peyronie's disease treatment

Penile Peyronie’s Disease treatment varies from non-surgical options like oral medications and penile traction devices to surgical interventions for severe cases.

Non-surgical treatments aim to manage symptoms and reduce curvature, while surgery, such as plaque incision or penile prosthesis, is reserved for significant curvature or erectile dysfunction. The choice of treatment depends on the disease’s severity and the patient’s specific circumstances.

Peyronie’s disease is found in about 1% of the male population, predominantly affecting middle-aged and older men. However, it’s not uncommon in younger demographics, with an incidence of 8-10% in men below 40 years and even observable in men in their 20s. 

This condition is marked by the development of localized scar tissue in the penis, leading to deformities such as curvature, along with pain and erectile dysfunction.

What is the Normal Functioning of the Penis?

The penis primarily serves two functions: it expels urine and sperm from the body. Within the penis, there are three tubes. The urethra, a hollow tube, transports urine from the bladder through the penis to the exterior.

The other two tubes, known as the corpora cavernosa, are soft, sponge-like structures that become engorged with blood, causing the penis to become rigid during an erection. These three tubes are encased in a strong, fibrous sheath known as the tunica albuginea.

During sexual intercourse, the rigidity of the penis is essential for penetration. Simultaneously, the urethra serves as a conduit for semen to enter the vagina.

Symptoms and Prevalence of Peyronie’s Disease

Symptoms:

Peyronie’s disease is characterized by the formation of plaques, which occur predominantly (70% of cases) on the upper (dorsal) side of the penis.

These plaques reduce the flexibility of the tunica albuginea, often causing an upward bend in the penis during an erection.

Plaques on the underside or side of the penis can lead to downward or sideways curvature. Multiple plaques can result in complex bending.

In cases where plaques encircle the penis, curvature may not occur, but there can be a noticeable narrowing of the penile shaft, resembling the neck of a bottle, commonly referred to as “bottle-necking” or “waisting.”

Severe forms of the disease can lead to the hardening of plaques, similar to bone. This may result in a noticeable reduction in penis size.

Additional indicators of Peyronie’s disease include:

  • Bent or curved penis
  • Lumps in the penis
  • Pain during erections
  • Weaker erections
  • Difficulty engaging in sexual activities due to the penis’s curvature

Peyronie’s disease can significantly impact mental well-being, with over 75% of affected men experiencing stress and depression. The disease often leads to embarrassment, resulting in many men choosing to suffer silently rather than seeking medical assistance.

Prevalence:

Peyronie’s disease is estimated to affect about 4% of men between 40 and 70 years old. Though rare in younger men, instances have been reported in men in their 30s.

The actual prevalence might be higher than estimated due to the reluctance of many men to consult healthcare professionals due to embarrassment.

Interestingly, there has been an increase in reported cases of Peyronie’s disease recently, possibly linked to the advent of new erectile dysfunction (ED) medications.

Men seeking treatment for ED are more likely to be diagnosed with Peyronie’s disease, suggesting that the reported incidence of the disease may continue to rise.

Causes of Peyronie’s Disease

Peyronie’s disease is generally believed to originate from minor injuries to the penis. Such injuries can occur in various scenarios:

Penile Trauma During Sexual Activity:

This is the most common cause. The trauma can happen when the penis is bent during penetration, or due to pressure against a partner’s pubic bone, resulting in damage.

Sports or Accidental Injuries:

Apart from sexual activities, injuries sustained during sports or through accidents can also lead to the development of Peyronie’s disease.

When these injuries affect the tunica albuginea, the protective sheath of the penis, it can lead to the formation of scar tissue within the cells (a process known as fibrosis). This scar tissue is what forms the characteristic plaques of Peyronie’s disease.

Fundamentally, Peyronie’s disease is a manifestation of an abnormal wound healing process in the body. The body’s response to the injury, rather than the injury itself, leads to the development of this condition.

