Peyronie's Disease

Section: Urology, Letter of the week
Subject: Peyronie's Disease

Question: "Peyronie's disease seems to be easily detected by plaque formations. Of the treatments I've seen, none seem to deal with removing the plaque. I gather the plaque is not a replacement of the erectile tissue, just something more. I guess if erectile tissue has not been replaced by the plaque, that removal of the plaque should reverse the effects (even though recurrence of the plaque is possible). Please clarify for me."

From: MSmyth
June 17,1997

Question: "How can you best treat Peyronie's disease, and what exactly is it?"

From: Judith T. Los Angeles, CA.
July 16, 1997

[Entry October 20, 1997]
[note: Patrons were answered individually at the time of inquiry.]

PEYRONIE'S DISEASE
Since the letters of MSmyth and Judith, I have received at least one request for information on Peyronie's disease each week. Thus, this is somewhat of a cumulative letter of the week!
Peyronie's disease is also known as 'penile induration' and 'plastic induration of the penis.' Peyronie's disease was first described in medical literature in 1742, and chiefly involves middle-aged and elderly men. Typically, a patient with Peyronie's disease will complain of painful erection, curvature of the penis, and poor erection distal to the area of curvature or plaquing. The deformation of the penis may become so severe that vaginal penetration is prevented. In the non-erect state, the patient has no complaints of penile pain.
The plaques of Peyronie's disease are dense and fibrous, and usually occur near the dorsal midline of the shaft (the part of the penis closest to the abdomen when the penis is erect.). Multiple plaques may be seen, and in severe cases these plaques may even calcify (become filled with calcium) so that they may be seen on X-rays. The origin of these plaques is not completely understood, but microscopically they appear to have been caused by severe vasculitis (inflammation of blood vessels). In addition, the fibrotic plaques of Dupuytren's contractures, which cause tendon stiffening in the hand, also appear identical microscopically to those of Peyronie's disease.
Approximately 50% of cases of Peyronie's disease resolve spontaneously. Older treatments for the condition involved the use of Vitamin E and/or p-aminobenzoic acid tablets for several months. The treatments of the last 15 years have centered on a surgical correction of the curvature of the penis. One of the oldest treatments is known as the Nesbit procedure, and involves plicating (tucking together) the tissue on the ventral (underside) of the penis so that the penis straightens out. The Nesbit procedure produces a satisfactory result between 82-88% of the time. Occasionally, the Nesbit procedure results in a small amount of penile shortening.
In comparison to the information reviewed by our questioner MSmyth, many of the newest treatments for severe cases of Peyronie's disease involve the removal of the plaque, and replacement of the tissue removed with either a skin graft or a Gore-Tex graft. In most of the cases in which the plaque or plaques are removed, a penile prosthesis is then implanted in order that erection and penile length are better maintained. Currently, there are several dozen surgical approaches being developed for the correction of the painful curvature characteristic of Peyronie's disease.