Peyronie’s disease is a problem revolving around the male sexual organ, the penis. Specifically, the scar tissue is known as plaque forms within the organ. This can result in a genital organ that is bent rather than straight. Men with this disease can suffer during intercourse and suffer from erectile dysfunction or ED as well. Based on the kind of symptoms, you may be required to opt for surgery. Medicines and observation, as well as care under doctors, can serve as a critical step for recovery. Peyronie’s disease results when the scar tissue develops inside the organ and is fibrous in nature.
This can cause a problem in sexual functioning. As the male penis varies in size and shape, there may not be a problem necessarily. But for most men with Peyronie’s disease, significant pain and discomfort are experienced. As per the National Institute of Health, close to 1-23 percent of men between 40 to 70 years of age are impacted by Peyronie’s disease. If the bend in the organ is severe or causes pain, this can interfere with the ability of males to engage in intercourse. Peyronie’s disease can also trigger anxiety, stress, and depression. In some cases, it may retreat, or the person might recover. In other cases, the condition might get worse. Treatment will be needed if the curvature is significant enough to cause a bend in the organ and interfere with normal functionality.
Causes
Table of Contents
The reasons for this disease are not understood. It is most commonly the result of damage to smaller blood vessels taking place during intercourse, sports events, a physical blow or a vehicular accident. Cells become trapped when injuries take place during the process of healing. This results in the formation of scar tissues.
The male sexual organ has tubes on either side known as corpus cavernosum. These are composed of small blood vessels called capillaries. The corpus carnevosum is in a tissue casing of elastic skin called tunica albuginea. When the organ faces injury, this tissue comprising the elastic casing suffers damage. Effective healing results in no issues. But if there is a scar tissue, the patient can develop this disease as the casing loses its elasticity.
Wound healing can be impacted by factors such as heredity, connectivity tissue disorders or even old age. Those with kin or family who have Peyronie’s disease are more prone to it. The appearance of Dupuytren’s contracture, a thick development of tissue also causes Peyronie’s disease to be more common. Older males are more likely to develop scars while healing.
Impairing sexual functioning, Peyronie’s disease can damage a man’s self-esteem as well. Plaque building up starts with inflammation that hardens. It reduces elasticity and leads to pain, discomfort, and ED.
Doctors are not aware of what exactly causes the disease to develop. Researchers hold that fibrous plaque can begin post-trauma such as injury or bending that leads to penile bleeding. The injury or trauma may not even be noticed. In certain cases, the disease may be linked to injury as well as genes.
Certain medications may also trigger Peyronie’s disease.
Symptoms
This disease can lead to psychological stress apart from physiological pain. Symptoms of the disorder may come about suddenly or over time. There is curving of the male sexual organ downward, sideward, or up depending on where the plaques develop. Sometimes the organ may narrow at a certain or specific point. The bend becomes pronounced and the curve stays the same for others. Other symptoms are as follows.
Scar tissues may be felt under the organ. It forms like a hard tissue band, flattening lumps. Additionally, those with this disease may face difficulty in erections and maintaining regular length. Pain can also be experienced during intercourse and this may go away post a few months sans treatment.
The first symptoms of the disease are the hardening of fibrous tissues along the shaft of the male sexual organ. The hardening can smoothen or appear like a lump. Along with these symptoms, self-esteem deficits may also be noted.
Diagnosing the disease requires a health professional to physically examine it. As fracture or penis injuries lead to hardening or scarring of tissues, such as radiation, diagnosis can only be confirmed through physical examination.
Experiencing pain, bruising or inflammation of the male sexual organ in regular course or post intercourse can also be indicative of this disease. This disease is more likely as males get older. Symptoms can appear in one go or overnight.
When the organ is flaccid, the problem may not be clear. But when it tightens, the plaque hampers flexibility. Common symptoms include scar tissue, a bend in the organ, problems in maintenance of erection and pain can result.
Your doctor can help. The specialists in the medical field can examine the organ. An X-ray or ultrasound may also be required. When doctor examinations do not confirm the disease, the condition develops fast, the doctor may carry out a biopsy. This removes tissues from affected lab tests.
