Reconstructive Urology & Men's Health
Causes and Treatments for Peyronie's Disease
No one knows the exact cause of PD. In general, we believe that it is an abnormal healing response. That is, there is an injury (sometimes very very minor) but the body acts abnormally and causes inflammation and scarring.
ED is VERY common with Peyronie’s disease, at least 50 percent of men with PD have some ED also. Since the scarring affects the tissue surrounding the erection bodies (and often affects the erection bodies themselves), men often have arterial (“inflow”) and storage (“outflow”) problems.
It occurs in 3.5% to 9% of men, depending on age.
Several items are crucial to making sure you get the right diagnosis and treatment. We start with a questionnaire.
In addition to the physical exam, the deformity needs to be examined and documented. The patient may take a photograph of the erection at home or we can give an injection in clinic to give an “artificial erection” that we can evaluate in clinic.
Additionally, an ultrasound (safe, quick, and painless) is very helpful to assess the penile tissue and direct treatment strategy.
In the early stages, the best treatments are medical, not surgical. There are many, many reported treatments for PD, most of which have no data whatsoever supporting them. However, men are often desperate and will try anything, even if it is unlikely to help. This is unfortunate because, while there is no perfect medical treatment for PD, there are certain strategies that are more likely to help than others. The treatment strategy depends on many factors and needs to be individualized for each patient. They may include pills, injections (a medication that goes directly into the affected area), and traction devices. In the later stages, once the deformity is stable, treatment is usually surgical. A patient only needs surgical treatment if the deformity is enough that they cannot have intercourse (for example, if they have pain or their partner has pain) or if there is associated ED.
The actual surgical treatment depends on both the situation as well as patient goals. We have developed a chart that summarizes the different general surgical approaches. Generally, surgical approaches include reconstructive and/or prosthetic surgery. The most popular reconstructive approach is to place permanent sutures in the penis on the opposite side of the curvature to straighten it out (“plication”). This approach has few risks but 1) this does not correct notches, waists, or other non-curvature deformities 2) this cannot correct any of the length/width loss that is often associated with PD.
Alternatively, the plaque/scar can be expanded and a patch can be placed (“grafting”). Although this can correct other deformities and may possibly reclaim some of the length/width loss, there are significant risks associated with this approach including worsening ED (up to 40%, depending on the patient) and further scarring. This should only be performed by a surgeon who has extensive experience in this type of reconstruction.
If the patient has ED associated with PD or if the patient develops ED (e.g. after a grafting procedure), usually the best approach is with a penile prosthesis. This usually corrects both the ED and the deformity at that same time. Occasionally, the prosthesis does not fully correct the deformity and additional procedures must be done, such as plication or grafting.
William O. Brant, M.D., FECSMLocations
|Redstone Health Center||(801) 213-2700|
|South Jordan Health Center|
|University Hospital||(801) 213-2704|
Specialties: Erectile Dysfunction, General Urology, Male Incontinence, Men's Health, Trauma and Reconstructive Urology, Urology, Vasectomy
James M. Hotaling, M.D., FECSMLocations
|Utah Center for Reproductive Medicine||(801) 587-1454|
Specialties: Andrology, General Urology, Men's Health, Reproductive Endocrinology & Infertility, Urology
Jeremy B. Myers, M.D.Locations
|University Hospital||(801) 213-2702|
Specialties: Bladder Augmentation, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, General Urology, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Radiation Injuries, Trauma and Reconstructive Urology, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vesicovaginal Fistula
Kathryn M. Trueheart, PA-C, MPAS
Specialties: Erectile Dysfunction, Men's Health, Physician Assistant, Trauma and Reconstructive Urology, Urology