Peyronies Disease Treatment London | Penile Curvature Surgery UK

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What is Peyronie's Disease?

Peyronie's Disease is a condition that often affects the curvature and length of the penis, caused by fibrous scar tissues called plaque that form inside of the penis.

This scar tissue can be easily palpated as a lump and tends to be tender for a few months during the initial phase of the disease.

Peyronie's Disease plaques cause loss of elasticity of the tunica of the penis and this reduces the capacity of the penis to stretch during erections. Patients therefore frequently report penile shortening and deformity such as curvature and narrowing of the shaft penis, which become visible during erections. In flaccidity, the lumps can still be palpated, but the deformity is not visible.

Most men who suffer from Peyronie's Disease are still able to have sex, although for some men it can become painful or cause further erectile dysfunction. Depending on the symptoms you have, you may opt for medical or surgical treatments. The disease rarely goes away by itself and often gets worse. However the curvature and penile shortening associated with the condition often stabilizes within three to 12 months.

If treated early, Peyronie's Disease can be stopped from progressing and you may even notice an improvement in your symptoms.

Peyronie's Disease can be a challenging condition to live with and may be harming your mental and emotional wellbeing and impacting on your romantic relationships. Peyronie's Disease treatment can help with the mental and emotional impact as well as easing the physical symptoms of the condition.

The lumps that form in Peyronie's Disease are noncancerous.

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What are the symptoms of Peyronie's Disease?

There are a number of symptoms which may indicate Peyronie's Disease. Sometimes symptoms appear suddenly but sometimes they develop very gradually over an extended period of time. You may be experiencing some or all of the following:

Significant bend in the penis (curvature): Peyronie's Disease often causes a noticeable curvature of the penis. You may notice that your penis is bending towards one side or curving upwards or downwards.
Lumps or bands of scar tissue: Scar tissue, known as plaque, can be felt under the skin of the penis as a hard lump or band.
Penile pain: Peyronie's Disease can cause penile pain which may happen with or without an erection. Some sufferers may experience more pain than others. Pain during erections usually improves within a couple of years.
Erection problems: It is common for men with Peyronie's Disease to experience getting or maintaining an erection (also known as erectile dysfunction). However it is not uncommon for a man to experience erectile dysfunction before the beginning of Peyronie's Disease symptoms.
Shortening of the penis: You may find that your penis becomes shorter as a result of Peyronie's Disease.
Other penile deformity: Peyronie's Disease can also be responsible for other penile deformities, such as indentations, narrowing or the penis may even take on an ‘hourglass’ shape when in an erect state.

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How is Peyronie's Disease diagnosed?

Peyronie’s Disease diagnosis is based on history taking and on the examination of the patient. Frequently patients report that the disease has started following a trauma to the penis during sexual activity. Examination of the penis will demonstrate the presence of a lump, which can be elastic or indurated in texture.

Penile deformity can be assessed only during erections, when the tunica albuginea of the penis is stretched to its maximum capacity. Self-photography of the erect penis can be a useful tool to identify the nature of the deformity, but this has its limitations. A photo taken at home may not fully demonstrate the extent of the curvature and a semi-erection will make the deformity appear less pronounced. If required, the doctor will be able to administer vasoactive medication to induce an erection at the clinic for assessment.

As patients with Peyronie’s Disease frequently have cardiovascular disease, which might have produced a degree of obstruction of the arteries feeding the penis, a thorough assessment of the penile blood supply will be carried out using an Eco Colour Doppler Ultrasound Scan. This will provide the doctor with information that will also help to better decide which is the most appropriate treatment option for each specific patient.

How is Peyronie's Disease treated?

There are various treatment options for Peyronie’s Disease depending on the progression of the disease:

Medication

There is very little evidence that this type of treatment is effective during the beginning phase of the disease. Treatment options such as oral medication, topical treatments and supplements such as oral Viitamin E, Tamoxifen, Pentoxyphilline, Potassium Paraaminobenzoate, Colchicine and Verapamil have been offered to patients with no proven success on reducing penile curvature or plaque size, however, they may help with pain management and potentially slowing the progression of the disease.

