UNDERSTANDING PEYRONIE S DISEASE

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1 Learn more about Peyronie s disease and how Chesapeake Urology s Men s Sexual Health specialists can help restore your quality of life. Call to schedule an appointment with a urologist or visit UNDERSTANDING PEYRONIE S DISEASE A Patient s Guide /2015 Chesapeake Urology Associates, PA

2 What is Peyronie s Disease? Peyronie s disease is a condition of the penis in which plaques, or scar tissue, grow on the connective tissue of the penis. This may cause pain, abnormal curvature, loss of girth and/or shortening of the penis, as well as erectile dysfunction or indentation. Plaque on the topside of the penile shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. In addition to the physical symptoms of this condition, some men experience emotional distress and problems with sexual intercourse. Peyronie s disease is believed to affect up to 10 percent of all men, but the condition is also thought to be under-diagnosed because many men are reluctant to discuss it with their doctor The Help You Need is At Chesapeake Urology Chesapeake Urology has specialists who focus on men s sexual health conditions such as Peyronie s disease and restoring a man s health and quality of life. Our physicians understand that Peyronie s disease is not only a physical condition, but also causes emotional stress as it affects a man s sexual well-being. Rest assured that our men s sexual health specialists are experienced in the latest in diagnostics and treatments to help restore your health, and quality of life. 1

3 How Do I Know If I Have Peyronie s Disease? The common symptoms of Peyronie s disease can start suddenly or develop gradually over time. A few of the more common symptoms of the condition include: Abnormal curvature of the penis You may notice that your penis bends upward or downward. This is caused by the plaque, or scar tissue. The scar tissue can also cause small indentations in the penis. The curvature can gradually worsen but eventually stabilizes. It is important to discuss any and all symptoms with your physician as some symptoms of Peyronie s disease can also be caused by other underlying medical conditions including cardiovascular disease. In some men, the pain associated with Peyronie s resolves over time, but the bend in the penis can remain a problem. Occasionally, milder forms of the disease will resolve on its own. Peyronie s disease Painful erections During an erection, the area inside of the penis that fills with blood doesn t fully stretch due to the scar tissue build up, which often results in the curvature and/or the pain during erection. Over time, the pain usually improves. Erectile dysfunction Problems achieving and maintaining an erection are associated with Peyronie s disease. Erectile dysfunction (ED) should be addressed with your urologist as ED can also be a sign of other underlying medical conditions not related to Peyronie s disease. Indentation of the penis, caused by the plaque or scar tissue. Loss of girth or shortening of the penis may be experienced by some men. Normal Difficulty with intercourse, due to the curvature of the penis. Discomfort for your partner during sexual intercourse may also interfere with sexual relations. Illustrations courtesy of Hybrid Medical 2 3

4 What Causes Peyronie s Disease? The exact cause of this condition still remains unclear. However, our urologists do know that certain factors may contribute to the condition, including: Trauma to the penis Any type of injury (hitting, bending, etc.) can cause localized bleeding inside of the penis. As the injury heals, scar tissue can develop causing the curvature many men experience with this condition. Hereditary factors Men with a family history of Peyronie s disease (e.g. father, brother), may have an increased risk of developing the condition. Autoimmune disorders While it is not entirely certain, some autoimmune disorders and connective tissue diseases can increase the prevalence of Peyronie s disease in some men. Age The prevalence of Peyronie s disease increases as men age. Diagnosing Peyronie s Disease A physical exam performed by your urologist is typically all most men need to diagnose Peyronie s disease. Your doctor will examine your penis when it is not erect, feeling for the location and size of the scar tissue. Your doctor may also measure the length of the penis to serve as a benchmark to later determine if the penis has shortened due to the condition. In some cases, your doctor may also want to examine the penis when it is erect to see the degree of curvature and location of the scar tissue, or may ask you to take a digital photo at home. This helps your urologist develop the best plan of care for your condition. Other Diagnostic Tests Ultrasound In addition to the physical exam, your doctor may order an ultrasound of the penis to pinpoint the location(s) of the plaque, or scar tissue. The ultrasound can also be used to evaluate blood flow in the penis when erectile dysfunction is also an issue. Treatment for Peyronie s Disease Your doctor will recommend the best treatment option based on the results of your physical exam and any other diagnostic tests performed. Watchful waiting In some cases of less severe Peyronie s disease, the condition may clear up on its own without medical intervention. Your doctor may recommend this approach if your condition is not causing pain or interfering with sexual intercourse. 4 5

