Peyronie's Disease

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Treatment

Treatment options for patients with Peyronie's disease are limited. The goal of treatment is to reduce pain and maintain sexual function. Surgery is the only effective treatment, and because Peyronie's may resolve on its own, physicians often advise waiting 1 or 2 years before choosing this option.

Nonsurgical treatment should be implemented within 6 months of the onset of symptoms and before the plaque has calcified. Vitamin E supplementation and para-aminobenzoate tablets (e.g., Potaba) may be taken for several months. Chemical agents such as a calcium channel-blocker (e.g., verapamil), an enzyme that breaks down connective tissue (collagenase), and steroids (e.g., cortisone) may be injected into plaque or delivered by iontophoresis.

Iontophoresis is a painless method of delivering medication to localized tissue using electrical current. Like electrical charges repel, therefore a positive charge applied to a positively charged solution repels the medication into the tissue. Low-dose radiation (high-energy rays) therapy may reduce pain, but it does not effectively diminish plaque.

Complications

Tissue atrophy may occur with these treatments, and successful results are not well documented.

Surgery

Surgical treatment may be used in severe, persistent cases of Peyronie's that have not responded to nonsurgical treatment. Surgery may be considered one year after the onset of the condition. Procedures involve the removal (excision) of hardened tissue and skin graft, the removal or pinching (plication) of tissue opposite the plaque to reduce curvature (called the Nesbit procedure), a penile implant, or a combination of these.

The removal of plaque requires a skin graft from another area of the patient's body and may result in a partial loss of erectile function (e.g., less rigidity). The Nesbit procedure reduces the length of the erect penis.

Penile implant involves implanting a device in the corpora cavernosa that increases rigidity. This procedure may be combined with incisions and skin grafts, or plication to effectively reduce curvature.

During the recovery period, patients are prescribed medication that prevents them from having an erection and are advised to avoid sexual activity. Antibiotics are also prescribed to reduce the risk for infection.

Complications

Complications that may develop as a result of surgery include the following:

• Adverse reaction to anesthesia
  
• Damage to the tube that carries urine and semen from the body (urethra)
  
• Excessive bleeding
  
• Infection
  
• Neurovascular damage resulting in a lack of sensation
  
• Prosthesis malfunction
  
• Scar tissue resulting in impotence
  

Prognosis

The prognosis for maintaining sexual function is good when treatment is started within 6 months of the onset of symptoms.

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