What is Peyronie's Disease?
Peyronie’s disease is a benign condition that can result in changes to the penis. These changes include curvature, shortening, narrowing, indentations, discomfort, and associated problems with sexual function. It is usually a result of some injury; however, most patients do not remember a specific injury to their penis. This injury usually results in scar tissue or “lumps” in the penis that can be felt by the patient.
In most cases, this condition is treatable with observation, minimally invasive treatments, or surgical repair.
The Peyronie’s Program at Yale Urology is run by Dr. Stanton Honig, a national expert in Peyronie’s Disease. He has a large practice of Peyronie’s patients and over 22 years of experience treating the disease. The Phase II and Phase III clinical trials for the new drug Xiaflex were run by Dr. Honig as part of his Peyronie’s disease practice. He continues to have one of the largest Peyronie’s practices in the Northeast.
After a thorough history and physical exam, and once the patient is in a stable state of disease, further evaluation and testing is recommended. This usually includes a duplex ultrasound with injection of an active agent to initiate an erection in an office setting. This will allow Dr. Honig to evaluate the blood flow to the penis and the degree of curvature to formulate a personalized plan that best suits your needs.
Minimally Invasive Treatment
Minimally invasive treatment is personalized to the degree of curvature, the degree of bother, and any other associated sexual dysfunctions. Very often in patients who can function sexually and have minimal curvature and minimal bother, observation and reassurance is a reasonable first step. Patients with at least a 30-degree curvature and/or significant bother are candidates for minimally invasive treatment with intralesional therapy with either Xiaflex (collagenase) or verapamil.
Intralesional verapamil has been used for years in the treatment of Peyronie’s disease. This is an off-label treatment and involves 6 injections of the medication over a 12-week period. Approximately 50% of patients will show some improvement in curvature and bother with minimal side effects. There is usually minimal bruising and no limitations on sexual activity during the treatment protocol.
Intralesional Xiaflex (collagenase)
The Xiaflex protocol involves 4 six-week cycles over a period of six months. Each cycle includes two injections of collagenase followed by patient-administered stretching and modeling of the penis. This treatment gives a higher success rate in terms of improvement of curvature and improvement in bother and is FDA approved for this indication. There are limitations on sexual activity during these cycles, and side effects includes bruising, swelling, and a less than 1% risk of injury to the penis that will require an operation to repair.
Surgical repair of Peyronie’s disease is very successful in treating curvature.
Penile plication to correct curvature involves a minor outpatient surgical procedure. The treatment does not involve removing the scar tissue but actually puts sutures on the opposite side to bend the penis back to its correct angulation. Most procedures will correct curvature to within 10 degrees of straight. Risks can include bleeding, infection, incomplete straightening, shortening to the penis, and a small risk of changes to sensation of the penis. Almost all patients will have a slightly shorter penis, but in most cases this will not interfere with intimate relations.
Incision of Plaque and Graft Placement
In patients who have more than 70 degrees of curvature, a more involved outpatient procedure to correct the curvature may be necessary. In these cases, the scar tissue is incised and a graft of tissue is laid in place to allow for correction of the curvature. This, sometimes in combination with penile plication, is an excellent option to improve curvature of greater than 70 degrees. Depending upon your preoperative evaluation of blood flow to the penis, there may be a decrease in erection quality of between 10 and 50%. There may also be a higher risk of changes in sensation to the penis.
In patients who have a combination of significant curvature and significant erectile dysfunction, the placement of a penile prosthesis is an excellent option to fix both problems at once. This procedure has a success rate of over 95% in correcting both problems.