Peyronie’s disease is an inflammatory condition affecting the penis of about 1% of males. The cause is unknown but may bring about some discomfort, nodularity and, in some, bending of the penis. If the bending on erection becomes severe enough to compromise vaginal penetration, surgical treatment may be indicated.
There are no known preventive treatments for this disease, as we do not know the cause. Spontaneous remission may occur in about half the cases over several years. Vitamin E may be helpful. At times, Potaba may be administered. However, neither of these options has been conclusively proven to be beneficial. Most men will seek treatment because of concern for possible cancer when they feel the hard plaque or nodule in the penis. Some will also complain of discomfort during erection. This may be ameliorated with anti-inflammatory medications. Some men will note bending on erection. When the bending is first noted, it is often at its worst; and patients are often surprised at the rapidity at which this appears to have presented from one day, when it was not there, to the next, when it was.
In most men, the Peyronie’s disease does not tend to progress in terms of worsening bending or increasing nodularity. Some men will also complain of some softness in the penis on erection beyond the plaque, and some may also complain of apparent shortening of the penis.
Many forms of non-surgical treatment have been tried, but many of their successes appear to parallel that of spontaneous improvement, which can take on average some 4 years or so. These non-surgical treatment options have been aimed at attempting to inhibit or reverse the inflammatory changes occurring with this disorder.
A. Oral medications, including mineral water, salicylates, Vitamin E, Potaba, steroids and a host of other medications over the years.
B. X-rays, including external beam and radiation implants.
C. Topical applications of DMSO or another of the many other forms.
D. Electrical, such as electrolysis and iontophoresis with different medications.
F. Injectable agents such as steroids, hyaluronidase, collagenase and others.
Various reconstructive surgical procedures may be indicated in those where bending is too severe to allow vaginal penetration. These penile reconstructive procedures can usually be done without resorting to the use of a penile prosthetic implant.
Many men can have their penile bending normalized with a less involved reconstructive procedure as an outpatient under a general anesthetic using application, tuck or imbrication technique opposite the area of bending.
The penile skin is sleeved back after a Foley catheter has been inserted to drain the bladder. A glans traction suture may also be inserted to enable better control of the penis for the corrective surgery. After the penile skin has been sleeved back and hemostasis achieved, a tourniquet is placed about the base of the penis. An artificial erection is performed by placing a butterfly needle into the base of the penis and injecting sterile physiologic saline to produce an erection.
Being careful to preserve the dorsal neurovascular bundle, Allis clamps are applied to the penis opposite the curvature to normalize and straighten the penis. The impressions made by the jaw marks of these clamps then indicate the proposed incision lines in the tunica that can then be approximated with interrupted sutures, thereby counteracting the curvature and straightening the penis. The straightness of the penis can then be verified with another artificial erection; and if satisfactory, the penile skin is redraped over the penis and the circumcision wound closed after a small drain is left under the skin.
The penis is dressed with a semi-occlusive plastic dressing which helps control post-operative penile swelling. The Foley catheter and the drain can be removed more or less the following day in the office. This is not a painful procedure, and most patients have no trouble voiding after the catheter is removed.
The plastic dressing is removed in the office after about 5 days. Spontaneous erections are discouraged for a further 6 weeks with the use of amyl nitrite snaps that the patient inhales to suppress erections while allowing the repair to heal. This type of reconstructive procedure is associated with a minimum of complications in addition to minimal compromise in length of the penis.