All material provided is for informational purposes only. It is not intended to be a substitute for a physician's consultation.
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Patrick E. Wherry, MD Inc.
2505 Samaritan Drive
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San Jose, CA 95124-4009

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REFERENCE LINKS:
 
Vasectomy
Coloplast
American Medical Systems
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Urological Surgeons of Northern California
Peyronie's Disease

Peyronie's Disease ... learn more

This is an inflammatory – fibrotic process of the erectile bodies of the penis that is much more common than usually appreciated. Although this can occur at any time it is most likely to develop between the ages of 40 to 60 years. Despite investigation the underlying processes are poorly understood. This usually presents as penile curvature-deformity, penile pain on erection, penile shortening and increasing erectile dysfunction. Some, or all, of these problems can occur together. They usually lead to the inability to have satisfactory intercourse.

The usual finding is that of a penile lump best felt when the penis is flaccid. Typically this is the area where discomfort develops with erection. Occasionally, the aching with rigidity may develop even before a lump can be felt. As time progresses the scarring may spread and cause even more irregularity, discomfort and shortening. Spontaneous regression and resolution are very unlikely. Almost always the end result is a persistent, painful deformity that interferes with sexual relations.

Because we are not certain of the reasons for Peyronie’s disease it has proven difficult to develop any treatment plan that is universally effective. At present there is no definite cure. All the treatment options are only palliative. Nonetheless, it is usually possible to decrease the curvature, resolve the pain, lengthen the penis and improve erectile function.

There are many therapeutic choices available ...often these are combined in order to achieve the best results

Medication


  Orally
    – many have been tried and most have not proven to be significantly effective
– the most “in vogue” at present is Pentoxifylline ...this is also used to treat peripheral arterial insufficiency
– these usually require at least 3 to 6 months of treatment


  Topical 
  – this can be done by:
   • application of a gel or cream to the surface of the penis
   • none have been effective enough to become standard therapy
   • skin penetration has proven to be the limiting barrier

– iontophoresis...
   • this uses an electromotive force to facilitate-accelerate transporatation of medication to the scar
   • used with topical Verapamil and/or Dexamethasone
   • may be most effective early in the disease
   • safe and an excellent non-invasive option
   • usually done by the patient at home


  Injection
  – this is only done after the penis is “blocked” with local anesthetic
– these are then injected directly into the penile deformity
– there are only three medications that have been proven to be effective
    • Verapamil...this is a calcium channel blocker which exerts effects on collagen synthesis and resorption
    • Interferon alpha-2b...also interferes with collagen production and degradation
    • Xiaflex...actively degrades, and removes, established collagen and the associated plaque
      ...now only licensed for use in Dupytren's contractures
      ...plan to implement as soon as it is available
– the injections
    • protocols are medication, and patient, specific
    • treatment cycles usually extend over several months
    • results may demonstrate some delayed improvement even after the injection therapy has finished


Non-surgical therapy

  ...these use different types of energy transfer to try and alter the diseased tissue. The most common are:

  ESWT (Extracorporal Shock Wave Therapy)
  – usually used to treat urinary stones (called Lithotripsy)
– easy to utilize
– has not been shown to cause any significant improvement


  Laser and Ultrasound Therapy
    – based on the local dilation of arterioles and capillaries
– allows tissues to use more oxygen and correct metabolic imbalance
– never established as a standard treatment
– no reports available in the English literature


  Radiation Therapy
    – non-invasive but of questionable value

  Even though these may have theoretical scientific basis bases they not been effective enough to use in a clinical setting


 
  Penile Traction Devices
  – these “extenders” do work
– if used correctly have been proven to be safe
– can be used alone or in conjunction with other treatments


Surgical Therapy

  ...there are only a few principles but many different procedures
...those that correct the deformity but shorten the penis are not the preferred options


 
  Plication procedures
    – many different names and choices
– all result in penile shortening
– best used as an adjunct to some other approach


  Plaque incision-excision + grafting
  – these techniques correct the scarred areas and allow significant lengthening
– there are several variations but all work about equally well
– this is the preferred approach if there is good erectile function


  Implantation of a multi-component penile prosthesis
  – this restores erectile function and synchronously corrects the curvature
– this is the preferred approach if the erectile function is not adequate to warrant plaque incision-excision
+ grafting



Typically, these are complex issues that very often require several, sequential, treatment options. However, the abnormalities can be corrected and satisfactory sexual function can be restored.

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