Peyronie’s disease is a connective tissue disorder of the penis characterized by the triad of bent erections, pain in the penis with erections, and palpable penile plaque. Peyronie’s disease is quite common, affecting as many as one in 11 men, despite the lack of public awareness.
Peyronie’s Disease Essence
The penis is composed of the same connective tissue as every other joint in the body. The anatomy of the penis is composed of three cylinders: the paired erectile bodies and the urethra.
The erectile bodies (corpora cavernosa) are made up of sinusoidal tissue that fills up with blood during an erection and an outer covering (tunica albuginea) composed of tough fibroelastic tissue. The outer covering determines the size and shape of the erection.
The principal finding in men with Peyronie’s disease is the deposition of scar tissue in the tunica albuginea. All of the clinical symptoms are derived from this event. The curvature of the penis is due to the fact that scar tissue does not stretch as well as normal tissue.
The normal tunica albuginea is composed of elastin fibers and collagen. The site of scar tissue from Peyronie’s disease is composed mostly of collagen that can harden to the thickness of bone.
Although most men with Peyronie’s disease report that their penis is bent upwards, a variety of other abnormalities are frequently observed, including bends in other directions, complex bends, divots in the side of the penis, and hourglass deformities.
The palpable plaque is the actual scar tissue that has been deposited on the outer covering of the erectile bodies. This is present in the vast majority — but not all — patients with Peyronie’s disease. The plaque may become calcified, like bone, with severe disease. Finally, the pain experienced with erections is thought to be due to active inflammation in the plaque and usually disappears on its own with time (usually by 12 months).
Erectile function may be adversely affected by Peyronie’s disease. While most patients with Peyronie’s disease report normal penile rigidity during erections, some have trouble maintaining erections due to leaky veins in the penis (a process called veno-occlusive disease of the penis).
The disease process of Peyronie’s disease does not normally affect the sinusoidal tissue within the erectile bodies, but it can affect the veins exiting the erectile bodies and prevent their proper closure. The main sexual complaint despite the physical deformity is the bend itself, preventing vaginal intromission or causing pain to the partner.
The exact etiology of Peyronie’s disease is unknown. There is evidence that it may have a genetic basis. Positive family history is common but not typical. There is an association with other connective tissue disorders, specifically Dupuytren’s contracture, affecting the palms of the hands.
The most popular theory today is that Peyronie’s disease is induced by trauma. The trauma may be acute and distinct such as a penile fracture, but more often it is chronic and low grade, such as repeated attempts at sexual intercourse with weak or incomplete erections.
When a patient presents with active Peyronie’s disease, the chance of spontaneous improvement is approximately 20%, the chance of stabilization is 40% and the chance of further progression is 40%.
Treatment of Peyronie’s Disease
The management of Peyronie’s disease is dependent upon the extent of stabilization of the disease state, the severity of the penile defect, and erectile function.
Surgical therapy is employed when there is a significant penile defect preventing sexual relations. Patients with concomitant erectile dysfunction should undergo therapy for erectile dysfunction first.
The potential complications of penile-straightening surgery are palpable suture knots, penile shortening (approximately 1 centimeter for every 15 degrees correction), numbness of the penis, residual curvature, and worsening erectile dysfunction. This is why we don’t recommend trying surgery in the acute phase of the disease because it is treatable with conservative treatment methods.
Shock Wave Therapy for PD
The procedure involves the use of shockwave lithotripsy technology to treat Peyronie’s disease. Extracorporeal shockwaves are high-pressure, low-frequency sound waves, generated by a device outside the body and applied to the affected tissue in a site-specific manner.
In Peyronie’s disease, the penile plaque is the target of these shockwaves and is generally localized using an ultrasound scanner. Shockwaves per session range from 2000-3000, with the average person receiving around 3-5 treatment sessions. There are three basic energy levels:
- low-density energy around 0.04 and 0.12 mJ/mm2
- the average density of energy varying between 0.12 and 0.28 mJ/mm2
- a high density of energy generally between 0.28 and 1.5 mJ/mm2
When you have shockwave therapy for Peyronie’s disease, we put a handpiece against the affected area of your penis and use sonic gel to transmit single pulses of energy. This process helps produce new blood vessels in the site and breaks up plaque, which helps increase blood flow in the area.
Shockwave therapy usually takes between 25-30 minutes and doesn’t require any anesthesia or numbing cream. At the most, you might feel a mild tingling or buzzing sensation throughout the entire treatment.
Based on the results from the comparative studies, the main benefits of extracorporeal shock therapy were alleviation of pain and reduction of angulation. In one comparative study, 50% (10/20) of patients receiving extracorporeal shockwave therapy experienced a 30% decrease in curvature.
In the studies identified relatively few complications were reported as a result of treatment. Complications were mostly of a transient nature and included bruising, skin discoloration (petechiae), and hematoma.
Specialist Advisors did not note any particular safety concerns of this procedure.
PRP for Peyronie’s Disease
PRP, or platelet-rich plasma, is a technology used over the last decade to treat musculoskeletal injuries. Over 7,000 papers have been published speaking to the efficacy of PRP in healing tissue. Today, this technology is used for treating erectile dysfunction and Peyronie’s disease.
How is PRP provided?
A small amount of blood is drawn from the arm. Using a centrifuge, we isolate platelets from your blood (platelet-rich plasma, or PRP), all within about 15 minutes in the office. The platelets are then “activated” to release at least eight growth factors that would normally be used to heal injured tissue. These growth factors work like magic to cause increased collagen, blood flow, and break down the hardened plaque causing the curvature.
How does PRP work for Peyronie’s disease?
The anti-inflammatory properties, growth factors, nutrients, and water of the PRP softens the fibrotic tissue in the plaque, reducing the curvature of the penis typical of this condition.
PRP therapy works by drawing blood from the patient’s arm and then taking it to a centrifuge where the platelet-rich plasma is isolated to obtain the resultant growth factors.
The PRP is injected into the affected area can then stimulate blood flow and promote younger tissue growth.
These are not the only methods we use for treating your PD, so contact us to learn more and get a free consultation.