Peyronie’s Disease And Its Treatment

For the first time, fibrous plaques that bend the penis were described in 1743 by Francois de la Peyronie, the life-surgeon of the French monarch Louis XV. For 250 years, medicine has advanced far in the treatment of a disease that is named after its discoverer.

There are many methods for getting rid of the curvature of the penis, one of which was proposed by Peyronie himself. In addition, proper consultation of patients gives such impressive results that it is difficult not to go to extremes: do not treat at all or offer surgery indiscriminately.

So, we’ll start the discussion of treating Peyronie’s disease with the idea of “not treating at all.”

    • Sometimes the disease goes away on its own and the reasons for this are not known. According to various researchers, spontaneous cure occurs in 3 – 12% of cases.
    • Erectile dysfunction in Peyronie’s disease is functional in 70% of cases. With proper counseling and psychotherapy, many patients are able to perform normal sexual intercourse, and they do not need surgery at all.

Conservative therapy

    • Vitamin E, pentoxifylline, colchicine, unfortunately, have shown their low effectiveness, although they are still used.
    • Injections of glucocorticosteroids into plaques show real improvement, however, they can cause complications after surgical treatment. Also, these injections can lead to atrophy of the corpora cavernosa, which in itself can cause erectile dysfunction.
    • Verapamil in 60% of patients slows down the rate of disease progression.
    • Physiotherapy (magnetic, laser, iontophoresis) – at least, do no harm, but their effectiveness is questionable.

The summary of the above is as follows: after the diagnosis is established, the treatment tactics should be as expectant as possible. During the year, it is necessary to try to eliminate the psychological problems caused by the curvature of the penis, conduct conservative therapy and monitor the course of the disease.

Surgical treatment

Surgery is the most reliable and effective treatment for Peyronie’s disease. Indication for surgery is the curvature of the penis in combination with erectile dysfunction.

To perform the operation, in addition to the availability of evidence, it is necessary to observe a number of conditions:

    • inactive phase of the disease,
    • the possibility of spontaneous erection,
    • lack of effect from conservative treatment for 1 year,
    • complex curvature (two and three directional),
    • curvature of more than 600.

Surgical interventions for Peyronie’s disease are divided into two large groups:

1. The formation of a fold or resection of the tunica from the opposite (convex) side of the penis. The oldest and most popular group of operations.

The first option was suggested by Reed Nesbit in 1965. The classical technique is as follows: skin incision, isolation of the protein coat, cutting out one or more ellipses from it on the side opposite to the curvature, suturing the defect.

Subsequently, the Nesbit operation was modified, making it less traumatic. Modification of Gordon-Devin, Essed-Schroeder, Darenkov, Jonas and others looks like this: a skin incision, isolation of the albuminous membrane, the creation of folds using seams on the side opposite to the curvature. At the same time, the differences in the methods consist only in the methods of creating this very fold.

The results of applying this group of operations are as follows:

    • restoration of normal sexual function in the first year after surgery reaches 100%, decreasing in the second and subsequent years;
    • according to various authors, the effectiveness of the Nesbit procedure is from 33 to 85%;
    • the level of complications after such operations is very low.

Disadvantages of Nesbit operation:

    • significant shortening of the penis, about which the patient should be warned in advance;
    • can be used only with simple curvature;
    • possibly the formation of nodules above the seams, which can be felt under the skin.

2. Elimination of the concavity of the penis by excision of the plaque and replacement of the defect with a natural or artificial graft. These operations are essential in the treatment of complex curvatures.

Artificial graft implantation operation

Back in 1974, Bistrum and Horton suggested excising the plaque and replacing the defect in the protein coat with a skin graft. The immediate effect of the operation was very impressive, but some patients, after some time, developed erectile dysfunction, the reasons for which were unclear. Therefore, natural materials are rarely used in the treatment of Peyronie’s disease, and synthetic grafts have gained the greatest popularity.

Requirements for a synthetic transplant: flexible, well extensible, cheap and affordable, low risk of rejection reaction. The following tissues are used in the treatment of Peyronie’s disease: Dacron, Dexon, Gore-Tex, etc.

The disadvantages of this group of methods:

    • high cost of treatment
    • some risk of erectile dysfunction.

As can be seen from the above, Peyronie’s disease is not a sentence. In the arsenal of medicine there are enough methods that can return to the patient his masculine power.

REFERENCES:

  1. https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease
  2. https://www.health.harvard.edu/a_to_z/curvature-of-the-penis-peyronies-disease-a-to-z