Peyronie's Disease
It is a condition characterized by the development of fibrous plaques or nodules in the substance of the penis.
Most patients will present one or more of the following complaints :
The noticing of a lump in the substances of the penis
- Development of pain in the penis, especially on erection
- Bending or deformity of the erect organ
- Loss of erection
- Difficulty in vaginal penetration
- Pain accompanies the lump in approximately two-third of all patients but is often self-limiting and disappears after the disease has run its full course.
- The lump (or plaque or nodule) is generally about a centimeter in size and is usually located on the upper midline. Sometimes, it may be much larger in size and in diffuse or multiple forms. The dorsal and ventral midlines are the common sites. When lumps are present in the midline septum , they are difficult to feel during examination of stretched penis
- Ulrasound scan examination of penis is helpful in identifying plaque area.
- Plaque may be seen on an xray if they are calcified
Treatment
- Several treatment modalities have been employed in the past to reduce pain and arrest the progression of the fibrotic process. These include several oral medications, X-ray therapy, topical applications, electrical therapy, ultrasonic treatment and locally injectable agents.
- None has so far proved conclusively superior to others, and benefits derived are probably sympathetic, placebo (psychological) or because of the self-limiting nature of the illness in some cases. It must be remembered that, in some cases, Peyronie”s disease runs quite a benign and self-limiting course. Such patients are fortunate and will require little or no therapeutic interference.
- On the other end of the spectrum, of course, we have the much less fortunate patient, who not only has severe deformity (greater than 30 degrees) but also has severe impotence and just cannot perform sexually. Such patients will require surgery.
- Loss of erection
Surgery
- Many operations are available for the surgical treatment of this condition. The choice of operation in a given case will depend on the location of the lump, the extent of the lump and the degree of deformity caused.
- Plication Procedure : attempt to straighten the penis by trying to shorten the longer side to match the shorter side. Though simple and effective, can occur minimize of penile length
- Excision-Grafting Procedure : involve the incising of the lump in the tunica followed by reconstruction of the resultant defect using graft material. A variety of graft sources are available. Most currently available / described grafts give satisfactory results.