Normal Anatomy

The main structures in the penis that contribute to erections are the paired corpora cavernosa. These structures that course along the penis deep to the skin are composed of a casing or covering called the tunica albuginea, and contain spongy vascular tissue. Important arteries and nerves that provide blood supply and sensation to the head of the penis travel along the top of the penis between the tunica albuginea and the skin.

Normal tunica albuginea is elastic and can stretch. During erection, blood fills the corpora cavernosa, and these structures enlarge and become rigid. In some ways, the penis is similar to a water balloon. Imagine a balloon that is almost empty. The balloon will be very flexible. If the balloon were to be filled with water, as the rubber expands, the elastic balloon will become longer, wider, and more rigid. In the penis, there is elastic tunica albuginea instead of rubber and the penis fills with blood instead of water. There are also many tiny veins within the penis that occlude, or pinch off during an erection, allowing the blood to stay within the penis.

MEDICAL TREATMENT:The FDA has approved the first drug for treating Peyronie’sdisease,Xiaflex. It is believed to work by breaking down the scar tissue that causes the curvature.

Vitamin Therapy

Some studies have shown that vitamin E improves Peyronie’s disease. Similar studies have been done on para-aminobenzoate, a substance related to B-complex vitamins, but the results have been inconclusive. Both of these substances theoretically decrease or inhibit the scar tissue (plaque) formation.

Other Options

Other approaches to treating Peyronie’s disease that have yet to be confirmed as effective include the injection of chemical agents directly into the plaque or radiation therapy. However, because radiation therapy can only relieve pain associated with Peyronie’s disease and pain frequently disappears without treatment, it is seldom performed.

Since the severity of the condition varies from person to person, talk to your doctor about what treatment strategy is right for you.

Pain Management

In the majority of men with penile pain due to Peyronie’s disease, the discomfort usually will resolve on its own as the penile injury heals and matures over time. This process may take as long as six to 18 months. In certain instances, the calcium channel blockers Calan or Isoptin may be effective in decreasing the pain related to Peyronie’s disease when injected directly into the penile scar or plaque.

SURGICAL MANAGEMENT

Most experts recommend against surgery during the early inflammatory phase of Peyronie’s disease. Your doctor might suggest surgery if the deformity of your penis is severe, especially bothersome, or prevents you from having sex. Surgery usually isn’t recommended until the curvature of your penis stops increasing.

Surgical methods include:

• Suturing (plicating) the unaffected side. A variety of procedures, such as Nesbit plication, can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This can straighten the penis, but it might result in actual or perceived penile shortening. In some cases, plication procedures cause erectile dysfunction.
• Incision or excision and grafting. Generally used in cases of more severe curvature, this procedure is linked to greater risks of worsening erectile function compared with plication procedures. The surgeon makes one or more cuts in the scar tissue, sometimes removing some of that tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may sew in a piece of tissue (graft) to cover the holes in the tunica albuginea, a membrane within the penis that helps maintain an erection. Various type of grafts which can be used are:
  • Autologous tissue grafts: These are grafts made of tissue taken from another part of your body during surgery. Some sources of grafts used for Peyronie’s disease are a vein from your leg (saphenous vein) or skin from behind your ear (temporalis fascia). Since autologous grafts are living tissue, they often grow into the surgical site much better than some other materials. A drawback to using an autologous graft is that the surgeon must make a second cut to harvest the graft.
  • Non-autologous allografts: These are sheets of tissue that are commercially made from human or animal sources. Before use, they are sterilized and treated to remove anything that could cause infection. These grafts act as supports for your body to grow fresh, healthy tissue on while they are slowly absorbed by your body. Allografts are strong, easy to work with, and well tolerated by most patients. Man-made materials such as Dacron® mesh or GORE-TEX® aren’t often used for Peyronie’s surgeries now. These materials can cause fibrosis that can make the deformity worse.
• Penile implants.Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse. Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie’s disease and erectile dysfunction.

The type of surgery will depend on your condition. Your doctor will consider the location of scar tissue, the severity of your symptoms and other factors.

RESULTS:

Oral and injectable medicines are effective only in the early or initial phase of the disease.
For stable/ permanent curvature of penis surgical procedure has success rate more than 95%.
In patients with erectile dysfunction and peyronie’s disease penile implant with surgical correction leads to good quality and painless erection in more than 80-85 % of patients.

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