Treatment
As the condition enhances without treatment in some individuals, doctors often suggest waiting for a couple of years before correcting it. With new nonsurgical option shock- wave therapy, there is no need to wait anymore.
Shock Wave Therapy
Shockwave therapy for PD is also known as extracorporeal shock wave therapy/treatment. It is a pain-free or mild non-surgical procedure that delivers shockwaves to penis plaque to break up and stimulate healing. This approach is used for treating and breaking kidney stones is successful. Use of electroshock wave therapy has yielded many benefits.
In one study, reductions of plaque were seen in 27 of 56 individuals given shock wave treatment. There was also an improvement in sexual performance and abation of pain. The 2000 research study, therefore, concluded that shock wave therapy along with injections of medicines like verapamil offers effective nonoperative treatment for stabilizing Peyronie’s disease. Electroshock wave therapy also reduces the number of later treatments required for Peyronie’s disease. Electroshock wave therapy can also prevent the advancement of the disease, whether it comes to increase in average plaque size or degree of curvature of the male sexual organ.
Shockwave therapy works by applying low frequency, high-pressure sound waves on the injured area namely the penis plaque in case of Peyronie’s disease. Shockwaves can be applied through the use of external devices and local anesthesia would be performed under this condition. Shockwaves are from two to three thousand per session. Generally, men with this disorder undergo anywhere between 3 to 5 sessions and more than ten total sessions are not recommended.
Peyronie’s shock wave treatment is only for men who have reached a stable stage when disease and the symptomatology associated with it has stopped progressing. It involves the use of wound healing with scar tissue. Electroshock waves break down the scar tissues and the area becomes calcified by trauma and boosts the process of curing the trauma.One of the biggest advantages of this therapy is that it is noninvasive. Additionally, it is a safe procedure with low chances of and mild side effects while complication rates tend to decrease. Moreover, the treatment can also be safely coupled with other forms of therapy or medication.
Other Avenues of Treatment
Some cases of the condition need treatment. Pain comes from this disease and is generally mild. As repeated injuries or accidents occur, and scar tissues form in a disorganized manner, it leads to a nodule that can be detected during the formation of the disease. If treatment is required, surgery or medicine may be needed.
Medications
These include capsules and tablets like potaba and pentoxifylline. If this does not impact the scar tissue, injection shots of Xiaflex or verapamil may be inserted to prevent hardening of scar tissues.
Operations
A common surgery for removing the plaque and getting tissue graft in its position is a treatment of choice if medication does not work. Additionally, surgeons may alter or remove the issue on the organ opposite the plaque leading to bending or curvature of the male organ being corrected. The prosthesis may also be used for those with Peyronie’s disease/PD or ED.
Different types of surgeries help. Most doctors operate only if the bend in the organ is severe.
Other Options
There is inconclusive evidence on the use of Vitamin E capsules with potassium aminobenzoate associated with B vitamins. These are not cures which are proven. Yet another way to treat the disease is radiation therapy or injection. It is rarely carried out though because pain does not stop many times post the treatment. The discomfort fades as the inflammation subsides, but this process can take between six months and 3 years.
Symptoms of the disease may resolve on their own or remain mild to prevent treatment. For those who do not experience recovery, injections of corticosteroid into the tissue which is hardened could be a line of treatment too. Apart from surgery and injections, Interferon Alpha 2B may be used. Additionally, a type of shock wave therapy called lithotripsy may also be applied.
Effectiveness of Treatment
Treatment impact varies from person to person. Some side effects can cause infertility in males too. Disease-based medications like interferon alpha 2B can cause diminished penile curvature. But corticosteroid injections can have side effects such as damage to tissue. While there is no cure for this disease, it can be treated and go on its own. Medication may be recommended, or the doctor may adopt a wait and watch approach.
Drugs injected into the organ or surgery can be a solution. But it should be noted that Clostridium hystolyticum or Xiaflex is the only FDA approved drug for curves of more than thirty degrees. Collagen building needs to be broken down as well and injections may be applied for this purpose.
