What is Peyronie’s disease?

Peyronie’s disease is most common in men over 50. There are several symptoms that can be warning signs. For example, men may notice a lump or hard spot in their penis when it is not erect. These lumps are then made of fibrous scar tissue, also called plaque. The penis may also appear indented, curved or shrunken. During an erection, the penis may not reach its full length. Men with Peyronie’s disease also often have painful erections.

What causes Peyronie’s disease?

The penis contains two erectile rods. Due to trauma or infection, scar tissue and inflammation can occur in the rods.

When this happens, there is hardening of the tissue due to plaques, narrowing of the penis and sometimes erectile dysfunction. Although the disease is quite common, many men ignore it and do not seek treatment until the symptoms have worsened.

Peyronie’s disease is usually caused by a slight injury to the penis, either from vigorous sexual intercourse, sports or other accidents. It is a result of the way the body heals wounds.

How do I find out if I have Peyronie’s disease?

Your doctor may be able to determine if you have Peyronie’s disease through a physical examination. During the examination, he or she will check for hardened plaque to determine whether or not the penis is stiff.

Another examination involves injecting a medicine into the penis to make it stiff and taking photographs to examine it. Plaques usually form on the top of the penis and can cause the penis to bend upwards as it stiffens.

If plaques form on the underside of the penis, it will bend downwards or sideways.

Penile curvature – Induratio penis plastica (IPP)

Induratio penis plastica, or IPP for short, is the term used to describe the extensive proliferation of connective tissue (plaque), collagen and elastic fibres, especially on the back of the penis, with increasing hardening of the penile shaft. The plaques of IPP are usually located on the concave side of the curvature. The plaque formation leads to shortening and curvature of the penis.

IPP is a two-phase disease. First there is the active phase with painful erection and increasing curvature (deviation) of the penis, followed by stable phase with stable deviation and absence of pain. A spontaneous improvement of the pain usually occurs within 6 months. There is also increasing erectile dysfunction as the disease progresses. Spontaneous regression of the disease is possible in up to 15% of all patients, and the disease remains stable in 40%. The following factors make spontaneous regression unlikely: deviation over 45 degrees, disease course over 2 years, plaque calcification or known Dupuytren’s disease.

Therapy of IPP
In the acute, painful, inflammatory phase, conservative therapy should be used. For chronic pain, therapy should be with NSAIDs (non-steriodal anti-inflammatory drugs) such as ibuprofen. For very severe pain, extracorporeal shock wave therapy would be indicated. In addition, PDE-5 inhibitors should be administered in case of concomitant erectile dysfunction. In addition, a therapy trial with potassium paraaminobenzoate (potaba) can be made, which should prevent the progression of the disease if used for a long time (>6 months).

Surgical therapy should only be attempted when the disease has been present for at least 12 months and there is a progression-free and pain-free interval of at least 6 months (stable phase). After all conservative options have been exhausted, surgical therapy is then indicated depending on the extent of the curvature and erectile function. In cases of minor deviation and preserved erectile function, the Nesbit operation or the plication technique is suitable. In case of severe deviation and erectile function, plaque excision and grafting is recommended. In the absence of erection despite SKAT therapy, a penile prosthesis should be implanted.