Dr. Benjamin Breyer Urology
San Francisco, CA 94143
Phone: (415) 353-2200
 
     

Benjamin Breyer

Clinics

Urology Practice

400 Parnassus Ave.,
Sixth Floor, Suite A610
San Francisco, CA 94143
Phone: (415) 353-2200
Fax: (415) 353-2641

Hours: Monday to Friday
8 a.m. – 5 p.m.

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Peyronie's disease

Peyronie's disease is an illness characterized by structural degeneration of erectile tissues and formation of inelastic scar tissue under the skin of the penis.

Peyronie's disease has a few symptoms, the main of which are significant curvature of the penis during erection; pain in the penis during erection; plaques in the area of root, corpus or glans of the penis, decrease in the length and (or) thickness of the penis; erectile dysfunction (ED).

  • At the initial stage of Peyronie's disease, men usually complain only of pain in the penis during erection.
  • In chronic forms of Peyronie's disease, the penis is curved by more than 30 degrees and sexual intercourse becomes difficult or impossible.

Many medical journals claim that Peyronie's disease develops in men aged 40 years and older. However, in 2015, European Association of Urology published the results of studies that show Peyronie's disease is most often diagnosed in men aged 55 to 60 years.

Despite the fact that Peyronie's disease has been studied for many decades, the causes of its development are still unknown.

The most common hypothesis about the causes of Peyronie's disease is the repeated microvascular injuries of connective tissue that surrounds the corpora cavernosa of the penis. As the cause of Peyronie's disease, genetic predisposition is also often called.

The exact causes of Peyronie's disease are unknown; however, there are some risk factors that often contribute to this disease. In addition to Peyronie's disease, many men with curved penis are diagnosed with Type II diabetes, heart diseases, hypertension, hypolipidemia or hypercholesterolemia.

Failure to understand the real causes of Peyronie's disease does not allow preventing this connective tissue disorder timely. Therefore, most men start treating Peyronie's disease only after they experience pain in the penis and a significant curvature of the penis during erection is observed.

To cure Peyronie's disease, surgical methods, non-surgical treatment or drug therapy is used. Before to start the treatment, several diagnostic tests are recommended.

At the first stage of diagnosis of Peyronie's disease:

  • Severity and location of penile fibrosis are determined.
  • Length, girth and rigidity of the penis during erection are measured.
  • Abnormal changes in the shape of the penis are evaluated.

For the objective assessment of the penis deformation, photos of the erect penis can be required.

  • Before to make a photo of the erect penis at home, a man with Peyronie's disease and ED can get an erection with a vacuum pump.
  • When the penis curvature is evaluated in clinics, intracavernous injection of vasoactive substance Alprostadil can be used to achieve an erection.

In addition to physical examination, men with Peyronie's disease should undergo Doppler ultrasound test, by means of which the blood flow, signs of atherosclerosis and venous leaks into the erectile tissue can be evaluated.

After the necessary diagnostic tests, the man is prescribed with one of the available treatment methods of Peyronie's disease, such as:

  • Oral drug therapy
  • Injection therapy
  • Topical therapy
  • Shock wave therapy
  • Surgical treatment

The easiest and most affordable method of straightening the penis is oral therapy. To cure Peyronie's disease at home, various types of oral drugs can be used, such as:

  • Colchicine (alkaloid)
  • Fat-soluble vitamin E
  • Tamoxifen (nonsteroidal antiestrogen)

None of these drugs is not approved as a treatment of Peyronie's disease, but clinical studies show that each of these drugs is able to provide a significant therapeutic effect on penile fibrosis.

Oral Vitamin E is the most available and cheap means to treat Peyronie's disease. Vitamin E provides a powerful antioxidant effect, therefore, may affect energy metabolism in the cavernous tissue of the penis.

Despite the fact that the ability of vitamin E to straighten the penis in penile fibrosis has not been proven, many urologists recommend starting the therapy of Peyronie's disease exactly with this fat-soluble vitamin.

Anti-inflammatory agent Colchicine is quite often prescribed in combination with vitamin E. Clinical studies demonstrate that Colchicine in combination with vitamin E can help to reduce the size of fibrous plaques and noticeably to straighten the penis.

However, a disadvantage of such combined therapy is that vitamin E and Colchicine do not reduce pain in the penis. Therefore, such combined oral therapy of Peyronie's disease should include analgesic agents.

The only oral drug that helps straighten the penis and reduce pain in the penis in Peyronie's disease is Tamoxifen.

Short-term studies demonstrate that in the use of a Tamoxifen 20mg tablet twice a day for 90 days, fibrous plaques, curvature of the penis and pain during erection can be reduced.

Despite the availability of data on Tamoxifen ability to stimulate regression of penile fibrosis, this antiestrogen is not approved as a treatment of Peyronie's disease and is used off-label in urology.

It should be noted that oral drug therapy is a conservative treatment method of Peyronie's disease. As an innovative method of straightening the penis, injection therapy with Xiaflex drug, which was approved as a treatment of Peyronie's disease in 2013, is used.

Advantages of Xiaflex injections over oral drugs is that the efficiency of Xiaflex is proved by the results of large- scale clinical studies.

A key disadvantage of injection therapy of Peyronie's disease is that the FDA-approved drug Xiaflex is very expensive. Therefore, in the short and medium term, men continue to use cheap oral drug therapy to cure Peyronie's disease

 
     
 
 
© Dr. Benjamin Breyer