Dr. Werner's practice is participating as a research center in a study for an investigational treatment for men with Peyronie's disease. Read about the clinical trial for Peyronie's Disease.
Peyronie's Disease is characterized by a hard bump of plaque on the penis and often penile curvature. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.
Cases of Peyronie's Disease can range from mild to severe. You should know that symptoms may develop slowly or happen overnight. What you'd notice in severe cases is that the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple's physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with a milder form of Peyronie's Disease, inflammation may resolve without causing significant pain or permanent bending.
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PEYRONIE'S DISEASE DIAGNOSIS
Your first appointment will typically be between 45 and 60 minutes. Here's what to expect and what will happen.
- History: Your physician will take a history. He'll focus on whether you have had any history of penile trauma. He will ask for any other medical conditions you may have that may make you more likely to have developed this problem. He will need to know when the curvature began to develop. He will also ask you to quantify the curvature. It may also be very useful to take a Polaroid picture both from the side and from the top while erect as possible, to provide important visual information about the amount of curvature you have developed. You will need to explain how much, if any, the rigidity of your erections has been altered.
- Physical Examination: Next, your physician will do a focused physical examination of the penis and testes. He'll be looking for evidence of scar tissue on the penis. You may even be able to feel this yourself by squeezing your penis gently through your fingers along its length and seeing if there are any hard nodules. The physician will check the sensation of your penis with a biothesiometer (a test that measures how intense vibrations need to be for you to sense them).
- Laboratory Testing: Your physician will usually check your hormone levels by taking blood from your arm.
- Treatment: Your physician will usually begin conservative treatment if you are seeing him within six months of developing a curvature. The facts we have on curvatures are that one third of them will resolve on their own, one third will stay constant, and one third of them will progress. The curvature needs to be stable for six months before a final treatment can be determined. Any pain that you may have with erections (pain often accompanies the development of a curvature) must be stabilized before you begin treatment.
Your treatment may include Potaba, a member of the vitamin B complex family and your physician may also start you on vitamin E and/or vitamin E oil. Some physicians are currently using more experimental techniques. These may include injecting the plaque with certain substances, taking oral colchicine, or attempting to keep the penis straight by using a vacuum erection device to create erections.
- Definitive Treatment: If the curvature has stabilized for six months and there is no pain in the penis or with erections, your doctor can begin treatment. This will be determined by two factors. First, the physician will assess the amount of curvature. Many men are born with a small amount of curvature that causes no problem. Even a fair amount of curvature may allow successful intercourse without discomfort to either partner. You should know that a presence of a curvature doesn't necessarily mean that an operation is warranted. Some men do have significant curvature that makes penetration uncomfortable to one or both partners. This would be a curvature that needs treatment.
Next, the doctor looks at the degree of erectile dysfunction the patient has aside from the curvature. Many men have preexisting moderate amounts of erectile dysfunction. The scar tissue that causes the curvature may cause a worsening of erectile dysfunction. There is no point in straightening out the penis if the surgery will not result in rigid erections that are adequate for penetration. For this reason, the erectile dysfunction and whether or not it can be treated (separately from the problem of the curvature) must be assessed.
Once these two parameters have been assessed adequately, a decision about treatment can be made.
PEYRONIE'S DISEASE TREATMENT
A determination will be made if you can have successful intercourse without pain with this degree of curvature, which can, of course, go two different ways:
- YES – No treatment necessary
- NO – Treatment dependent on erectile function
Again, the doctor will assess whether you can get and maintain an erection with adequate rigidity with two outcomes:
- YES – No treatment necessary
- NO – Treat like all patients with erectile dysfunction
If you have reasonable erectile function (adequate rigidity obtained and maintained) as well as a curvature that is not significant enough to prevent comfortable intercourse, then only conservative treatment is necessary.
If there is a significant curvature, that makes intercourse uncomfortable, but there is adequate erectile function, then surgery may be considered to correct the curvature of the penis.
If there is significant erectile dysfunction, but a curvature, that is not significant enough to prevent intercourse, then the patient will be treated like all patients with erectile dysfunction.
If there is significant erectile dysfunction as well as significant curvature, the patient can consider an implantation of a penile prosthesis and straightening at the same time.
After all this discussion you can understand that it takes a very sophisticated evaluation to treat penile curvature (Peyronie's Disease). You'll be making difficult decisions about what treatment you'll undergo. Once a plan of treatment is determined, there is a significant amount of expertise required to perform the various surgeries involved in correcting the curvature. It is truly advisable to see a specialist when facing these decisions.
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