By: Dr. Jesse Martinez
Peyronie’s disease is a condition which affects the penis, usually resulting in painful erections, scarring in the penis and a bend in the erection. It is caused by damage to the penile tissue creating a scarring under the skin, known as a plaque. Depending upon the size and location of the plaque, it can cause the penis to bend upwards, downwards or become indented.
The condition is fairly common, affecting approximately three per cent of men. It can occur at any age, but most typically affects men in their forties and fifties. There is a link between Peyronie’s disease and the hand condition Duypetren’s contracture, which causes one or more fingers to bend into the palm. About one in ten men with Duypetren’s contracture have Peyronie’s. However no-one knows exactly why some men get Peyronie’s disease and others don’t; it appears to be a matter of chance.
The first symptom of Peyronie’s disease is usually painful erections, or a bend in the erection, or both. Sometimes, men notice lumps in the shaft of the penis, although they may not be very obvious. Symptoms may come on suddenly or more gradually. This is known as the acute inflammatory stage of the disease.
The length of this first phase varies, but usually the disease stops progressing after six to 18 months. The second phase is called the acute stage. The penis stops bending and erections may cease to be painful. The lumps in the penis are likely to become harder and more obvious.
Men are left with a degree of deformity which varies widely. For men with a minor deformity, there is no need for surgery. But many men experience sexual dysfunction, due to the degree of curvature in the penis and often accompanying psychological factors. If the penis bends to 60 degrees or more, sexual intercourse may not be possible.
Unfortunately there is no guaranteed cure for Peyronie’s disease. Lots of treatments have been tried, but none of them have been proven in controlled trials to be successful. This means that for most people in the initial stages of the disease, it is simply a matter of waiting for the disease to stop progressing after about 6 to 18 months.
The only reason to consider surgery is in order to straighten the erection. Only men whose erection is so bent that they are unable to have satisfactory sexual activity should undergo surgery. However, surgery will not improve potency or remove penile lumps.
Surgery should only be performed once the disease is stable. This means that the pain has gone and that the bend has not got worse for at least three months. There are three principle operations for Peyronie’s disease: the Nesbit procedure, the Lue procedure, and in the most severe cases, insertion of a penile prosthesis.
Nesbit’s operation is the easiest and most straightforward operation to perform for Peyronie’s disease, but it has one major drawback – it causes shortening of the erection. Shortening is approximately 1cm per 30 degree bend of the penis. However, providing men are thoroughly assessed and this drawback is discussed, it is rarely a major problem after surgery.
For the majority of men, the Nesbit procedure is the best choice. The principle of the operation is to remove some tissue from the long side of the bent penis, thereby shortening the long side of the bend and straightening the erection.
The Lue procedure does the opposite of the Nesbit’s and makes the short side of the bend longer. However the operation is harder to perform and has a higher risk of complications. Shortening of the erection can still occur, the risk of impotence after surgery is greater that with Nesbit’s operation and there is a risk of damaging the delicate nerves which go to the end of the penis, resulting in the glans of the penis being numb. Incision and grafting can also be used to treat deformities of the penis where Peyronie’s disease causes indentation on one side. The graft is inserted into the indented area to expand the penis’s circumference.
A penile prosthesis is only used when there is very severe impotence, which can’t be treated by other means such as drugs. The operation has many drawbacks, but can restore satisfactory erections in selected cases. It should be considered only as a last resort.