Peyronie's disease is a benign condition which is thought to affect approximately 3% of men over the age of 50. It is associated with the development of a fibrous plaque in the penis which, depending on its location, can result in the penis becoming angulated. It is also associated with erectile dysfunction.
There are two distinct phases of Peyronie's disease - these are termed the acute phase and the chronic phase.
During the acute phase there is a progressive curvature of the penis on erection. There can also be pain associated with the erection. Patients may notice a thickening of the tissue under the skin of the penis. This is the development of a plaque. The acute phase lasts between six and twelve months and once the curvature has stabilised, the chronic phase sets in.
The chronic phase is characterised by a stable penile deformity on erection which can cause the penis to bend upwards, downwards or to the side. More complex deformities include an 'hour glass' or waist deformity where the penis has a concave in-drawing. This can cause instability of the penis during intercourse. It is only during the chronic phase of the disease that surgical intervention is undertaken.
The cause of Peyronie's disease is still not fully understood. There are a number of theories - one of the most commonly accepted is that there is micro trauma during intercourse which causes a small bleed under the thick fibrous tissue of the penis. This then causes abnormal wound healing and the development of a fibrous plaque. There are certain conditions which are associated with Peyronie's disease such as smoking, treatment with beta-blockers, high blood pressure and diabetes.
There have been a number of medical treatments which have been tried over the years for Peyronie's. These are generally given during the acute phase of the disease when surgical treatment is not an option. The common types of medication which have been used are anti-oxidants such as vitamin E or potassium aminobenzoate. However the benefit of these medicines is still unclear as there have been very few good clinical trials which have assessed the response. Alternative treatments include injecting the fibrous plaque with calcium channel blockers or steroids. Again these have shown some improvement in some small studies but are unlikely to be beneficial during the chronic phase of the disease.
Surgery is still the preferred option to manage the penile curvature. The aim of surgical intervention is to correct the penile curvature and maintain the erectile function. The two main types of procedures which are performed are the Nesbit Procedure or plaque incision and grafting.
The Nesbit procedure involves removing an ellipse of tissue from the convex side of the curvature. The aim is to shorten the convex side and ultimately straighten the penis. One of the side effects of the procedure is penile shortening, although patients are generally still satisfied with the outcome of the surgery.
This procedure was developed in order to reduce the degree of penile shortening. The operation involves incising the Peyronie's plaque and then filling the resulting defect with a graft. Various graft materials can be used - these have included using the saphenous vein from the leg as well as synthetic materials. This procedure is not suitable for all patients with Peyronie's disease as there is a higher risk of erectile dysfunction, particularly if there are underlying risk factors for erectile dysfunction already present. It is mainly used for patients with very severe penile curvatures or those which are associated with a waist or hour-glass deformity.
In patients with very extensive Peyronie's disease and erectile dysfunction, the option of a penile prosthesis addresses both problems. The use of an inflatable penile prosthesis gradually corrects the deformity over a period of months as the prosthesis is used.