Peyronie’s Disease (Abnormal lump, bump or curve of penis)
By Dr. Bhavik Shah and Dr. Chirag Dave, Advanced Urology
Updated 9:26 AM ET, Mon Jan 20, 2020
Summary
If you’ve noticed a painful curve in your penis, you may have Peyronie’s disease. All penises vary and can have a slight curve but with Peyronie’s disease, the curve is significant and sometimes painful. It’s usually associated with hard lumps or bands of scar tissue just underneath the skin.
Understanding Peyronie’s Disease
The penis is made of a spongy material that fills with blood and expands during an erection. With Peyronie’s disease, the fibrous scar tissue restricts the blood flow and stops the spongy tissue from expanding with the rest of the penis. This is what causes the penis to curve while erect.
Doctors don’t know exactly what causes Peyronie’s disease but it could be described as wound healing disorder. Usually, after an accident or some sort of repeated or persistent trauma form attempts at having sex with a partially or non-erect penis. The penis will essentially overcompensate the healing process and cause too much collagen to build up and form a fibrous plaque, which is the hard lumps under the skin of the penis. Sometimes, it will correct itself, but the curve is more likely to remain the same or even become worse. The curve can be so drastic that it will make sexual intercourse extremely painful or practically impossible. If you’ve been diagnosed with Peyronie’s, there’s a range of treatment plans ranging from oral medication to minor surgery that can correct the curvature of the penis.
What Causes Peyronie’s Disease?
It isn’t exactly known what causes Peyronie’s disease, but most doctors believe it’s is caused by prolonged trauma or damage to the penis usually through sex or physical activity. Sometimes, even regular intercourse over a period of time can damage the penis and cause Peyronie’s disease. Beyond damaging the penis, there are several less common causes Peyronie’s disease.
Low Testosterone
Recent studies have shown a relationship between low testosterone and Peyronie’s disease. Speak to your doctor about testing your testosterone level during your next checkup.
Medication Side Effects
Some medications will have Peyronie’s disease as a possible side effect. Although the possibility is low, many beta blockers like Acebutolol may have an association with Peyronie’s disease.
Genetic
It may be hereditary. Some studies may have found a connection between a dominant gene and the possibility of Peyronie’s disease. Other inherited disease, like connective tissue disorder, may also cause Peyronie’s disease.
There are two stages of Peyronie’s disease: Active phase and Chronic phase.
Active phase of Peyronie’s Disease
This is the first stage of the disease and usually lasts the first 12 to 18 months. This is called the active (or acute) phase because this is when the physical changes to the spongy tissue is actively happening. He most common symptom of this phase is penile pain and active worsening of the penile curvature or deformity. Often times there may be worsening of erectile dysfunction during this phase related to scar tissue formation within the spongy tissue of the penis. The end result of this phase may be a change in penis shape caused by the fibrous scar tissue collecting under the skin. Some penis deformities men find are indentations, hourglass narrowing, penis shrinkage, and loss of girth but the most common is a bend or curve.
During this phase treatments goals direct towards controlling the pain and inflammation and reducing further scar tissue formation. Early treatment may slow or stop the progress of the disease so seeking medical treatment earlier is always better than waiting around to see if it gets worse.
Chronic phase of Peyronie’s Disease
Chronic or Stable Peyronie’s disease usually occurs after 12 to 18 months of the onset of the first phase. Usually, the symptoms of the disease will be stabilized by this point, hence the name. There is typically no penis pain during this phase, although if there is a resultant bend, you may have pain or discomfort to you or your partner during intercourse. The bend or erectile dysfunction does not worsen during this phase.
At times, Acute Peyronie’s disease will flare up and cause more damage to the penis. You should seek treatment immediately after noticing your Peyronie’s disease, but it’s never too late for treatment. Although, the farther along the disease, the more drastic the treatment plan.
