Peyronie’s Disease (PD)-What Is It?
Peyronie’s disease is where a curvature/bend/angulation of the shaft of penis happens either in resting or erectile status due to an area of scar tissue (plague) that builds up inside the penile tissue (Tunica Albuginea layer). This plaque pulls on the surrounding tissues causing painful erection and the penis to bend & sexual intercourse becomes difficult.
Peyronie’s Disease-Symptoms & signs
The signs and symptoms of Peyronie’s disease may develop acutely or gradually (over 12-18 months), they include
-During the acute phase, the plaque forms, and this phase can last up to 18 months.1 During this phase
Pain in the penis at rest or with an erection.
Painful sexual intercourse
The penis starts to curve/bend. The angulation in shape persists even at rest and is associated with segmental narrowing and shortening of the shaft
Painful Erections
Erectile Dysfunction (no or difficult or inadequate erection)
–The chronic phase
It occurs after the plaque has formed.1 During this phase:-
· The pain lessens but the bendy shape of the penis persists, as the plaque thickens with tough lumps or indentation or segmental narrowing or shortening develop.
· Erectile Dysfunction (ED) worsen over time.
Incidence, Possible Causes & Predisposing Factors:
The incidence is 3-9% of adult males, however, Peyronie’s disease is more likely to develop in
· Micro injuries to the shaft that unnoticeably happen during vigorous sexual or nonsexual activities (such as sports) or due to overenthusiastic use of the mechanical stretching devices. The healing process of these micro-injuries by scar tissue formation i.e developing Peyronie’s disease.
· Those with certain Connective tissue or autoimmune disorders e.g Dupuytren’s, SLE, Scleroderma, Sjogren’s syndrome, Behcet’s disease etc
· Age, more likely to happen to men over 30s
· Those with diabetes-induced ED or after prostatectomy
· Those with family history of Peyronie’s disease
· Stress, depression, anxiety about sexual abilities or the appearance of their sexual organ.
In most cases, there is no recall of trauma/injury or no cause found, but still medical history and assessment is so important as in some conditions, a cause might be identified like Dupuytren’s contraction, where oral tablets could be prescribed
Ultrasound will show the exact location and size of the plaque.
Non-surgical Treatments:
The treatment of Peyronie’s disease (PD) is a challenge for the clinician. In the quest to straighten the penis, alleviate pain, prevent further shortening, and restore erectile function, many non-surgical treatments have been offered in lieu of an operative approach which has been the sole option for some years back.
Nonsurgical treatments include injections, shockwave therapy, mechanical devices, oral medicines, lifestyle & nutritional guidance, more successful results in the acute phase.
1) Plasma Injections (aka P-Shot®):
Platelets Rich Plasma injections (aka P-Shot; invented & registered by Dr C. Runels) is one of the very successful natural options in practice, that could result in straightening of the shaft & regaining the function back.
The success rate is logically related to the number of treatment sessions that to be determined after assessment of the affected area, thickness of the plaque(s), general health, medical comorbidities (e.g Diabetes, autoimmune diseases etc). Adding to that- the time and degree of the body response to stimulation of regeneration by the growth factors & healing cells extracted from patient’s own blood sample and spun in centrifuge.
The procedure takes 30-40 minutes with topical application of numbing cream and has no complications or down time. The assessment, the care plan and treatment procedure are performed by Dr Nadia Yousri
2) Shockwave Therapy
It is the use of focused or linear low-intensity sound waves to reduce pain & the plaques’ sizes1 and to induce new tissue & new blood vessels formation in the area.
Individualised treatment plans and the sessions are performed by Dr Nadia herself after proper medical history and clinical assessment made a significant difference in improving the success rate.
Other Non-Surgical options: –
3) Collagenase:
it is FDA- approved treatment, Collagenase injection (Xiaflex) which is an enzyme that helps breaking down the plaques.
4) Verapamil:
it is a known antihypertensive treatment but also it may reduce the pain and curvature when injected locally
5) Interferon-alpha 2b:
A protein made by white blood cells. It reduces pain & plaque size.
6) Oral medicines.
There are no oral medicines that effectively treat penile curvature at this time.7 Colchicine plus Vitamin E was suggested as a conservative option with about 40% success rate in one study. Cortes. During the acute phase where pain is a feature, non-steroidal anti-inflammatory drugs are prescribed for analgesia
7) Nondrug medical adjuvant therapies.
Other medical modalities for Peyronie’s disease are still being studied to calculate the success odds.7 These therapies include: –
· Mechanical traction and vacuum devices:
the idea is to produce tissues’ stretching of the penis to reduce curving
· Nutrition and lifestyle changes (smoking, alcohol etc)
Surgical Techniques:
it is of note to mention that Dr Nadia offers NON-surgical treatments only.
On the other hand, the Uro-surgeons may recommend surgery to remove the plaque.
Medical experts recommend the surgery if contemplated is to be done when the penis curving stabilizes.
Some men may develop complications after surgery, like shortening of the penis or creation of de novo scar tissue or failure of the surgery to correct the lesion. Some men may experience numbness of the penis and ED after surgery.
Grafting.
the plaque is removed and a patch of tissue such as skin or a vein from own body.
This procedure may straighten the penis and restore some length that was lost due to Peyronie’s disease.
Plication.
is to plicate a piece of the tunica albuginea from the side of the penis opposite the plaque to help straighten the penis. Plication cannot restore the length or girth, the penis may become even shorter and more likely to cause numbness or ED.
Device implantation.
A urologist implants a device into the penis that can cause an erection. The device may help straighten the penis during an erection.
References:
– Article on Shockwave Therapy performed by Dr. Nadia Yousri, published in Daily Mail on September 14th 2020. “Shocking treatment to perk up a man’s flagging lovelife: Can erectile dysfunction really be cured with soundwaves?”.
–Conservative treatment of Peyronie’s disease: colchicine vs. colchicine plus vitamin E. J R Cortés-González 1, S Glina. Actas Urol Esp. 2010 May;34(5):444-9
Cakan M, Demirel F, Aldemir M, Altug U. Arch Androl. 2006 Jan-Feb;52(1):21-7.
Toscano L Jr, Rezende MV, Mello LF, Paulillo D, Glina S. Int Braz J Urol. 2016 Sep-Oct;42(5):1005-1009
– Current status and new developments in Peyronie’s disease: medical, minimally invasive and surgical treatment options. Gur S, Limin M, Hellstrom WJ. Expert Opin Pharmacother. 2011 Apr;12(6):931-44
–Review of current nonsurgical management of Peyronie’s disease.
Levine LA. Int J Impot Res. 2003 Oct;15 Suppl 5:S113-20
-Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie’s Disease: A Systematic Review of Evidence. Alkandari MH, Touma N, Carrier S. Sex Med Rev. 2022 Apr;10(2):341-352.
-Platelet-Rich Plasma Therapy for Male Sexual Dysfunction: Myth or Reality?
Epifanova MV, Gvasalia BR, Durashov MA, Artemenko SA. Sex Med Rev. 2020 Jan;8(1):106-113
–Extracorporeal Shockwave Therapy in Peyronie’s Disease: Systematic Review and Meta-Analysis. Bakr AM, El-Sakka AI. J Sex Med. 2021 Oct;18(10):1705-1714.
Porst H. Sex Med Rev. 2021 Jan;9(1):93-122