Peyronie's disease

What it is

Peyronie's disease is a condition where scar tissue (a plaque) forms inside the penis. Over time, this can cause the penis to curve or change shape during erections. It can also cause pain, loss of length, or trouble with intercourse.

It is more common than many men think. The exact cause is not fully known. Repeated minor injuries to the penis, and individual differences in how tissues heal, are thought to play a part.

The two phases

Peyronie's disease usually goes through two phases:

• Active phase - the inflammatory phase. A lump forms, the curvature changes, and erections may be painful. This often lasts several months.
• Stable phase - the lump has firmed up, the pain usually settles, and the curvature stops changing.

Common symptoms

• A lump or area of hardness that can be felt in the shaft of the penis.
• Curvature, narrowing or "hinging" of the erect penis.
• Pain with erection, especially in the early phase.
• Loss of stiffness or trouble getting or keeping an erection.
• Worry, distress or low confidence about appearance or sex.

How it is assessed

An assessment usually involves:

• A detailed history, including how it started and how it is affecting you.
• A physical examination to feel for lumps and to estimate the curvature.
• Sometimes photographs of the erect penis, or a special ultrasound scan, to map the curvature and check the blood flow.
• An assessment for erectile dysfunction, since the two often go together.

The main treatment options

There is no single best treatment for everyone. The plan depends on the phase, the degree of curvature, the impact on function, and what each man wants.

Conservative and medical options

• Watchful waiting, for mild disease that is not affecting function.
• Tablets. Several oral medications have been tried. Evidence is mixed, and most provide only modest benefit.
• Injections into the plaque, in selected patients. The most studied agent is collagenase clostridium histolyticum (where this is available and appropriate).
• Traction or vacuum-based therapy, sometimes used by itself or alongside injections.

Surgical options

Surgery is generally considered when:

• The disease has been stable for at least 6 to 12 months.
• The curvature is interfering with intercourse.
• Conservative treatment has not given enough benefit.

Surgical options include:

• Plication - shortening the longer side of the penis to straighten it.
• Plaque incision or excision with grafting - cutting or removing the scar tissue and patching the area with a graft.
• Penile prosthesis - if there is also severe erectile dysfunction, an implant can both treat the ED and help straighten the penis.