Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaque in the soft tissue of the penis. This results in abnormal curvatures and hardening or thickening of the penis which causes pain and affects sexual functions. The exact cause of Peyronies disease is still unknown but it is believed to be due to injury or inflammation in the penis.
Non-Surgical Treatment Options
Oral Medications
Traditionally, oral medications like vitamin E, potassium para-aminobenzoate (Potaba), colchicine, or tamoxifen have been used to treat Peyronies disease but their efficacy has not been well established. Recently, oral collagenase clostridium histolyticum (Xiaflex) injections are gaining popularity for treating Peyronies disease. It dissolves the plaque and helps in reducing pain and curvature.
Injections
Intralesional injection of drugs like collagenase directly into the Peyronies Disease Treatment plaque is the most effective non-surgical treatment currently available. The enzyme breaks down the collagen in the plaque to relax the curvature over time with multiple treatments. Verapamil injections are also used to relax the contracted scar tissue in the plaque. Corticosteroids like Triamcinolone injections help reduce inflammation and may sometimes improve curvature.
Physical Therapy
Penile traction therapy uses gentle longitudinal stretching and modeling of the penis to help straighten the curvature over months of daily use. Low Intensity Shockwave Therapy involves using acoustic shockwaves to break down the Peyronies plaque and stimulate healing. It is given as outpatient treatment for a few weeks.
Surgical Peyronies Disease Treatment
Penile Prosthesis Implant
For severe deformity or inability to engage in intercourse, penile prosthesis implant surgery to replace the erectile tissue with a malleable or inflatable rod prosthesis provides a permanent solution.
Plaque Incision and Grafting (PIFG)
During PIFG surgery, the fibrous plaque causing curvature is cut vertically and then grafted with healthy penile tissue to replace the incised area using dermal grafts or buccal mucosa grafts from the inner cheek. This aims to correct the curvature.
Penile Lengthening and Girth Enhancement
Sometimes Peyronies disease can cause penile shortening due to scarring. Penile lengthening surgery using dermal grafts can potentially add 1-3 cm in length. Peyronies disease induced hourglass deformity can also be corrected surgically with grafting to improve erectile function and girth.
Other Complex Techniques
More complex surgeries like Nesbit's procedure,plication or plaque excision with grafting, and hinged or sliding grafts are also sometimes performed for severe or recurrent curvatures. However, they may not fully correct the deformity and have a higher risk of side effects like erectile dysfunction.
Most mild cases of Peyronies disease resolve spontaneously over 1-2 years without treatment. Moderate and severe deformities require interventions to restore sexual function. Non-surgical methods have moderate success rates. Surgery provides definitive correction but should be considered only after non-surgical options fail or the curvature interferes with intercourse. Early treatment provides better outcomes.
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