Traction therapy (penile stretching)

There may be rationale for penile stretching and straightening exercises during the acute phase of the disease. This can be achieved either by enhancing natural erections with the administration of Phosphodiesterase Type 5 Inhibitors such as Sildenafil, Tadalafil and Vardenafil, or mechanically, with the use of a vacuum or stretching device. Either treatment on its own is unlikely to show an enormous benefit and should be performed together to get any result. The evidence of the effectiveness of the use of the vacuum pump or penile stretching device in isolation to mechanically straighten the penis is minimal. In the best-case scenario, the regular use of these devices may just slightly reduce penile curvature, which would be beneficial only in very selected patients (under 10%).

Injections

Injections of the Collagenase of the Clostridium Histolyticum (Xiapex®) is one of the latest treatment options available for Peyronie’s and the first non-surgical therapy that has proved effective in treating Peyronie’s plaque. These injections treat the curvature by “chemically” softening the plaque and restoring some of the length lost due to the scarring process. Xiapex® injections provide better results if combined with the regular use of a vacuum pump or of the penile stretching device in order to provide an extra stretch of the plaque softened by the Collagenase of the Clostridium Histolyticum. These should be performed at four weekly intervals and the residual curvature should be assessed after the third injection, once the healing process at the level of the plaque is likely to be complete. If significant deformity persists, the cycle injection/stretching can be repeated. In expert hands, Xiapex® injections are a simple and safe procedure and can be performed in the outpatients’ clinic and would typically be the first line of treatment (subject to consultant’s diagnosis).

Surgery

Surgery represents the gold standard treatment for Peyronie’s Disease and its aim is to guarantee a penis straight and hard enough to allow the patient to engage in penetrative sexual intercourse without pain or discomfort. The choice of the best surgical approach, apart from patients’ preference, should take into consideration the quality of an erection and the degree of deformity and shortening. In patients with preserved erections, the curvature can be corrected either by shortening the longer side of the penis, which has not been affected by Peyronie’s Disease or lengthening the shorter side incising the plaque and interposing a graft. Both procedures can be performed as a day case.

Before the introduction of Xiapex, surgery was the only effective treatment for penile curvature caused by Peyronie’s and still remains the most successful for most patients. Surgery should only be performed after the disease progress has stopped which usually occurs 12 months from onset (chronic phase).

Who is suitable for treatment?

You will be considered suitable for treatment for Peyronie’s Disease if you experiencing one or more of the following:

A pronounced curvature of the penis
A noticeable shortening of the penis
Penile pain, particularly during an erection
Pain during sex
Difficulty getting or maintaining an erection (erectile dysfunction)
Seeing/feeling noticeable scar tissue (plaques) underneath the skin
Penile deformity (including indentations or narrowing)
Harm to your mental wellbeing (anxiety, depression etc)
Difficulty in your romantic or sexual relationships caused by the presence of Peyronie’s Disease
You are in the chronic phase of the disease and your symptoms are stable (3-12 months after symptoms begin)

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Frequently Asked Questions

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What are the risks?

The most common side effects from hydrocortisone injections is pain or swelling in the joint where the injection was given. This is temporary and usually resolves in one to two days. There may also be some mild bruising at the injection site.

As hydrocortisone shots are injected straight into the joint, the medicine does not travel around your body. However sometimes hydrocortisone may get into your blood and as a result there is a very slim chance you may experience a serious side effect. Potential side effects include: depression, mood changes, infection, deep vein thrombosis (DVT), eyesight changes, diabetes or complications of diabetes, and Cushing’s syndrome. Some of these side effects may happen after a few days while others may not present until months after treatment. These are all very rare side effects.

It is extremely rare to have an allergic reaction (anaphylaxis) to a hydrocortisone shot.

Peyronie's Disease