Stages of Peyronie’s Disease

Peyronie's Disease Treatment

Peyronie’s disease, a condition that affects the penis, typically progresses through two distinct stages, each with implications for treatment approaches:

Acute Phase (Early Phase):

      • This initial stage can last between 6 to 18 months.
      • During the acute phase, the disease is active, and patients may experience changes in symptoms, such as pain or the development of new plaques or curvature.
      • Non-surgical treatments, using Extracorporeal Shock Wave Therapy ESWT, PRP, or even Stem cell during the acute phase can lead to a recurrence of the disease, as the condition is still evolving.
      • Treatment in this phase is usually conservative, focusing on managing symptoms and possibly using medications to reduce inflammation or pain.

Chronic Phase (Stable Phase):

    • In the chronic phase, the disease stabilizes. This stage is reached when symptoms, such as the degree of curvature or the size of plaques, have not changed for at least 3 months.
    • Surgical treatment is considered only during this stable phase. Surgery aims to correct the curvature and restore normal function as much as possible.
    • Although injection treatments into the plaque can be performed during this phase, their effectiveness is often limited.
    • This phase is crucial for evaluating the feasibility and timing of surgical intervention if necessary.

Understanding these stages is vital for healthcare providers and patients in managing Peyronie’s disease effectively, ensuring that treatments are appropriately timed and tailored to the stage of the disease.

Additional Factors Influencing Peyronie’s Disease

The development of Peyronie’s disease is not solely attributed to mild penile trauma, as not all men experiencing such trauma end up with the condition. This observation suggests the influence of genetic or environmental factors in the formation of Peyronie’s disease plaques. Key factors include:

Genetic Links:

There is a higher likelihood of developing Peyronie’s disease in men with certain genetic predispositions. This includes men who have specific connective tissue disorders like Dupuytren’s contractures or tympanosclerosis.

Additionally, a familial history of Peyronie’s disease can increase the risk, indicating a possible genetic component.

Health Conditions:

Certain health issues may predispose men to the disease. High blood sugar levels, the use of tobacco, and a history of pelvic trauma are all factors that can potentially impair wound healing.

This impaired healing response can contribute to the development of Peyronie’s disease.

These factors indicate that while trauma to the penis plays a significant role in the onset of Peyronie’s disease, genetic and health-related factors can also significantly influence its development.

This combination of elements suggests a complex interplay between bodily responses to injury and inherent susceptibilities in the development of Peyronie’s disease.

Non-surgical Peyronie’s Disease Treatment in Turkey

peyronie's disease treatment

1- ESWT Therapy for Peyronie’s Disease Treatment

In the initial, acute phase of Peyronie’s disease, non-surgical treatments are often favored.

One such method is ESWT for Peyronie’s Disease treatment, which has been employed in the field of Andrology for approximately 10 to 15 years and is increasingly becoming more popular. 

ESWT for Peyronie’s Disease treatment is a non-invasive therapy that can be administered in an outpatient clinic setting without the need for anesthesia. It is a painless procedure that doesn’t necessitate hospital stay. 

Widely used for treating erectile dysfunction, ESWT is also a preferred option for managing Peyronie’s disease, particularly effective during its acute or early stage. Numerous studies have demonstrated its effectiveness in alleviating pain during this early phase of the disease.

In our clinical practice, we’ve observed exceptionally positive outcomes with ESWT (Extracorporeal Shock Wave Therapy) in alleviating pain during the acute phase of Peyronie’s disease. 

In fact, most of our patients experienced a complete resolution of pain. Additionally, in follow-up examinations, a significant reduction in penile curvature was noted in these patients.

However, the effect of ESWT for Peyronie’s Disease treatment on plaque size varies. While some studies report limited instances of plaque disappearance, in our own patient group, complete plaque elimination occurred in a small number of cases after 6-8 ESWT sessions, particularly in patients with initially smaller plaques. 

On the other hand, for patients with larger plaque sizes and those in the chronic stage of the disease, we typically opt for surgical interventions, which is in line with the general trends in medical literature. 

In chronic cases treated with ESWT, we observed partial plaque reduction and curvature improvement, but complete plaque disappearance, especially in cases of large plaques, is not achievable.

It’s crucial to communicate this to patients: while ESWT in the chronic phase may not lead to significant plaque reduction, its primary benefit lies in addressing erectile dysfunction caused by the disease. 

Therefore, despite its limited impact on the plaque itself, ESWT is still recommendable for its positive effects on erectile function.

