What is Peyronie's Disease?Peyronie's disease is a condition in which a layer of hardened scar tissue (plaque) builds up under the skin of the penis and causes a curvature of the penis. Curvature of the penis or an abnormal bend of the penis that occurs during erection is called Peyroni's disease. The buildup of plaque is commonly the cause painful erections and penile curvature that results in pain during intercouse. Peyronie's disease is most painful during erection and may also cause indentations or shortening of the penis. For some men, the changes in the penis' shape make intercourse impossible. Peyronie's CausesIn Peyronie's disease, fibrous scar tissue (fibrosis) develops under the skin of the penis. The cause of this fibrous tissue is not known. Fracture of the penis (injury during intercouse, sports, or other physical activity) can lead to this condition. Radiation treatment for prostate cancer can lead to a hegher risk factor. Peyronies is uncommon and generally affects men between the ages of 40 to 60 years old. Newborns may have a curvature of the penis, which may be part of an abnormality called hypospadias (this is different from Peyronie's disease). Peyronie's DiagnosisA physical exam is often sufficient to identify the presence of the plaque or fibrosis in the penis and diagnose the condition. Your doctor will also talk to your partner about your sexual relationship. A digital photo of an erection at home can help your doctor see the severity of the curvature of the penis. Your doctor will personally examine the penis with ultrasound to assess the plaque formation and blood flow. The sensitivity of the penis will also will be tested. It is important to ensure that the erectile mechanism of the penis functions well before considering surgery. Peyronie's TreatmentIn a small percentage of men, Peyronie's disease goes away on its own. But most times, treatment is required. Peyronie's treatment may include; surgery, corticosteroid injections into the fibrous tissue, oral medications, radiation therapy, shock wave therapy (lithotripsy), Verapamil injections, Verapamil cream, or Vitamin E. In the past, surgery has been the most effective way to treat Peyronie's disease, but Verapamil creams have shown great results (see Verapamil Study). Nonsurgical treatments are usually recommended in the first 12 to 18 months of treatment. All medical treatments are regarded as experimental — none is approved by the Food and Drug Administration. Peyronie's MedicationsA number of medications have been studied for Peyronie's, including L-carnitine, colchicine, aminobenzoate potassium, tamoxifen and vitamin E. There is little evidence that using any of these is better than watchful waiting. One of the more promising medications is Verapamil creams available at compouonding pharmacies. InjectionsDoctors have tested injecting drugs directly into the scar tissue (plaque). Two have been found to have some positive effect:
IontophoresisIontophoresis uses an electric current to administer a combination of verapamil and a steroid noninvasively through the skin. Early research has shown the treatment effective in reducing pain, plaque size and penile curvature. Other therapiesVerapamil has also been tried as a gel, rubbed on the penis. But there is no evidence that the drug reaches the inner tissues of the penis. Shock wave therapy has been tested as a means of breaking up plaques, but effectiveness has been inconsistent. SurgerySurgery is the most effective way to correct the penile curvature associated with Peyronie's disease. You could be considered a candidate for surgery if:
Reconstructive surgery for Peyronie's disease is a complex operation, requiring specialized techniques and experience. Mayo Clinic urologists have achieved a high rate of success using surgery to restore the normal shape and function of the penis in men with Peyronie's disease. Most urologists use different surgical procedures, depending on each man's symptoms and needs. RisksRisks of surgery for Peyronie's disease include:
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