Peyronie's disease and the options of treatment

Have you been diagnosed with Peyronie's disease, do you suffer from unpleasant symptoms and you want to know more about this disease and options of treatment? Keep reading on. If you have more questions, you can turn to us any time.

PEYRONIE'S DISEASE
Clpeyronie

It is a disease that affects approximately 1 - 2% of male population, usually between 45 and 60 years, but males around the age of 20 are also not exception. The essence of this disease is a process of scarring and fibrosis affecting the cavernous bodies in penis, going from the tunica albuginea (fibrous envelope of the cavernous tissue of the penis). It leads to formation of fibrotic scarred tissue, which causes pain, curvature and deformation of the penis, usually during the erection. It is therefore abnormal activation of the healing process with formation of stiff scars.

The exact causes are not entirely clear. It is thought that one of the most probable causes, although not the only cause, can be repeated microtraumas during the sexual intercourse on the microvascular level. Genetic predisposition probably also plays a role. Scientists also observe the connection to the Dupuytren's contracture (thickening of the ligaments in the hand), where 15 - 20% descendants of people with Dupuytren's contracture are affected as well with Peyronie's disease.

Because it is a vascular disability, the risk factors are high blood pressure, diabetes and atherosclerosis. Increased risk of formation of this problem is also during catheterisation of the urethra and general injury of the penis. Effects of lack of vitamin E is also described.

MANIFESTATIONS

  • Tangible stiff plaque on the penis
  • Pain in the penis in a calm state as well as during erection
  • Abnormal shortening or curvature of the penis during erection in a direction backwards, forward or to the side
  • Erectile dysfunction

PHASES OF PEYRONIE'S DISEASE

In the first 6-18 months is typical inflammatory phase with painful erection, curvature of the penis or formation of stiff plaques. During this period can also occur worsening of the problems, but also stabilization of the condition or improvement.

When the plaques are fully developed, the painfulness during erection will stop, but the curvature and erectile dysfunction remains.

In a study about Peyronie's disease, 14% of patients noticed spontaneous retreat of the problems, 40% described further worsening of the problems and 47% noticed stabilization of the condition - the pain faded away, but curvature of the penis and erectile dysfunction remained, but the condition didn't continue to worsen.

OPTIONS OF TREATMENT

The treatment always precedes the examination by a specialised doctor. The examination includes entry interview, physical examination, ultrasound imaging of the penis, alternatively X-ray imaging or MRI.

Medicamentous treatment is taken orally, usually before sexual intercourse in order to induce erection, or by injecting a substance into the area of the plaques in the penis to disolve them (vitamin E, Tamoxifen, POTABA, Colchicine, Interferon, steroids and more). The effect is often short lasting and minimal (medicaments inducing erection, decreasement of the plaques) with significant negative side effects (damage to the digestive system, damaging the urethra with the injection, worsening of the problems, etc.).

Surgical treatment includes correction of the curvature and deformation of the penis in an advanced, fully stabilized stage of the disease. By a failing conservative treatment are plaques removed, or penile implants or prosthesis are used. But there is a risk of many complications (infection, negative reaction to anesthesia, bleeding, injuring the urethra, worsened erectile disorder, etc.).

Physical treatment offers radiation therapy, used by insoluble cases and by older patients because of high risk of scarring the penis. Another option is ultrasound, low-energy laser and iontophoresis. Combination of low-energetic laser with application of medicament (Verapamil) by injection directly into the penis. But it is again an invasive therapy with possible complications.

Revolutionary novelty presents use of ESWT (therapy with extracorporeal shock waves), which is nowadays offering the only effective, non-invasive therapy of the Peyronie's disease or erectile dysfunction without any side effects and with long lasting effects. You can find more informations about this therapy in article about Therapy of Peyronie's disease with shock waves.



Author:
 FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

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