Peyronie's disease is an abnormal curvature or deformity of the erect penis caused by the thickening and hardening of penile tissue that is normally flexible and elastic. The tissue, or plaque, can be felt as nodes or flat fibrous bands. Plaque does not allow the penis to straighten, making sexual activity difficult or impossible.
Early Stages of Peyronie's Disease is Painful
Inflammation and pain characterize the first 18 months of Peyronies. Treatment during this time is with oral supplements and medication; usually vitamin E and C with the amino acid L-carnitine are tried, with mixed results. Medications aimed at slowing the progression of the disease also have been disappointing in most cases. However, 15% of men with Peyronie's disease get better without treatment. Some stay the same, and up to 50% get worse. Some men continue to have pain, some can maintain an erection, and some experience impotence.
The Cause of Peyronie's is Unknown
The risks of developing Peyronie's disease are higher for men whose fathers or brothers are affected, and for men who smoke. Injuring the penis, even slightly, is thought to trigger the abnormal scarring that characterizes Peyronie's. A class of medications for high blood pressure known as beta blockers lists Peyronie's disease as a possible, but rare, side effect. Men who have other connective tissue disorders, such as Dupuytren's syndrome, are at greater risk of Peyronie's disease. The condition is not contagious.
The Drawbacks of Nesbit Surgery
In Nesbit surgery, the flexible tissue opposite Peyronie's scars is shortened to equalize the curvature and straighten the penis. Unfortunately, this results in a significant loss of penis length. Recovery time for this invasive surgery is lengthy, and most men are unhappy with the outcome.
The Leriche Technique Has Better Outcomes
Frequently an outpatient procedure, the Leriche technique was developed by urologist Albert Leriche. His inspiration was a technique used by hand surgeons to break up abnormal connective tissue that contracts the palms in Dupuytren's syndrome. By slicing the plaque, or inflexible scar tissue on a penis affected by Peyronies, straightening can be achieved. The plaque has to first be located and measured under ultrasound. After an anesthetic is given, saline is injected into the penis to create an erection and the scar tissue is then slashed with a lancet or a needle until the desired shape and angle is achieved. A pressure dressing must remain on the site for three hours. After completion of the procedure, men are required to have frequent sexual activity for one month to maintain results. Although results vary, nearly a third can be cured with Leriche technique. The procedure can be repeated one or more times to increase improvement.
The Procedure is Not Appropriate for All Men
Co-morbidities such as diabetes and the need to take blood thinning medications may bar some individuals from treatment with the Leriche technique. It is only performed in the stable phase of Peyronie's disease and most doctors will require at least a three month's trial of oral medication before considering the option of a Leriche procedure. The condition must be serious enough to interfere with sexual function, however, plaque that has spread too far cannot be helped with Leriche technique.
Other Treatments Can Be Helpful
Traction and penis extenders have improved some cases of Peyronie's. Penile implants are another option that are successful in many instances. Having the Leriche technique performed, or repeated, does not prevent men from trying other options later on.
Peyronie's disease causes deformity of the male penis in two phases, inflammatory and stable. Medical treatments have mixed results and Nesbit surgery shortens the penis in order to straighten it. The Leriche technique has successfully restored function to otherwise healthy men who do not have extensive scarring.
References:
The Peyronie's Disease Society
The Association for Peyronie's Disease Advocates
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