Peyronie’s disease is a disease of unknown cause whose main characteristic is the appearance of a curvature of the penis during erection. In many cases, the patient has a fibrous plaque in one of the sheaths surrounding the penis that can be palpated. It usually appears in men from 45 years of age onwards.
Peyronie’s disease
This process begins as an inflammatory reaction in the layer that surrounds the corpora cavernosa of the penis called tunica albuginea; this inflammatory response ends up transforming into a fibrous and non-elastic scar that causes the penis to curve during erection. It is also possible that this scar does not appear and the patient presents a significant curvature.
The origin of this pathology remains unknown, although the most accepted theories speak of an inflammatory process suffered by the penis during sexual activity, which would cause an abnormal scarring in a part of the penis in genetically predisposed individuals.
In theory, it can occur in all men since we do not know the true factors causing this process. In case of doubt, it is recommended to visit a specialist in Urology for diagnosis.
Symptoms of Peyronie’s disease
Peyronie’s disease has a series of characteristic symptoms:
- In the early stages, there may be pain on erection. The pain starts during the inflammatory phase of the disease and tends to disappear a few months (3-6 months) after the onset of the process.
- Curvature of the penis during erection. The incurvation can occur on the dorsal side of the penis, which is the one we see when we look down, although it can also occur on the lateral or central sides.
- Erectile dysfunction when the curvature is significant
- Narrowing of the penis
- Decrease in penile size
The diagnosis of Peyronie’s disease
The diagnosis is simple because the patient provides photos in erection where the curvature is clearly seen; also by inspection, in many cases, the area of fibrosis in the penis can be palpated.
An important test is the performance of a penile Doppler ultrasound with Prostaglandin E1 test, since it allows evaluation of the penis in erection with its vascularization, assessment of erection problems, visualization of the size of the plaque, degree of curvature, etc.
This disease cannot be prevented since we do not know its true origin and the main factors that produce it.
Treatment of Peyronie’s disease
In the medical literature, there are a multitude of treatments that have not demonstrated any proven efficacy. In the painful phases of the disease, low intensity shock waves can improve pain.
In complex cases, lateral curvatures, with severe erection problems, the only solution is penile reconstructive surgery which allows the curvature to disappear. There are multiple surgical techniques but to avoid the significant loss of penile length, biological patches are used to cover the plaque when it is incised or removed. These techniques allow the penis to be reconstructed with good results. Most of these surgeries must be performed by expert surgeons dedicated to penile surgery.
The risks of treatment can be loss of penile length, post-surgical bruising, swelling of the penis that can last for days or weeks, or in some cases, risk of erectile dysfunction. Many of these inconveniences, if they arise, have a good response to the various post-surgical treatments.
In patients with erectile dysfunction that does not respond to drug treatments, the only option is the placement of a penile prosthesis with curvature surgery. It usually has excellent results.
Collagenase, a biological drug to combat Peyronie’s Disease
In 2013, the first medication for Peyronie’s disease or penile curvature was approved: collagenase from Clostridium histolyticum. It is indicated for patients with penile curvature of at least 30 degrees. Collagenase is a biological drug made from Clostridium histolyticum. This drug works by undoing the accumulation of collagen or fibrous plaque responsible for the curvature.
This treatment is based on several treatment cycles. In each cycle, the drug is injected directly into the plaque causing the curvature and the procedure ends by performing a penile modelling. Sometimes, several cycles of injections are needed.