2- Platelet Rich Plasma Therapy for Peyronie’s Disease Treatment

Another innovative approach to treating Peyronie’s disease in recent years is platelet rich plasma (PRP) therapy. This treatment harnesses essential components from the patient’s own blood to facilitate tissue healing.

The process begins with extracting blood from the patient. This blood is then separated into its constituent parts using a centrifuge. From this separation, the plasma and platelets are extracted and subsequently re-injected back into the patient.

Plasma is the liquid part of the blood that carries dissolved substances, while platelets are small cellular fragments instrumental in clotting and tissue repair. When re-injected, these components of blood deliver vital growth factors that synergize with the reparative properties of the platelets to mend damaged tissues.

A key advantage of PRP therapy is its use of the patient’s own blood, eliminating foreign substances and minimizing the risk of an immune response. This aspect not only makes PRP therapy a very safe option but also ensures that the procedure is

3- Stem Cell Therapy in the Peyronie’s Disease Treatment

Erectile Dysfunction Treatment

Beyond platelet rich plasma (PRP) therapy, The emergence of advanced stem cell technologies has opened up a novel avenue for Peyronie’s Disease treatment. Stem cells, which can be obtained from various sources, possess the unique ability to transform into multiple cell types.

During their differentiation, stem cells release a range of growth factors and chemicals that aid in repairing and regenerating diverse damaged tissues. 

They also emit substances that modulate the body’s immune response, potentially reducing inflammation and other adverse effects of an overactive immune system.

Specifically in Peyronie’s disease, the chemicals released by stem cells during differentiation play a crucial role in reducing the production of structural proteins that lead to the formation of fibrous plaques.

However, given the unclear etiology of Peyronie’s disease, it’s challenging to precisely determine how stem cells contribute to its treatment, especially during the disease’s chronic phase.

Stem cell treatments are recognized for their safety and minimally invasive nature. Wharton’s Jelly stem cells, in particular, are deemed optimal for various therapies. 

These cells have a minimal risk of being rejected by the body and the treatment can be administered through a few simple injections. This approach is significantly less invasive compared to traditional surgical methods typically employed for Peyronie’s disease.

4- Traction Therapy forPeyronie’s Disease Treatment

Traction therapy involves using a specially crafted device that is fitted onto the flaccid penis to modify its internal structure through the application of steady pressure, guiding it towards a more natural alignment.

This therapy is most effective when initiated during the early stages of Peyronie’s disease. Its primary goal is to counteract the structural alterations in the penis induced by the formation of plaque. 

Research and clinical experiences have demonstrated its efficacy in not only diminishing the curvature of the penis but also in reducing the degree of penile shortening that can occur over time as a result of the disease.

5- Vitamin Therapy  in the Peyronie’s Disease Treatment

In past for Peyronie’s Disease treatment, vitamin E was commonly used. However, recent scientific research has conclusively shown that vitamin E is ineffective in treating the disease. 

It has no beneficial impact on plaque formation, reduction, penile curvature, or pain. Consequently, we, along with the American and European Urology Associations, no longer endorse vitamin E as an option for Peyronie’s Disease treatment.

 Additionally, other vitamins, minerals, and supplements have not shown any positive effects in treating the disease. While they may contribute to general health and nutrition, they do not offer benefits specifically for Peyronie’s disease.

6- Plaque Injection in the Peyronie’s Disease Treatment

One of the non-surgical approaches for for Peyronie’s Disease treatment involves injecting treatment directly into the penile plaque. 

Numerous methods have been tried for this purpose, but the majority have been discontinued due to ineffectiveness and are not in use today. This highlights the ongoing evolution of treatment strategies as new research and clinical experiences inform medical practice.

It’s very important to note that some of the treatments we mentioned can be combined together based on each and every individual case.

Surgical Methods for Peyronie’s Disease Treatment

Peyronie's Disease Treatment in Turkey

Surgical Methods for Peyronie’s Disease treatment is considered when the condition causes significant pain, curvature, or erectile dysfunction that interferes with sexual function. There are various surgical options for Peyronie’s Disease treatment, each with its own indications and outcomes:

Nesbit Procedure: 

This is one of the most common surgeries. It involves removing or pinching a piece of the tunica albuginea (the tough fibrous layer of connective tissue that surrounds the corpora cavernosa of the penis) from the side opposite the plaque, which cancels out the curvature. It’s most effective for less severe curvature and doesn’t involve the plaque directly.