What to Expect When Seeking Treatment for Peyronie’s Disease: Diagnosis & Testing
Peyronie’s disease is a painful condition that affects men. While the exact causes of Peyronie’s disease aren’t clear, doctors suspect it is caused by injury to the penis. Often, a history and physical exam is sufficient to identify Peyronie’s disease however a medication is often times used in clinic to induce an erection and evaluate the severity of your disease. Ultrasound of the penis can be used to evaluate the blood flow of the penis and can help measure the size of the underlying Peyronie’s plaque and can also evaluate for underlying erectile dysfunction.
If you are experiencing any of the symptoms of Peyronie’s disease, you will want to see your doctor as soon as possible so that he or she can diagnose and treat it. You should see an Atlanta urologist if you experience any or all of the following:
- You are prevented from having sexual intercourse due to the pain.
- Your partner experiences discomfort.
- Having an erection is painful.
- Maintaining an erection is difficult.
Typically, you will know when it’s time to see a urologist as the symptoms can be painful and uncomfortable. It’s important that you seek a diagnosis and treatment as soon as possible so you can get back to your life.
How Do you treat Peyronie’s Disease?
Treatments during the Active Phase of Peyronie’s Disease:
Oral Drugs and topical Agents:
- Treatments with oral medications or topical agents are typically directed towards pain control and improving blood flow. Medications that may be given during this phase include:
- NSAIDs (ibuprofen or naproxen)- this is often times given to control pain and acute phase inflammation
- Tadalafil (Cialis)- This is a PDE5 inhibitor that is also used for men with erectile dysfunction. During the active phase, it is used to promote penile blood flow in hopes of decreasing scar tissue formation by sending healing cells to the area of concern
- Pentoxyfylline- this medication both increases blood flow, similar to Cialis, as well as has anti-inflammatory properties, similar to NSAIDs.
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- Verapamil – Normally used to treat high blood pressure, this oral or topical medication has shown promising signs for correcting the curvature of the penis by breaking up the scar tissue all while reducing pain.
- Interferon – This less commonly used agent may break up the scar tissue in the penis caused by Peyronie’s disease. This may be injected or is sometimes used as a topical agent.
Supplements or Natural Products for Peyronie’s disease
o For Peyronie’s disease, like any disease, there is no natural alternative to conventional medicine, although there are natural remedies that can help with your treatment plan and keep your body healthy. Herbal supplements and vitamins haven’t been proven to affect recovery but there is data that show an increase in health. The most common are:
- Vitamin E – This vitamin is known to help break up collagen and fat. Although there is insufficient data that it helps with Peyronie’s disease.
- Acetyl-L-Carnitine – An amino acid that is naturally produced in the body. It is a precursor to nitric oxide and can have an effect similar to Cialis in promiting blood flow to the penis. Some data has shown that it helps with Peyronie’s disease.
- L-argenine- Another amino-acid that is commonly found in red meats, poultry, fish, and dairy products. It has similar effects to L-Carnitine.
- Para-Aminobenzoic Acid – A naturally forming chemical found in folic acid. It’s used for several skin issues including Peyronie’s disease.
Traction Devices and Vacuum Erection Devices
- Traction devices, such as the RestoreX device, are used to stretch the scar tissue out and align the penis. It is typically placed for 30-90 minutes a day.
- Vacuum erection devices are a more cost effective way to allow for both upward traction on the penis as well as increased blood flow. This is typically used for 15 minutes at a time, twice a day.
Xiaflex:
- Xiaflex is a collagenase (scar tissue dissolving medication) that is injected into the penis. It is FDA approved for stable peyronie’s disease but there is some evolving data suggesting benefit during the active phase as well.
Electroshock Wave (ESWL) Therapy:
- ESWL therapy may be of benefit for reducing penile pain related to Peyronie’s disease. Reports have shown that this treatment does not break Peyronie’s scar tissue or improve the penile bend.
Treatments during the Stable (Chronic) Phase of Peyronie’s Disease:
Xiaflex:
- Is a collagenase (scar tissue dissolving medication) that is injected into the Peyronie’s plaque. It is given in cycles of two injections followed by 4 weeks of molding. It is typically given over a total of 4 cycles (24 weeks of treatment) and is a non-invasive treatment option that has been shown to help reverse any penile bend caused by scar tissue of greater than 30 degrees. This is only recommended for men with good erectile function.
