Health Topics: Peyronie's Disease

Peyronie's disease is a medical condition characterized by the development of a lump on the shaft of the penis. This lump is a scar (plaque) that forms on the lining (tunica) of the erection chamber (corpus cavernosum) and is believed to be caused by trauma. Early on following the trauma, an inflammatory reaction occurs, often bringing a man's attention to the problem because of pain associated with erection.

With time, the inflammation progresses and a scar develops. The time to develop this scar and the degree to which it occurs varies from patient to patient. Often the process heals itself over the first 12 months after the scar forms. In some cases, however, the scar formation is severe. In these cases, the scar becomes progressively harder and more obvious, causing the penis to curve during erection. While the scar is benign (noncancerous), the resulting curvature may lead to the inability to have sexual intercourse.

The incidence of Peyronie's disease is approximately 2%, although this figure is most probably an underestimate. The condition occurs most often in middle-aged men but can occur in men from 20-70 years of age. Men with Peyronie's disease typically seek medical attention because of painful erections, penile curvature or erectile dysfunction.

Because the plaque in Peyronie's disease often shrinks or disappears without treatment, medical experts suggest waiting a full year before attempting to correct it surgically. During that wait, patients are often willing to undergo treatments that have not yet been scientifically proven to be of significant benefit. In the early phases of the condition, such empiric treatments are used to reduce or reverse the inflammatory process.

Therapies that have been used include oral agents (pills) such as vitamin E, paraminobenzoate (Potaba), colchicine and agents that are injected into the scar (intralesional therapy), such as steroids, calcium channel blocking agents (verapamil) and interferon. There is no strong medical evidence supporting the effectiveness of these agents when compared to a placebo (sugar pill). Providing education regarding the disease and its course is often all that is necessary for most patients in the early phase of this condition. Some of the medical therapies have produced significant side effects.

Another treatment that has been used by some centers is radiation therapy. This has not been associated with any significant improvement in the scar or curvature, although it has been linked to a reduction in pain. It is, however, potentially associated with damage to the underlying erectile tissue, which may lead to impotence. Other therapies such as shock-wave lithotripsy and transcutaneous delivery of medication have been explored only in a preliminary fashion and require more extensive investigation. At this point they remain purely investigational. The number of agents investigated to date clearly indicates that none of them represent a proven, effective treatment.

Peyronie's disease has been treated surgically with excellent success. The most common surgical methods are:

• incision of the plaque followed by placement of a graft over the defect (skin, vein or synthetic material)

• performance of a tuck procedure on the side opposite the scar (typically, termed a Nesbit procedure)

• placement of a penile prosthesis (implant), which is typically reserved for men with Peyronie's disease and severe erectile dysfunction (impotence).

The first method can involve partial loss of erectile rigidity (hardness) in some men. The second method does not interfere with erectile rigidity but may cause some shortening of the erect penis. Most types of surgery produce a straight penis. Because spontaneous resolution may occur, however, most doctors prefer to perform surgery only on the men with long-standing curvature that interferes with sexual intercourse.

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