Overview

What is Peyronie's Disease?

What is Peyronie's Disease?

Also known as bent penis or induratio penis plastica, Peyronies disease (PD) is a surprisingly common disorder that can cause significant sexual problems. Reconstructive urologists in our urology clinic can offer solutions to treat this condition.

PD is a condition in which inflammation or scarring of the tough covering of the erectile portion of the penis leads to symptoms. It usually starts with inflammation and, over time, becomes scar and stabilizes. During this first, or inflammatory phase, patients may have pain (either just in the flaccid state or with erection), tenderness, a mass, curvature or other deformities.

Often, men notice that the process evolves during this period. The deformity may get worse. For example, men usually notice that the penis gets shorter and narrower, sometimes just at one part of the penis. This period lasts for a variable amount of time, ranging from months to years. Eventually, the disorder goes into the second, or stable, phase. Usually the pain is gone (except sometimes during intercourse) and the deformity is stable.

One of the more frequent problems in men with Peyronie’s disease is a bend in the penis that interferes with sexual activity. Treatments either medical or surgical can help with this bending and restore sexual dysfunction.

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Causes

No one knows the exact cause of Peyronie's disease (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.

Along with Peyronie’s disease, erectile dysfunction (ED) is VERY common. 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.

How common is PD?

Peyronie's disease occurs in 3.5% to 9% of men, depending on age.

Diagnosis

How is PD evaluated?

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.

Treatments

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 the following:

  • Pills
  • Injections (a medication that goes directly into the affected area)
  • 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.

Surgery

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.

  • Plication - 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; however: 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.
  • Grafting - 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 percent, depending on the patient) and further scarring. This should only be performed by a surgeon who has extensive experience in this type of reconstruction.
  • Penile Prosthesis - If the patient has ED associated with PD or if the patient develops ED (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.

This table lists three surgical PD treatment options offered at University of Utah Health. Each surgery gives the patient different treatment options to choose from.

Plication Grafting Penile Prosthesis
Surgical technique Put stitches on the longer side of the penis to pull the penis to the middle Making incision on the short side of the penis and place a graft (either vein or other material) to match the long side Placement of a prosthesis to help erection and straighten the penis
Penile length Same as the length when stretched in the flaccid state 1/2 to 1 inch longer than the stretched penile length (depends on the amount of curve) About the same as stretched penile length
Risk of impotence after surgery Very small From 10 to 50%, depending on penile circulation N/A
Risk of nerve injury Small Moderate Small
Operation time 1 hour 3–4 hours 1–3 hours
Anesthesia Local & sedation General or epidural General or epidural
Hospital stay Not necessary Overnight stay Outpatient/Overnight
Return to work 1 day 2–3 days 1–4 weeks (depending)
Resume sexual intercourse 5 weeks 8 weeks 5–6 weeks
Other Cannot correct indentation or hourglass deformity Second incision needed in some cases Severe penile shortening if the device gets infected