Peyronie’s disease plaques mostly (70% of the time) form on the top (or dorsal side) of the penis. The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. When plaques form on the bottom or side of the penis, the bend will be downward or sideways. Some men have more than- plaque, which may cause complex curves.
Sometimes plaques form that go all the way around the penis. These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”). In bad cases, the plaque may collect calcium and become very hard, almost like a bone. Men may also notice that their penis has shrunk or gotten shorter.
Other signs that you may have Peyronie’s disease are:
lumps in the penis
having trouble with sex because of a bent/curved penis
Peyronie’s disease can make your quality of life worse. Over 75 out of 100 men with Peyronie’s disease are stressed and depressed because of it. Unfortunately, many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help.
Peyronie’s Disease Diagnosis
Your health care provider may be able to tell if you have Peyronie’s disease with only a physical exam. The hard plaques can most often be felt whether the penis is stiff or not. To check how the penis curves, your health care provider may inject a drug into your penis to make it stiff and may take pictures for study. In some cases, dynamic ultrasound, which uses sound waves to get a picture of what’s in your body, is used to see where the plaque is, check for calcium buildup, and show how the blood flows in your penis.
Treatment of Peyronie’s Disease
In a very few number of cases (about 13 out of 100), Peyronie’s disease goes away without being treated. Many health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed.
Men with small plaques, not much curving of the penis, no pain, and no problems with sex may not need to be treated. If you need to be treated, there are many choices.
– Oral Drugs
Drug therapy may help men who are badly affected by the disease during the acute phase. There haven’t been enough studies to tell exactly how well these drugs work, though.
Oral vitamin E
Vitamin E is an antioxidant that’s popular because of its mild side effects and low cost. Studies as far back as 1948 show that taking vitamin E may make plaques smaller and help straighten the penis. But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn’t work better than placebo. (A placebo is a pill with no drugs in it – a “sugar pill.”)
Potassium amino-benzoate (“Potaba”)
Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It also can upset your stomach, so many men stop taking it.
This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie’s disease. There are only a few controlled studies of this drug and they haven’t shown that tamoxifen works better than placebo.
Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn’t been proven to work better than a placebo.
Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn’t show it to work better than a placebo.
– Penile Injections
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute-phase disease who aren’t sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection also works for penile pain and curving. Verapamil appears to be a good, low-cost option for Peyronie’s disease. More controlled studies are needed to prove how well it works.
Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue.
A large-scale test of interferon injection for Peyronie’s disease showed that this treatment can help. But more studies are needed.
Collagenase is made in the body and breaks down certain tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie’s disease. This drug (Xiaflex®) is now approved in the U.S. for treatment of men with penises curving more than 30 degrees.
– Surgery for Peyronie’s Disease
Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex. Most health care providers suggest putting off surgery until the plaque and curving have stopped getting worse, and the patient has been pain-free for at least 9 to 12 months.
Before surgery, your health care provider may check the blood flow in the penis by injecting a drug that will make it stiff, and may also look inside the penis using ultrasound. These tests help show what is going on inside your penis (such as whether there is also ED) so your health care provider can decide which type of surgery is best for you.
There are 3 basic ways to fix Peyronie’s disease with surgery:
making the side of the penis opposite the plaque shorter
making the side of the penis that curves longer
placing a prosthetic device inside the penis