Peyronie's disease is a condition in which localized inflammation develops into scar tissue, forming a hard plaque within the penis. The hard plaque can be very painful and, depending on the location of the scar tissue, often causes the penis to bend upward or downward during erections. Researchers aren't sure what causes Peyronie's disease, but believe it can stem from either an injury or genetic factors.
If a man is experiencing inflammation in the genital area and related symptoms, a urologist can help make a diagnosis. After Peyronie's has been diagnosed, a physician may suggest a patient wait a year to see if the condition resolves with nonsurgical treatments. If less conservative measures fail, surgery may be recommended.
Nonsurgical Treatments of Peyronie's Disease
Because the cause of Peyronie's disease is not fully understood, treatment is often experimental.
Medication
Medication can be taken orally or injected directly into the plaque in the penis. Some men prefer injections because they deliver a higher dosage and have the ability to treat the problem at the source.
Oral medications may include:
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Vitamin E -- Some small studies have found significant results when vitamin E oral supplements were taken at the first sign of Peyronie's disease, but further research is needed to determine its effectiveness. For some, the antioxidant has been known to reduce pain and penile curvature, but most patients have seen no change in their symptoms at all.
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Potaba -- Other small studies have found Potaba (potassium amino-benzoate) to be successful in reducing the size of the plaque, but not in lessening the penile curvature. Treatment consists of taking 24 pills a day for three to six months, and can cause stomach upset.
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Tamoxifen -- This anti-estrogen medication, most often used as for breast cancer therapy, may encourage the release of a protein that halts the body's inflammatory response and thus slows plaque development. Some men experience a reduction in pain, plaque size, and penile curvature. So far, however, there have been no placebo-controlled studies to prove the drug's efficacy for Peyronie's.
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Colchicine and carnitine -- Colchicine (Colcrys) is an anti-inflammatory that decreases collagen production and may break apart the hard plaque. Carnitine is an antioxidant that may encourage wound healing. No controlled studies have been completed on either of these therapies, and they have yet to prove more effective than a placebo.
Injected medications may include:
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Verapamil -- Verapamil is a calcium channel blocker that disrupts collagen production. Some studies have found it reduces pain and curvature of the penis.
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Interferon alpha-2b -- This immune-system protein may work by stopping cells from producing collagen. It may also produce collagenase, an enzyme that breaks down collagen. A large placebo-controlled study found interferon injections to be effective for penile pain and curvature. Sexual function also improved.
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Collagenase -- Collagenase is an enzyme that breaks down collagen. It may also break down the plaque, and researchers are currently investigating this possibility.
If these measures aren't enough to improve a man's symptoms, a surgical approach may be necessary.
Surgical Treatments for Peyronie's Disease
Surgery is only recommended when the condition is stable, has lasted for over a year, and interferes with sexual intercourse. Surgical options for Peyronie's disease include:
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Grafting -- This surgical procedure straightens the penis and restores its length by removing or slicing the plaque and replacing it with a skin graft (using a piece of healthy skin from another area of the body). This is a difficult procedure that may result in erectile dysfunction and numbness.
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Nesbit procedure -- This approach, which corrects the penis arc (curve), involves making an incision along the penis and then pulling down the skin to expose the underlying tissue. The penis is straightened, and the excess tissue on the outer side of the curve is either cinched together or removed. This method is less likely to result in erectile dysfunction or numbness, but may reduce penis size.
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Implantation -- An implanted prosthetic penile device may improve the penis' rigidity and help straighten it. In some cases, this approach can be combined with other methods.
Prognosis for Peyronie's Disease
Injection therapy to treat Peyronie's disease typically has a good prognosis, though multiple injections may be necessary before they result in decreased pain and penile curvature. But injections and many nonsurgical treatments may not always be effective and can result in more scarring. Surgery can have a higher success rate, with symptoms usually improving after six months. But among other side effects, surgical approaches can cause impotence, which is why these approaches are only recommended when the condition is severe. While new treatments are being investigated, there is currently limited evidence on their effectiveness and side effects.
References
Weidner W, et al. (2005). Potassium Paraaminobenzoate (POTABA) in the treatment of Peyronie’s sisease: A prospective, placebo-controlled, randomized study.
Riedl CR, Sternig P, Gallé G, et al. (2005). Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study. European Urology 48 (4): 656–61.
Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, et al. (2003). Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU International 91 (6): 522–4.
Riedl CR, Plas E, Engelhardt P, et al. (2000). Iontophoresis for treatment of Peyronie's disease. The Journal of Urology 163 (1): 95–9.