Non-Surgery Options
Another treatment for PD is Iontophoresis which involves the use of weak currents of electricity to deposit medication under the skin. Traction therapy, shock wave therapy, and vacuum devices can result in better outcomes. Changes in lifestyle can also lead to better health, such as regular exercise, quitting smoking, reducing alcohol consumption and not taking illegal drugs. Surgery is the last course of action and may include increasing the length of the scar tissue side, shortening affected sides, penile implants or more.
Non-medical options include acetyl l carinitine, coenzyme Q10 supplements and vitamin E.
Research Advances in Treatment
Peyronie’s Disease is a common condition, which can be a real problem for treating physicians, given the underreporting of the medical condition. Prevalence is in the region of 3 percent. Men display new-onset curvature of the erect penis, which can be associated with pain in the active phase. Peyronie disease is associated with penile shortening and erectile dysfunction. There is a palpable plaque of the disease, on the penile dorsal region. The disease’s natural history suggests stabilization phase of twelve to eighteen months, with the treatment for pain. Penile deformity may also result, though there is an improvement in some patients regarding the resolution of curvature problems. It impacts chiefly anyone between 40 to 60 years of age and is linked with diabetes mellitus as well as other conditions like Dupuytren contracture and plantar fascial contractur or Lederhosen’s disease. There must be some instance of trauma as well. The disease is associated with repeated minor trauma to the microvascular part during physical or sexual intercourse. This results in intra-tunical bleeding and inflamed fibrosis. The irregular healing response is set to stem from the transformation of the growth factor beta. This is associated with excessive connective tissue buildup, increased cellularity and random collagen fiber orientation within Peyronie disease infected men’s plaque formation. The pathological tunical tissue restricts the normal expansion of the corpus cavernosum underneath creating an observed curvature. Flaccidity distal to the lesion with or without deformity or penile rotation may be noted in most severe conditions.
The main treatment focuses on the surgical correction, while there is associated morbidity, most commonly in terms of hematoma and infection, during the early post-operative phase and resulting penile shortening, recurrent curvature, ED, and glans hypoesthesia. Remedial intervention requires men to take on corrective surgery and this is something they tend to be reluctant about. This results in a massive delay in definitive treatment. This also impairs sexual health and causes anxiety and dissatisfaction in patients. There’s an extensive research into non-surgical options which can be implemented, reducing surgical morbidity and improving quality of patient’s life.
Intralesional Therapy
Collagenase
Way back when the research was conducted in 1982, collagenase clostridium histolyticum was given approval by the US-FDA as Xiaflex or Xiapex in the EU. This was for patients with a minimum of 30-degree deformity and palpable disease. Treatment is in the form of collagenases injections which work synergistically to cleave tropocollagen. The regimen itself is for 4 cycles around 6 weeks apart, requiring two injections of 0.58 mg separated by 1 to 3 days. Patients are also given lessons in penile modeling 3 times per day. A research by Investigation for Maximal PD reduction efficacy and safety or IMPRESS found that curvature of the penis was reduced by 17 and 9 degrees in 34 and 19 percent of the treatment and placebo groups. Serious instances of rupture and hematoma were observed in a minority of cases. All ruptures were related to intercourse. The treatment is presently being examined by the National Institute for Health & Clinical Excellence.
Verapamil
Calcium channel blocker verapamil in Peyronie’s Disease is associated with an upgrade of collagenase activity and inhibiting collagen transport across cells. Both intra lesional and electromotive drug therapy of verapamil have yielded positive results. While research has found no significant difference in plaque size reduction, there is an improvement in erectile function for the EMDA roup. Penile pain was reduced in the EMDA group as compared with the injection group at three months. Penile curvature improved in both those given intra lesional and EMDA treatment.
Electromotive drug administration has been found to be the least invasive modality for the treatment of PD patients. Studies and treatments generally leave out those with penile curvatures of 45 degrees or more and those unable to perform penetrative intercourse.
In another study, intra lesional administration of verapamil was assessed alongside tadalafil in a randomized trial. The study found no difference in curvatures, though there was an improvement in pain.