5 Injection therapy The goal of medication injected directly into the area of the plaque formation is to reduce the plaque as well as diminish pain and curvature of the penis. - Xiaflex is the first FDA approved nonsurgical treatment for Peyronie s disease, approved for use in men with a palpable lump from plaque in the penis that causes a curvature of at least 30 degrees during erection. This medicine works by decreasing the plaque that causes the curvature of the penis and involves a series of injections. The injections are given in your doctor s office and most men receive as many as four treatments, each of which is two injections of the drug. The treatment does have side effects that should be discussed with your urologist. Surgery is the standard treatment option for Peyronie s disease when other treatments have proven ineffective. Your urologist may perform one of several surgical procedures including: - Penile prosthesis - For patients with Peyronie s disease and erectile dysfunction, placement of an inflatable penile prosthesis (penile implant) in the penis is used to increase the rigidity and straighten the penis adequately. In severe cases, if the implant alone does not straighten the penis, implantation with excision of the plaque and placement of a graft may be performed. Penile prosthesis remains the gold-standard treatment for patients with ED and Peyronie s disease. Medical management - Many vitamins, supplements and medications have been studied in order to relieve pain from Peyronie s disease and stabilize curvature, with variable success. There are no oral medications currently approved for the treatment of Peyronie s disease. Penile stretching - Penile stretching devices may decrease the degree of curvature and increase the length of the shortened penis. This treatment option, however, remains controversial. - Excision This procedure involves removing or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length from Peyronie s disease. Risks of the procedure include numbness of the tip of the penis and decreased rigidity of erections in a small number of patients. - Plication This procedure involves removing or pinching a piece of the tunica albuginea (a thick membrane in the penis that envelopes the erectile tissues) from the side of the penis opposite the plaque, to straighten out the penis. This method is less likely to cause numbness or erectile dysfunction, but it is associated with a decrease in penile length. Excision procedure 6 7

6 Frequently Asked Questions About Peyronie s Disease Q: What is Peyronie s disease? A: Peyronie s disease is a condition of the connective tissue of the penis that causes the abnormal growth of plaques, or scar tissue, inside of the penis. This may cause pain, abnormal curvature, loss of girth and/or shortening of the penis, as well as erectile dysfunction or indentation. Q: How do I know if I have Peyronie s disease? A: Common symptoms of the condition include: Abnormal curvature of the penis Erectile dysfunction Loss of girth or shortening of the penis Painful erections Indentation of the penis Difficulty with intercourse Discomfort for your partner Q: Who do I turn to for help if I suspect I have Peyronie s disease? A: Chesapeake Urology has several specialists in men s sexual health who have extensive training, experience and success in treating men with Peyronie s disease. Our specialists understand the physical and emotional toll the condition can take and work closely with each patient to develop the best individualized plan of care. Q: What causes Peyronie s disease? A: While the exact cause is not entirely clear, factors associated with Peyronie s disease may include: Trauma or injury to the penis Hereditary factors Autoimmune disorders Age Q: How is Peyronie s disease treated? A: Depending on the severity of your condition, your doctor may recommend watchful waiting, as some cases resolve on their own over time. If symptoms persist, your doctor may recommend: Injection therapy with an FDA approved medication called Xiaflex. This medication works by decreasing the plaque that causes the curvature of the penis. Surgery, which includes such procedures as excision, plication and/or implantation of a penile prosthesis. Medical management, through the use of certain vitamins or supplements, although there are no oral medications for Peyronie s disease currently available. Penile stretching 8 9