Peyronie's disease

What is Peyronie's Disease?

Peyronie's disease was discovered in 1740, but it still motivates many medical and scientific studies. It can be defined as a disorder of the connective tissue of the male sexual organ, which involves the growth of fibrous plaques under the skin (in the tunica albuginea), which can deform the penis in various ways. Acquired penile curvature or deformity can be seen mainly in men over 40 years of age, however, there are cases of younger men who manifest the problem.  This problem can affect 3% to 9% of the male public, but there are some conditions that increase a man's probability of having the disease, for example, this rate rises to 16% in men who have had prostate surgery and 20% for men. diabetics.   But is Peyronie's disease curable?

What causes Peyronie's disease?

When talking about Peyronie's disease, the most accepted causes for triggering the problem are trauma (penile fracture, which is a case of medical emergency) or microtraumas during intercourse, masturbation or nighttime erections. These microfissures or a large one will form a “callus” by an exacerbated inflammatory process, which can even calcify, causing deformities in the sexual organ. However, other causes of Peyronie's disease can be a lack of oxygen to the penis, as in cases of diabetic patients, who have priapism or who have undergone penile surgery, such as a radical prostatectomy. In addition, genetic inheritance and metabolic syndrome (obese, heart disease and hypertensive patients) and erectile dysfunction are also causes of Peyronie's Disease.

The most common speeches of patients when they are at the beginning of the problem

These are some examples of very common situations in our office: – “Dr., I suddenly noticed a lump on my penis.” -“Dr., I suddenly noticed that erections were painful, I found a lump on my penis and my penis was bending. ” -“Dr., I woke up out of nowhere and noticed that my penis was more crooked and shortened.” -“Dr., my penis shortened, thinned and the erections became weak.”

Is having a crooked penis normal or not?

Although a slight curvature is considered normal in most penises, approximately 5% of men can develop Peyronie's disease. Normally, when the penis is naturally slightly bent, this is a condition that manifests itself early on, in the first erections. Peyronie's disease, on the other hand, is an acquired condition that can greatly affect a man's psychological state, affecting self-esteem, self-confidence, quality of life and happiness. Many may even think that Peyronie's disease may be emotional or transmissible. It's not about this. For reasons of misinformation, fear or shame of looking for a specialized professional for adequate treatment, many men end up compromising their relationships, failing to enjoy a healthy and happy sex life, with a better quality of life. But don't worry, Peyronie's disease is treatable! It is possible to regain your self-esteem, self-confidence, quality of life, happiness!

Symptoms of Peyronie's Disease

The main symptom of Peyronie's disease is a curvature of the penis, which was previously absent. However, there are other signs that can be observed:

• Formation of scar tissue (penile fibrosis), also called plaque, which can usually be felt through the skin on palpation;
• Decreased quality of erection: the curved penis can aggravate or provoke erectile dysfunction, that is, peyronie's disease causes impotence yes;
• painful erections: early in the disease, known as the inflammatory phase, erections can be painful;
• Difficulty or inability to have sex due to the degree of deformity caused by the disease;
• Penile curvature: due to the occurrence of fibrosis in a certain part of the penis, the membrane starts to show less elasticity in this affected area, causing curvature;
• penis thinning: the disease can also present as a constriction of the tunic, leading to thinning of the penis;
• acinturation of the penis: the plaque may affect the entire area around the penis, causing a thinning of the entire circumference of the penis;
• Decreased penis size: scar tissue (fibrotic plaque) can also cause the penis to shrink or shorten.

Stages of this penile disease

1) Inflammatory (acute) phase: It is characterized by progressive penile curvature, associated or not with pain during erections and with a plaque or nodule under the skin, palpable or not. This phase is transient (usually 6 months). At this time of Peyronie's disease, drug treatment with anti-inflammatory drugs and (symptomatic) analgesics are part of the clinical approach. Antioxidant medications and vitamins may also be prescribed to improve the curvature. 2) Chronic phase: when fibrosis already exists, there has already been healing. At this stage, the penile deformity is already defined and stable. At this stage of Peyronie's Disease, medication is no longer the indicated approach. Usually, surgery is what will help the patient who has difficulty in penetration.

What test should be done for an evaluation of this disease in the penis?

For Peyronie's Disease, the ultrasound known as drug-inducing penile Doppler US will be very effective in understanding how the vascularization of the penis is going.

