Disease Description (Causes and Symptoms)
- Definition and pathophysiology: Peyronie’s disease is a condition in which fibrous plaques (scar tissue) form in the tunica albuginea of the penis, causing the penis to bend to one side during erection or resulting in asymmetry in length or girth. The plaque reduces elasticity in the affected area, causing localized curvature, which may be accompanied by pain or erectile dysfunction.
- Causes: Congenital factors (imbalanced development of the corpora cavernosa and fibrosis during fetal development) and acquired factors (repeated microtrauma to the penis or abnormal wound healing after trauma) may be involved, and the incidence increases after middle age as elasticity declines. Excessive pressure to one side during sexual activity or masturbation, or sequelae of penile fracture, may be causes.
- Associated diseases/risk factors: Diabetes, hypertension, smoking, and fibrotic diseases (e.g., Dupuytren contracture) may be associated.
- Main symptoms: Curvature of the penis during erection (possible in any direction: left, right, upward, or downward). According to RAG information, downward curvature is common, and leftward curvature has been reported to be more common than rightward curvature. Pain (especially during the initial active phase), reduced erectile function, difficulty with sexual intercourse, and psychological stress may also occur.
Treatment Methods
- Conservative/non-surgical treatment
- Observation: Observation observation when symptoms are mild and do not interfere with sexual activity (especially withholding treatment when pain improves and the curvature stabilizes).
- Medication: Oral medications (e.g., some medications such as pentoxifylline have been suggested as potentially inhibiting the progression of fibrosis), anti-inflammatory drugs (for pain control during the acute phase) — evidence is limited. RAG reports that medication is recommended for mild symptoms.
- Local/local injection therapy: Local injection of collagenase (Clostridium histolyticum, CCH) (with modeling) is a treatment option with demonstrated efficacy when specific criteria are met (e.g., curvature of 30–90°, the course of the diagnosis and active phase, etc.). Local verapamil or interferon injections are also sometimes used, but the evidence is mixed.
- Mechanical treatment: Penile traction therapy and vacuum devices (used to avoid surgical treatment or to preserve penile length before surgery) — may help reduce curvature and preserve length.
- Laser/physical therapy: RAG mentions laser therapy in mild cases, but the effects of laser or topical treatment are limited, and consistent evidence is lacking.
- Surgical treatment (indications)
- Surgery is recommended when sexual intercourse is difficult, there is severe deformity in appearance, or there is no improvement with conservative treatment.
- Timing of surgery: Avoid surgery during the active phase (when pain or curvature is progressing), and perform it after the curvature has stabilized (generally when there has been no change for 6–12 months or longer).
- Surgical methods:
- Shortening surgery on the opposite side of the penis (e.g., Nesbit or plication): Relatively simple, may shorten the penis, and has a high likelihood of preserving sexual function.
- Grafting after incision/excision of the lesion: Used for severe curvature or when preserving length is a priority.
- Penile prosthesis implantation (when complete erectile dysfunction is also present): Implantation of a prosthesis can correct the curvature and restore erectile function.
- Treatment considerations (precautions)
- Before surgery, it is necessary to determine whether the condition is progressing in the active phase; surgery is not recommended during the acute phase (pain or progressive worsening).
- Surgical complications may include penile shortening, decreased sensation, worsening erectile dysfunction, recurrence, and infection.
- Non-surgical treatments may also cause side effects (such as pain after injection or localized bleeding), so consultation with a specialist is necessary.
- Complications: Erectile dysfunction, inability to have sexual intercourse, psychological stress (depression and anxiety), and urethral stricture (rare), among others.
Checklist Before an Outpatient Visit (Including Sample Questions)
- What to bring
- List of medications currently being taken (especially anticoagulants, antiplatelet drugs, PDE5 inhibitors, etc.)
- Medical history (especially penile trauma, history of penile fracture, diabetes, and cardiovascular disease)
- Previous test results (such as ultrasound and blood tests) and records of previous treatment (injections, surgery, and mechanical treatment)
- Symptom records: when symptoms began, whether pain is present and its severity, and the direction and degree of curvature (if possible, take photographs during erection)
- Lifestyle changes (smoking, alcohol consumption, frequency of sexual activity, etc.)
- Examples of questions to prepare in advance for the doctor at the outpatient visit
- How do you objectively assess the degree of curvature during erection?
- How likely is correction without surgery?
- Do the medications I am currently taking (e.g., anticoagulants) affect treatment?
Examples of General Questions to Ask the Doctor
- What are the side effects of this medication (or injection)? Does it interact with the medications I am taking?
- Is my curvature severe enough to require surgery? What results can be expected from surgery, and what is the recovery period?
- What is the prognosis if I receive treatment without surgery? Is there a risk of worsening?
- When is it safe to resume sexual activity (sexual intercourse)?
Examples of Disease-Specific Questions
- Based on my angle of curvature (or photographs), are collagenase injections or traction therapy appropriate? What degree of expected improvement (%) can I expect?
- How do you determine whether the curvature is progressing or has stabilized? When is the best time to have surgery?