Many men with Peyronie’s disease also develop erectile dysfunction (ED – the inability to get an erection firm enough for sex). It’s possible to surgically treat both conditions, and a new study in Sexual Medicine describes some of the latest research in this area.
Peyronie’s disease is a connective tissue disorder thought to occur when an injury to the penis doesn’t heal properly. Instead, areas of hardened scar tissue called plaques form on the penis, just below the surface of the skin. The plaques make the penis less flexible and can cause deformities like a distinct curve or a “hinge” effect. Intercourse can become quite difficult.
Peyronie’s disease generally develops in two stages. During the first (acute) stage, men may notice their penis starting to bend, and pain is common. After six to twelve months, the chronic (stable) phase begins, when pain goes away and the curve remains stable.
Surgery to straighten the penis is a frequent treatment for men with Peyronie’s disease, but it often isn’t performed until the chronic stage. Men who develop ED along with Peyronie’s disease may opt for a penile prosthesis that allows them to have an erection when they wish by activating their implant.
For the study, researchers analyzed 58 studies related to Peyronie’s disease with co-existing ED.
Treatment for men with both Peyronie’s disease and ED usually starts with ED medication, as long as the curve isn’t preventing intercourse, the authors reported. Sometimes, vacuum devices are used to manage both deformity and ED. If these approaches are unsuccessful, then a penile implant is generally the next step.
Implants come in two types: malleable (which allow a man to raise and lower his penis manually) and inflatable (which creates an erection using fluid that comes from a surgically implanted reservoir).
Before surgery, men should know about possible complications, such as shortening of the penis, recurrent curvature, and decreased sexual sensation. “[A] patient’s realistic expectations are crucial for a successful postoperative outcome,” the authors wrote.
For some men, penile implantation is enough to resolve Peyronie’s disease. But men might need a second procedure if they still have a curve greater than 30 degrees. One approach is manual modeling, which the authors described as “cracking the plaque using [a] rigid cylinder as a fulcrum.”
Further surgery is another option. Some methods involve folding tissue to straighten the penis. In more severe cases (when curvature is over 60 degrees), a surgeon may cut into the plaque itself and fill the space with a graft, which may come from human or animal tissue.
The ultimate goal of treatment is a “functionally straight” penis, defined as a curvature of 20 degrees or less, the authors explained.
Krishnappa, Pramod DNB, et al.
“Surgical Management of Peyronie’s Disease With Co-Existent Erectile Dysfunction”
(Full-text. Published online: September 18, 2019)
Urology Care Foundation
“What is Peyronie’s Disease?”