In our clinic, the following are evaluated:

• The thickness and extent of the fibrosis plaque;
• Curvature degree;
• Presence of tapering, indentation;
• Presence of plaque calcification;
• Presence of calcifications within the corpora cavernosa;
• Evaluation of penile blood flow and quality of erection;
• Presence of venous leakage;
• The presence of axial instability is manually assessed.

Peyronie's disease: treatment

How to treat Peyronie's Disease will depend on the stage of the disease. Treatment can be divided into 3 categories.

Peyronie's disease: clinical treatment  

This treatment is, in general, the approach used in the acute phase of the disease, when the disease is in the inflammatory process. A cocktail of antioxidant medications already tested for the treatment of Peyronie's Disease can be made to prevent the progression of the problem. In addition, starting with phosphodiesterase 5 inhibitors will also play an important role at this time, because Peyronie's disease can trigger or worsen erectile dysfunction. These medications will help in the vascularization of the penis. + Low intensity shock waves for stabilization of Peyronie's patch and pain relief. However, shock waves also help in improving erectile function. This approach is especially important for men who have penile vascularity problems, such as diabetics. + For Peyronie's disease, penile traction is associated with vacuum therapy (penile vacuum pump) and specialized penile extenders.  Another point to note is that, in Peyronie's disease, traction exercises while the scar is not sedimented will help to prevent further deterioration of the tissues of the penis, with improvement in the curvature and angulation of the organ. In general, clinical treatment is performed in the acute phase, which is the ideal time to treat the problem and correct small defects, aiming to reduce the chance of disease progression, improve small curvatures and even avoid atrophies, such as thinning and shortening.

injectables

The application of medication directly to the plaque in order to dissolve it and the association with penile traction is an alternative for selected cases. There is currently only 1 FDA approved medication for this purpose. It is a very expensive treatment and still we do not have very satisfactory results.

Peyronie's disease: surgery

To choose the type of procedure to be performed, we evaluated the degree of curvature, erectile function and the size of the patient's penis. Surgery is indicated for Peyronie's disease in 4 cases:

• Patients who are not achieving sexual penetration, due to the degree of penile curvature;
• Patients whose penile curvature is very accentuated causes pain in the partnership during penetration;
• Patients who have an associated erectile dysfunction;
• Patients who have already tried clinical treatment without success.

Among the various techniques described and internationally validated for the correction of Peyronie's Disease, we always use the most appropriate for each individual case. Aiming at the correction of the curvature, recovery of the size and caliber of the penis. In general, the most used surgery technique for Peyronie's disease is the multiple incisions in the penile plate, known as Egydio's Technique, published in a scientific journal (Journal Of Sexual Medicine) since 2020, but which had already been presented at medical congresses. sex in previous years. This method is based on geometric principles to lengthen and recover the largest possible size and diameter of the penis, up to the maximum limit of the nerves, vessels and urethra.  This ensures greater patient satisfaction, as it is rare for men to cope well with a shrinking penis, and recovering it is as important as treating the disease. We also achieved good axial rigidity, returning full capacity to a penetration relationship. Some patients will also need a penile prosthesis when the erectile dysfunction associated with Peyronie is very severe and the penile deformities are very complex, without any other therapeutic approach being successful. In this case, total penile reconstruction and implantation of the prosthesis will be performed.

Prevention of penile fibrosis

With the exception of genetic predisposition, Peyronie's disease can be prevented if the man takes certain measures:

1. Try to avoid trauma to the penis during sex or masturbation. For this, it is necessary to invest in good lubrication during sex and avoid very vigorous movements in certain sexual positions that favor these traumas, such as the four-pronged position (homosexual or heterosexual relationships) or partnering on top of the man (heterosexuals).
2. Adopt healthy habits such as good nutrition, physical exercise and avoid smoking. By having a balanced life it is possible to avoid obesity, overweight, high cholesterol, etc.;
3. It is necessary to do the proper control of diabetes;
4. make the treatment of erectile dysfunction early, to prevent the penis from running the risk of micro-cracks.

If it was not possible to prevent it and you have already noticed some type of nodule or fibrotic plaque on the penis, the best thing to do is to look for a doctor specializing in Peyronie's Disease as soon as possible.  When the disease is in the acute phase, it will respond well to drug and physiotherapeutic treatments. However, if the curvature is already settled, there are also surgical resources to correct the problem. So book an appointment to understand more about Peyronie's disease, surgery, price, symptoms, causes and other therapeutic approaches that can help you get rid of this problem!  All patients operated by Dr. Marco Túlio has access to the doctor's personal cell phone to answer any questions that may arise in the postoperative period, thus ensuring complete assistance for your case.