Peyronie's disease: an in-depth analysis of the condition and its impact on men's health
Escrito por:Peyronie's disease (PD) was considered to be quite rare in the past, but it has become apparent now that the condition is more common than previously thought. Fortunately, fewer men are suffering in silence and are instead seeking medical help.
As a direct result of medical assistance being sought, the various physical and mental effects of Peyronie’s disease can be addressed. Mr Sudhanshu Chitale, an expert on the condition, explains what exactly Peyronie’s disease is, its impact on men’s health, as well as outlining available and effective treatment.
Peyronie’s disease
Peyronie’s disease (PD) is an awkward and sometimes painful bend of the erect penis. It is the most common cause of bent penis, and, despite the fact that this condition has been known to the medical field for over 250 years, we still don’t know exactly why it happens. Therefore, treatment focuses on fixing the effect (the bend), rather than tackling the cause.
Peyronie’s disease is an acquired condition and collagen disorder. It is an abnormality that is characterised by one or more of the following key symptoms:
- fibrosis (scar tissue) on the tunica albuginea (the fibrous tissue that covers the testis)
- pain
- deformity
- erectile dysfunction
- emotional distress
Men of any age can develop PD, but the most common age-group is men in their mid-fifties, and they most often have no previous event that could have triggered the condition. Pain resolves in time for 90 per cent of patients. The penile deformity (the curve when erect) is progressive in 30 to 50 per cent of men with PD, and stabilises in 47 to 67 per cent with a hard and calcified plaque.
Risk factors
Peyronie’s disease has been associated with Dupuytren’s contracture, another collagen disorder. Other risk factors with an unclear link to PD are diabetes, hypertension (high blood pressure) and dyslipidaemia (an abnormal amount of lipids in the blood).
Peyronie’s disease: its impact on men’s health
Peyronie’s disease is not only known to have a psychological impact on men’s health, but so too on their physical health. PD can impact men’s self-image and the quality of their sex life.
Men with PD often suffer from depression. Up to half of PD sufferers admit to the condition negatively impacting their relationships. The curvature caused by PD can make penetrative sex difficult or painful to the patient and/or their partner, causing physical and psychological distress and difficulties in their relationship.
More men are speaking up
Peyronie’s disease is not considered uncommon these days, despite being considered rare in the past. Research findings vary between research papers, ranging from the condition affecting 0.5 per cent of men to 20 per cent of men. If the latter figure is true, this creates a significant impact on the health care system.
However, a large number of men avoid seeing the doctor for such issues due to embarrassment. Therefore, we (clinicians) must probe into the possibility of Peyronie’s disease when men visit us for erectile dysfunction and lower urinary tract symptoms (LUTS), which can both co-exist with PD.
Phases of Peyronie’s disease
1. Active (acute) phase
Men with Peyronie’s disease initially go through an active (acute) phase of the condition. This involves dynamic and changing symptoms, most commonly pain, and also an irregular curve of the erection, which can lead to increasing levels of distress. At this point, men may or may not be compromised in terms of being able to have an erection.
2. Stable (chronic) phase
When the PD symptoms have been stable for three to six months, the condition enters its stable (chronic) phase. The pain usually subsides, but both the irregular curve and hard scar tissue (fibrosis) on the penis remain.
It has been observed that in three to 15 per cent of men, PD resolves spontaneously over six to 12 months, particularly in younger men. However, there are treatments available for men with persistent PD.
Treating Peyronie’s disease
As mentioned earlier, treatment focuses on treating symptoms as we don’t yet understand the exact cause.
Treating erectile dysfunction
Men with erectile dysfunction caused by PD should be given the appropriate oral therapy using a PDE5 inhibitor. They may also be provided with a vacuum penile pump device (also called a vacuum penile constriction device).
Monitoring how Peyronie’s disease progresses
When PD is diagnosed in the active stage (the first stage), the best form of management is to monitor how the condition develops. By doing so, we can see if the condition resolves itself and if treatment is needed at all.
However, we (urologists) are still available while the active PD is left to develop. Patients can expect:
- a baseline assessment of the condition
- a detailed discussion of treatment options (and the risks and benefits of each)
- a discussion on how to best satisfy the patient’s goals
- a discussion to set realistic expectations
Treatment in the active phase
As the condition is monitored in the active phase, men could be offered NSAIDs (nonsteroidal anti-inflammatory drugs) for symptomatic pain relief. To date, any other oral treatments described in medical research haven’t yet provided evidence of any lasting benefit. Therefore, no other oral medication should be offered.
Treatment in the stable phase
In men with stable PD who don’t have associated erectile dysfunction, treatment depends on the following issues:
- Their penile deformity’s impact on their self-image.
- The level of difficulty with sexual intercourse (for themselves and/or their partner.)
- Psychological distress.
- The effect on their relationship.
- Their expectations regarding treatment.
A medical specialist ought to have a frank discussion with the patient about the options that are available to them, which are based on the extent of the penile deformity and angulation.
In this situation, patients might be offered:
- Surgical correction using the plication technique. This does include a slight loss of penile length.
- Surgical correction using penile lengthening. This includes an incision and grafting technique which may include a penile prosthesis.
- An intralesional injection (a high concentration of medicine injected into the skin) using verapamil and interferon alpha-2b.
Xiapex: a new treatment for Peyronie’s disease
The new treatment for Peyronie's disease has introduced itself as intralesional collagenase clostridium histolyticum, which is known as Xiapex in the EU and Xiaflex in the US.
It is administered as a course of up to eight injections over 24 weeks, depending on the curvature of the penis and the patient’s initial response to treatment. It is an outpatient procedure (meaning there is no hospital stay involved) and it is a minimally invasive, non-surgical treatment option, which removes the typical risks associated with surgery.
It has recently been licensed for managing PD (following its original license for Dupuytren’s contracture, another collagen disorder). In clinical trials, Xiapex reduced the curvature of the penis up to 17 degrees (37 per cent) for some patients in their one-year follow-up.
Xiapex may not be a complete cure for Peyronie’s disease, but it is certainly a significant addition to the range of treatments that we can offer patients.
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