Interferon α-2B
Interferon therapy impacts collagen formation in Peyronie’s Disease through the inhibition of fibroblast proliferation and promotion of in vitro collagenase activity. There are limited trial data at the time of review. Significant trials were last conducted in 2006 and suggested the interferon provides modest advantages and many side effects. A 91 percent response rate was noted with some amount of curvature improvement using this treatment. The American Urology Association and EU Association of Urology provide enough guidance for the same.
Pharmacotherapy Options
Vitamin E/ antioxidants
Vitamin E is being subjected to a lot of research, and the general finding that has emerged is that antioxidant properties improve pain at the time of acute phases but not curvature. Recent studies found the role of vitamin E taken in 600 mg doses to be useful along with intra lesional or transdermal Verapamil and NSAIDS as well as herbal antioxidants.
The group with Vitamin E demonstrated a curvature reduction in 97% of the patients in the experimental group with a mean angle of 12.2 degrees as against the control group’s 48% whose mean angle was 6.7 degrees. Follow-ups supported the use of such antioxidant-rich therapies in combination treatment. Patients given this drug alongside verapamil fared better than those on verapamil alone. No curvature improvement was noted. There is less evidence to support the use of vitamin E and antioxidants as against recognized therapies.
Tamoxifen & Potaba
Multiple oral agents are used for treating PD early on. Some of these include tamoxifen and potaba along with colchicine and acetyl L carnitine. The treatments of tamoxifen and potaba are endorsed by international guidelines for improving penile pain but not a reduction in curvature. Potaba, as opposed to combination therapy, was found more ineffective in pain management. Combination group also noted improvement in the curvature of 30% or more.
Non-Surgical Intervention
Extra Corporeal Shockwave Therapy
Extra Corporeal Shockwave Therapy or ESWT remains the third or second line of treatment in Peyronie’s disease. Decreased efficacy has been linked with single-blind randomized trial research studies. A reduction in pain was reported in 85 percent as against 48 percent in placebo groups. No improvement has been noted in the size of plaque formation and curvature was worsened up by 40 percent of patients in the treatment group.
Traction Devices & Vacuum tumescence
No randomized data exists for different treatment modalities. Objective improvement has been observed in recent controlled studies of traction devices. There have been cases of improved erectile functioning, curvature boost, and pain reduction. Close to 40 percent of patients need surgical intervention. This is useful for the treatment, though larger studies are needed and everyday traction time required up to eight hours may be a limiting factor. These devices have renewed role in penis modeling techniques with plaque dissolution in collagenase style therapy.
Surgical Options
There have been no chances of advancement in Peyronie’s Disease surgical management in terms of random controlled data. Numerous studies have found traditional grafting and plication techniques to be effective. Plication remains the standard for patients sans ED and curvature of less than 60-degrees provided associated length loss is not a problem. Incision and grating are found in patients falling outside this criteria, though plaque excision sans grafting is a simplified technique.
Inflated penile prosthesis and manual remodeling have been also studied. High satisfaction and a five-year mechanical survival in devices across brands like Coloplast Titan and AMS CX. Complication and revision rates of below 10 percent were noted. Further research results suggest implant insertion and plication in one go showed similar satisfaction levels.
Implant surgery remains the key line of treatment for PD patients with ED and curvature issues. Most data regarding surgery was associated with failed intra lesional therapy.
Traditionally, those who suffer from Peyronie’s disease are counseled regarding the disease’s natural course and morbidity linked with relevant options for treatment. Less attention is given to the psychological impact of the disease and its diagnosis. Emotional difficulties and clinical depression along with relationship difficulties were also noted in patients with Peyronie’s disease.
Conclusion
For a guy, his identity is influenced to a large extent by the impact of this disease. Peyronie’s disease can have severe repercussions on mental health and leave males feeling anxious, stressed and depressed. For effective treatment, medical supervision is a must. It can make the difference to health and functionalities and pave the way for better confidence and self-esteem. If you want to learn more on Peyronie’s shock wave treatment, visit healthwavetx.com.