Peyronie’s Disease

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What causes penile curvature of Peyronie’s Disease?

Peyronie’s Disease, build-up of excess scarring/collagen in the penis, occurs due to poor wound healing in the penis from trauma and genetic factors. Too much collagen (due to inflammation) is placed alongside the erectile chambers leading to penile scarring with inelastic tissue and plaque formation of the covering of the erectile chambers (called tunica albuginea, see diagram below). Subsequent penile shortening and curvature may occur which can be upsetting to men.  Peyronie’s Disease may occur in 3 to 9% of men and may occur in men with Dupuytren’s convtracture, diabetes mellitus (DM), hypertension, dyslipidemia, and low testosterone.  Men with Peyronie’s have a higher incidence of ED than the general population.

How is Peyronie’s Disease diagnosed?

Diagnosis will include a complete history and physical, assessment of penile vascular integrity, erectile response , and erect deformity with duplex penile ultrasound using a vasoactive drug injection to induce erection.  Further progress can be tracked with the Peyronie’s Disease Questionnaire (PDQ) which is a validated measure that was developed as a disease-specific and patient-reported measurement tool to permit quantification of symptom of bother.  Questions include bother from pain/discomfort, appearance, difficult intercourse, frequency of intercourse given bother by curvature.

What are possible treatment options for men with Peyronie’s Disease?

Possible treatments include intralesional verapamil injection or collagenase clostridium histolyticum (CCH) injection (office procedures).   CCH injection (also called Xiaflex) is approved by the FDA for Peyronie’s Disease treatment (first approved injection by certified providers) based on clinical trials showing safety and improvement in penile curvature and patient bother.  The injections were noted to work equally well after 4 treatment cycles for curvatures of 30-60 degrees and 60-90 degrees.  Of note, the studies did not include patients with downward curvature (ventrally) or calcified plaques.  If injections are not successful at reducing curvature, surgical procedures such as penile plication or penile plaque incision/grafting may be considered.  With simultaneous severe erectile dysfunction (ED), a patient with both medically-unresponsive ED and Peyronie’s Disease may be a candidate for penile prosthesis insertion. An important resource for men with Peyronie’s Disease is the Peyronie’s Disease Advocates Association.

We are pleased to discuss additional aspects of Peyronie’s Disease and possible treatment options including our multidisciplinary care team since we know that this issue can be very distressing to men and their partners. Please contact us for additional information.

Key points:
    • Peyronie’s Disease results from excess scarring and collagen in the penis.
    • There are multiple treatment options for Peyronie’s Disease which are best started as soon as possible after curvature is noted.

Peyronie's disease

Matthew Wosnitzer, M.D.