Plaque Excision and Grafting: 

In this procedure, the surgeon removes the plaque and replaces it with a graft of tissue (possibly from the patient or a biocompatible material). This method is usually reserved for more severe curvatures or when the Nesbit procedure is not appropriate.

Penile Prosthesis Implantation: 

For men with Peyronie’s Disease who also suffer from erectile dysfunction that doesn’t respond to medication, a penile prosthesis may be implanted. This can straighten the penis and restore erectile function.

The choice of surgical method depends on various factors, including the severity and stability of the curvature, erectile function, and the presence of other health conditions. Post-surgery, patients may need to avoid sexual activity for a certain period to allow proper healing.

It’s important to consult with Istanbul Urology Clinic or a specialist in men’s sexual health to determine the best course of action. These procedures should be carried out by experienced surgeons due to the complexity and potential risks involved, such as loss of penile length, numbness, erectile dysfunction, or recurrence of the curvature.

Post-Operative Care

Following the procedure, a mild compression bandage may be applied to the penis for 24 to 48 hours to aid in healing. A catheter is typically inserted through the tip of the penis into the bladder during the operation, and it might still be in place upon awakening.

This catheter is usually removed in the recovery area if you are being discharged the same day, or the next morning before you leave.

To reduce the likelihood of infection and minimize swelling, you may receive antibiotics to take for a few days, along with pain medication.

It is advised to abstain from sexual activity for a minimum of 6 weeks post-surgery.

FAQs About Penile Peyronie’s disease

The exact cause is not fully understood. It’s believed to result from repeated injuries to the penis, like during sexual activity, sports, or accidents. Genetic factors may also play a role.

 

Symptoms include a noticeable bend or curve in the penis, painful erections, the presence of hard lumps on the shaft, and difficulties with sexual intercourse.

 

Diagnosis typically involves a physical examination, medical history review, and sometimes imaging tests like ultrasound to assess the scar tissue.

 

Surgical risks include infection, anesthesia complications, and potential damage to the nerves or blood vessels of the penis, possibly affecting sexual function.

 

Effectiveness varies. Some men experience significant improvements with non-surgical methods, while others may see minimal change.

 

In some cases, Peyronie’s disease can improve without treatment, especially in its early stages. However, severe or long-standing cases are less likely to resolve naturally.

 

The long-term outlook varies. While the condition can be managed effectively for many, it may lead to persistent difficulties with sexual function or intercourse for others.

 

Peyronie’s Disease itself doesn’t directly affect fertility. However, the condition can make sexual intercourse difficult, which could indirectly impact the ability to conceive.

 

Peyronie’s Disease is relatively common, affecting about 3-9% of men. However, the actual number might be higher due to underreporting, as some men may not seek medical help.

 

While it’s more common in men aged 40-60, Peyronie’s Disease can occur at any age, including younger and older men.

 

Some forms of physical therapy, including penile stretching exercises and massage, may help reduce curvature and pain, especially when combined with other treatments.

 

Pain during erections is a common symptom, especially in the early stages of the disease. However, the level of pain can vary, and some men may experience mild or no pain.

 

Partners can offer emotional support, understanding, and patience. Open communication about the condition and its impact on the relationship is crucial.

 

Avoid activities that might worsen the condition, like aggressive sexual activity or certain sports without proper protection. Smoking and excessive alcohol consumption should also be avoided.

Takeaway

In managing Peyronie’s disease, a range of Peyronie’s Disease Treatment non-surgical options are available, but it’s important to note that these methods do not guarantee 100% effectiveness. 

Presently, surgery is considered the most effective approach. However, the timing of the surgery is crucial for its success. It is highly recommended not to perform surgery during the acute phase of the disease. 

The most optimal period for surgical intervention is during the stable phase, following the conclusion of the acute phase. Undertaking surgery in the acute stage is associated with a higher likelihood of recurrence, underscoring the importance of appropriate timing in surgical management of Peyronie’s disease.

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