Peyronie's Disease

continued from

Surgery: Surgery is reserved for men with severe disabling penile deformities that prevent satisfactory sexual intercourse. But, in most cases, it is not recommended for the first six to 12 months, until the plaque has stabilized. Since a spin-off of this disease is an abnormal blood supply to the penis, a vascular evaluation using vasoactive agents (drugs that cause erections by opening the vessels) is done prior to any surgery. A penile ultrasound if performed can also illustrate the anatomy of the deformity. The images allow the urologist to determine which patients are most likely to benefit from reconstructive procedures versus a penile prosthesis. The three surgical approaches include:

• Nesbit procedure: First described to correct congenital penile curvature by cutting a portion of tissue from the tunica albuginea and shortening the unaffected side of the penis, this procedure is used by many surgeons today for Peyronie's disease. Variations on the approach include the plication technique, where sutured tucks are placed into the side of maximum curvature to shorten and straighten the penis and the corporoplasty technique, where a longitudinal or lengthwise incision is closed transversely to correct the curvature. Nesbit and its variations are simple to perform and involve limited risk. They are most beneficial in men with ample penile length and lesser degrees of curvatures. But they are not recommended in individuals with short penises or severe curvatures as this procedure is recognized to shorten the penis somewhat.

• Grafting procedures: When plaques are large and curvatures severe, the surgeon may choose to incise or cut out the hardened area and replace the tunica defect with a graft material of some type. While the choice of materials depends on the doctor's experience, preferences and what is available, some are more attractive than others. For instance:

  • Autograft tissue grafts: Taken from the patient's body during surgery and thus less likely to cause an immunologic reaction, these materials usually require a second incision. They are also known to undergo postoperative contracture or tightening and scarring.

  • Synthetic inert substances: Materials such as Dacron® mesh or GORE-TEX® can cause significant fibrosis, a spreading of connective tissue cells. Occasionally palpated or felt by the patient, these grafts may cause more scarring.

  • Allografts or xenografts: Harvested human or animal tissues are the focus of most grafting material today These substances are uniformly strong, easy to work with and readily available because they are "off-the-shelf" in the operating room, so to speak. They act as scaffolds for the tunica albuginea tissue to grow over as the graft is naturally dissolved by the patient's body.

• Penile prostheses: A penile prosthesis may be the only good option for Peyronie's disease patients with significant erectile dysfunction and insufficient blood vessels verified by ultrasound. In most cases, implanting such a device alone will straighten the penis, correcting its rigidity. But when that does not work, the surgeon may manually "model" the organ, bending it against the plaque to break the deformity, or the surgeon may need to remove the plaque over the prosthesis and apply a graft to completely straighten the penis.

What can be expected after treatment for Peyronie's disease?

Routinely, a light pressure dressing is applied for 24 to 48 hours after the surgery to prevent any accumulation of blood. The Foley catheter is removed after the patient recovers from anesthesia and most patients are discharged later the same day or the following morning. During the healing process, medications to counteract erections are usually prescribed. The patient is also asked to take antibiotics for seven to 10 days postoperatively to ward off infection, and analgesics for any discomfort. If patients have no penile pain or other complications, they can resume sexual intercourse in six to eight weeks.

Frequently asked questions:

What happens to the cells following penile trauma?

In theory, following any penile trauma, there is a release of growth factors and cytokines or daughter cells that activate fibroblasts, cells that produce connective tissue. They, in turn, cause abnormal collagen deposition or scarring, which damages the internal elastic framework of the penis. Similar wound-healing disorders are commonly seen in the practice of dermatology, with conditions such as keloids and hypertrophic scarring, both involving tissue overgrowth in wound healing.

Are Peyronie's disease sufferers prone to other related conditions?

About 30 percent of Peyronie's disease sufferers also develop other systemic fibrosis in other connective tissue in the body. Common sites are the hands and feet. In Dupuytren's contracture, scarring or thickening of the fibrosis tissue in the palm leads progressively to a permanent bending of the pinkie and ring fingers into the hand. While the fibrosis occurring in both diseases is similar, it is not clear yet what causes either plaque type or why men with Peyronie's disease are more likely to develop Dupuytren's contracture.

Will Peyronie's disease evolve into cancer?

No. There are no documented cases of progression of Peyronie's disease to malignancy. However, if your doctor observes other findings that are not typical with this disease—such as external bleeding, obstructed urination, prolonged severe penile pain—he or she may elect to perform a biopsy on the tissue for pathological examination.

What should men remember about Peyronie's disease?

advertisement

Peyronie's disease is a well-recognized but poorly understood urological condition. Interventions need to be individualized to each patient, based on the timing and severity of the disease. The objective of any treatment should be on reducing pain, normalizing penile anatomy so that intercourse is comfortable and restoring erectile function in patients who suffer erectile dysfunction. Although surgical correction is ultimately successful in the majority of cases, the early acute phase of this disease is customarily treated by either oral and/or intralesional approaches. As medical researchers continue to develop basic and clinical research for a better understanding of this disease, more therapies and targets for intervention will become available.

Last updated: 12/02.  Last reviewed: 10/05.

top ~ pages 1 ~ 2 ~ 3 ~ send page to friend