Peyronie’s disease is a disease of unknown cause characterized by a fibrous plaque in the penis that produces a curvature during erection.
Depending on the extent of the fibrous band, the process may make penetration impossible because of the degree of curvature in the penis or make erection painful.
Symptoms of Peyronie’s disease
Peyronie’s disease (PD) is very common but poorly understood. It is characterized by penile pain, curvature during erection, sexual dysfunction and psychological insecurity.
In the absence of active treatment, most men experience symptoms that worsen over time, with only exceptional cases reporting spontaneous resolution of penile curvature or other deformity. In contrast, penile pain usually improves or resolves in most men.
Psychological repercussions of this disease
Men with this pathology may experience significant distress, the extent of which is not necessarily related to the degree of curvature or penile deformity.
Psychological concerns regarding self-image, appearance and sexual behavior, low self-esteem, anxiety, depression and relationship problems may contribute to the psychogenic component of erectile dysfunction (ED).
Causes of Peyronie’s disease
The exact origin of this disease is still unknown. The most accepted hypothesis is that, in genetically predisposed individuals, repetitive trauma or microtrauma to the erect penis causes inflammation, degradation of the elastic layer and the formation of inelastic plaques.
This scarring process can lead to a number of problems, such as penile deformity, erectile dysfunction or pain during erection.
How is Peyronie’s disease diagnosed?
Generally, patients are slow to come for consultation because at the beginning of the process they do not give it importance or believe that it is a passing situation. For this reason, the average time to consult a specialist is 12 months.
To detect if Peyronie’s disease exists, a physical examination must be performed, in which 90% of patients palpate a plaque or hardness in the penis. This plaque is usually located in half of the cases in the middle third of the penis on its dorsal or upper side.
After the physical examination, a penile ultrasound is performed, which is the most important diagnostic test to evaluate the different pathologies affecting the penis. This study allows the analysis of the different structures of the penis: the corpora cavernosa responsible for erection, the corpus spongiosum which includes the urethra, and the rest of the vascularization composed of a complex arterial and venous network.
The test is performed with the penis in flaccidity and in erection, in order to determine the vascular changes that occur. Erection is achieved by a painless injection of a substance called Prostaglandin E1, which acts without the need for sexual stimulation.
Finally, Doppler ultrasound provides more precise information on the vascular flows of the penile arteries. The advantages of this type of test are: it is non-invasive, painless and does not emit radiation.
Is there a treatment for Peyronie’s disease?
When choosing treatment, several factors should be taken into account: the stage of the disease, the presence of pain, the severity and direction of the curvature, the length of the penis, and the quality of erectile function.
In the initial/acute phase of this pathology, non-surgical treatments are aimed at relieving penile pain and minimizing disease progression with stabilization of inflammation, plaque formation and penile deformation.
During this stage it is normal for oral therapies to be indicated, although to date there is no strong data to support their use as monotherapy for Peyronie’s disease. In addition, penile traction therapy and intralesional injections into the plaque may be indicated, resulting in modest improvements for many patients, especially when used early in the onset of symptoms.
Many local treatments have been tried with injection of different substances into the plaque, but the truth is that they have not shown real efficacy. In 2013 the first drug for the treatment of this disease was approved: collagenase. This treatment has limited results reducing the curvature by about 15-17º in the best of cases.
Faced with this situation, there is also the option of surgery. This is offered when medical treatments have failed and the degree of penile curvature makes sexual intercourse impossible or when the patient requests it because of the psychological impact on his daily life.
To date, penile curvature correction surgery is the main treatment for penile deformity, with consequent relief of sexual distress.
This surgical treatment can be penile plication, plate incision, partial excision or grafting. These approaches represent the fastest and most reliable approaches to correcting the penile curve once symptoms have stabilized.
For patients with erectile dysfunction who do not respond to pharmacologic treatments, penile prosthesis placement is also available as an alternative.