penile traction device, worn during the day for six months, has been proven to diminish curvature and also produce lengthening and is strongly recommended.
Surgery for Peyronie's disease
Surgery, once the condition is static consists of three operations. A Nesbit (or "shortening") procedure is by far the most common procedure in which the longer side of the penile curve is operated upon to make it shorter, producing two sides of equal length and a straight penis. The penis at the end of the operation will be the same length as the stretched flaccid length pre-operatively, so in reality there is no loss of 'usable' length. This operation has high (>85%) satisfaction rates and low erectile dysfunction rates.
Grafting procedures are reserved for men with severe deformities, be that curvatures approaching 90 degrees or hourglass deformities, and is a far more involved operation. Sometimes referred to as the Lue procedure, it requires dissection of all the nerves and blood vessels to allow placement of a graft at the site of the plaque to make the diseased, shorter side, the same length as the longer healthy side. This comes at the price of a much higher erectile dysfunction rate however.
Finally, one can consider implantation of an inflatable penile prosthesis for men with severe erectile dysfunction accompanying severe Peyronie's.
Erectile dysfunction no more
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