What happens in Peyronie's disease
The cavernous bodies of the penis are surrounded by a dense but elastic tunica albuginea. It is believed that as a result of repeated microtrauma, most often during sexual intercourse, inflammation occurs in this membrane, and then a fibrous scar plaque forms.
Scar tissue does not stretch. During an erection, the healthy areas of the membrane lengthen, but the area with the plaque remains the same - the penis bends towards the plaque. Hourglass narrowing, shortening and deformation are also possible.
The disease is not infectious, is not transmitted and is not associated with oncology. However, it can significantly affect a man’s sex life and psychological state, and this is an important part of the problem.
Two stages and why this is important
- The active (inflammatory) stage is usually the first months: the curvature changes, may increase, and there is often pain during erection. Duration on average from six months to one and a half years
- Stable (chronic) stage - the process is completed: the pain disappears, the curvature ceases to change within several months, the plaque becomes dense, sometimes with calcifications
Symptoms
- A dense formation under the skin of the penis, palpable as a nodule or cord
- Curvature during erection - usually upward, but possible in any direction
- Pain during erection, especially in the active stage
- Narrowing or hourglass deformation
- Shortening of the penis
- Difficulty or impossibility of sexual intercourse with severe angle
- Erectile dysfunction often accompanies the disease
- Anxiety, low mood, avoidance of intimacy
Causes and risk factors
- Repeated microtrauma of the tunica albuginea during sexual intercourse - the main hypothesis
- Genetic predisposition to excess scarring
- Dupuytren's contracture on the hands - often combined with Peyronie's disease
- Diabetes mellitus
- Arterial hypertension and atherosclerosis
- Smoking
- Age over 40–50 years
- Previous surgeries on the pelvic organs and penis
- Taking certain medications
- Low testosterone levels
Diagnostics
- Inspection and palpation to determine the location and size of the plaque
- Photographs of the penis during erection in several projections are a standard way to objectively measure the angle of curvature
- Ultrasound of the penis - assessment of the size of the plaque and the presence of calcifications
- Doppler ultrasound of the penile vessels with concomitant erectile dysfunction
- Assessment of erectile function using a questionnaire
- Hormonal profile, glucose, lipids
- Examination of the hands for Dupuytren's contracture
Photo documentation is especially important: it allows you to objectively track whether the curvature continues to change, and thereby determine whether a stable stage has arrived.
Treatment in the active stage
The goal is to reduce pain and limit scar formation as much as possible. It is usually not possible to completely eliminate an already formed plaque using conservative methods.
- Observation with regular photo documentation - in some men the process stabilizes, and the curvature remains acceptable
- Oral medications - used, their effectiveness is limited
- Local injection techniques into the plaque - as prescribed by a specialist
- Shock wave therapy - mainly to reduce pain
- Traction devices and manual stretching techniques - as recommended by a physician
- Stop smoking, control diabetes and blood pressure
- Treatment of concomitant erectile dysfunction
Surgical treatment in a stable stage
Surgery is considered when the curvature interferes with sexual activity, the process is stable for at least several months and there is no pain.
- Shortening techniques - alignment using the opposite side; technically simpler, but lead to some shortening
- Lengthening techniques with dissection or excision of the plaque and replacement of the defect with a graft - used for severe curvature and intact erection
- Penile prosthesis - when severe deformity is combined with severe erectile dysfunction that does not respond to treatment
- The choice of method is determined by the angle of curvature, the length of the penis, the state of erection and the patient's expectations.
Where to get examined in Tashkent
The key to this diagnosis is to determine the stage and assess the state of erection: all tactics depend on this.
In Tashkent, consultation with an andrologist, ultrasound of the penis and observation for Peyronie's disease are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
It is useful to bring photographs of an erection taken in several projections to the first appointment: they allow you to objectively assess the angle and subsequently track the dynamics. Clinic contacts are below.