Penile Plication Surgery:
- This is a minor surgery that involves correcting the penile bend by shortening the side opposite to the bend. Healing time is as quick so 2-3 weeks. This can result in minor shortening of the overall penile length. This is a great option for patients with a 30-60 degree bend and good erectile function.
Penile Lengthening Surgery:
- There are several surgeries that can be done to correct the bend and simultaneously improve penile length often times lost due to the Peyronies disease. Many of these surgeries involve lifting the penis nerves and cutting the plaque itself to release it. The major risk of these surgeries include possible loss of sensation from lifting the nerves and erectile dysfunction from cutting into the spongy tissue of the penis. These surgeries are more commonly recommended with simultaneous penile implant surgery in patients with greater than 60 degree bend, concern for about their penile length, and simultaneous erectile dysfunction.
Penile Implant Surgery and Penile Molding:
- Penile implants allow men to have an erection by replacing the spongy tissue inside the penis with a special device. There are two types of implants, semi-rigid and inflatable. Each device has its advantages, but for Peyronie’s disease, the inflatable device is most recommended. The inflatable penile prosthesis is the gold standard treatment for patients with both Peyronie’s disease as well as erectile dysfunction. Click Here to Learn more about IPP (Penile Implant).
- After placement of the penile prosthesis, the penis can usually be molded in the operating room correcting minor bends less than 40-50 degrees. Patients with bends that are not corrected with molding can undergo other procedures listed above at the same time as their penile implant surgery.
Peyronie’s disease will sometimes go away on its own, but in most cases, it will worsen over time. It is recommended you consult a Urologist with experience treating this disease if you have experienced any new onset erectile dysfunction or penile pain, felt any scar tissue formation, or noticed any abnormal bend to the penis. The most common reasons to seek out a Urologist are:
- The pain has hindered you from having sex
- The bend of your penis causes you or your partner discomfort.
- You experience pain or discomfort while your penis is erect.
- You have difficulty maintaining an erection.
- You experience stress or anxiety in your relationship with your sexual partner.
- You have had trouble having a child because intercourse is uncomfortable or painful.
A Peyronie’s disease specialist may prescribe you with oral medication or injections directly into the penis that will correct the curvature over time or may suggest surgery to correct the deformity. Most surgeries for Peyronie’s disease are relatively simple. You can expect to be home from the hospital in bed that day. Most doctors will recommend abstaining from sex for 4-6 weeks after treatment.
At this point, you’ve probably researched your symptoms online and come to a conclusion about your condition. Maybe you’ve entered queries like “where to get Peyronie’s disease treatment near me” or “urologist near me.” If this is you, Advanced Urology in Atlanta is here for you. Call Advanced Urology today at 404-341-5219 to learn more about treatment options and make an appointment.
Is Surgery for Peyronie’s Disease Right for You?
In most cases, the doctor or specialist will recommend surgery before any other treatment. Unless the patient has a compromised immune system, surgery is usually the best option to treat Peyronie’s disease. Correcting the curvature of the penis and eliminating erection pain is the main priority of all the treatments. If you suspect you’re suffering with Peyronie’s disease or if you’ve recently been diagnosed with Peyronie’s disease, you should seriously consider surgery as your first option for treatment.
At this point, you’ve probably researched your symptoms online and come to a conclusion about your condition. Maybe you’ve entered queries like “where to get Peyronie’s disease treatment near me” or “urologist near me.” If this is you Advanced Urology is here for you. Call Advanced Urology in Atlanta today at 404-341-5219
to learn more about treatment options and make an appointment.
Some other factors to consider regarding any surgery are:
- Age – The older you are, the more risks there are with surgery.
- Immune system – If your immune system is easily compromised from a separate condition or disease, you’re at more of a risk for infection from surgery.
- Aversion to surgery – If your religion or culture is against surgical procedures, other, less effective options are available.
Your Atlanta urologist or specialist will take all those factors into account before recommending surgery after looking over your tests and screening results.
