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Oganes E. Dilanyan
Urologist, MD, PhD
+7(499)344-03-03

Peyronie's disease

In this article

Peyronie’s disease, a condition that we still don’t know that much about, is more common than we are used to believing. This condition can adversely affect a man’s sex life due to causing the penis to be bent when erect and can sometimes force the sufferer to give up sex all together. 

Peyronie’s: disease in men

“Everything seemed to be fine but then at some point the pain started. I thought it would eventually go away but a month later the penis developed a bend”; “What kind of man am I now, a thick plaque has tightened the penis and I can’t do anything in bed”; “Erections became painful and curvature followed”; All of these are the complaints of men who come to me with the diagnosis named after a well-known French doctor, Peyronie.

Complaints in the presence of Peyronie’s disease

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Basically, Peyronie’s disease does not have that many symptoms: at some point pain during erection develops and several weeks later it goes away and the patient is rather shocked to discover that their penis is bent. In some cases, patients can recall an injury and later a decline of erectile function. Often the brain is to blame: if erection is painful it is not required.

This condition was first described at the end of XVIII century by Francois de la Peyronie, who was the king’s surgeon. The disease has three distinctive symptoms: penis pain, development of penile deformity and erectile dysfunction. Usually the condition develops gradually, but there have been cases of it developing quickly. 

Symptoms of Peyronie’s Disease

Pain in the penis

It is important to note that all of the three symptoms mentioned above do not always occur together. Simply because they are not interconnected. Penis pain occurs in two out of three men and even then, in some people pain will only occur during erection and in others only during intercourse while in some patients pain may persist outside of erection or intercourse.

Penile deformities

The mechanism is quite simple: fibrous plaque tightens and shortens the penis’s tunica albuginea. This leads to a deformity. The curve is usually directed towards the abdomen but there are other possible variants which include the curve pointing to the left, to the right or downwards, several of those directions combined together or simply shortening of the penis without any noticeable curvature. The most difficult deformities to treat are the “hourglass” type and combined shapes.

Erectile Dysfunction

In the presence of this disease there are two main reasons for erectile dysfunction:

1. Loss of tissue elasticity and disruption of the smallest vascularisation lead to changes of the system responsible for blood collecting in the penis during the erection.
2. Pain during sex and embarrassment about the appearance of the penis cause serious psychological discomfort in a man.

This is why we thoroughly investigate our patients and try and identify the main cause of erectile dysfunction

PEYRONIE’S DISEASE ALWAYS LEADS TO SERIOUS DISRUPTIONS OF SEXUAL ACTIVITY IN MEN

Causes of Peyronie’s disease

Causes of Peyronie's disease

The causes of Peyronie’s disease are not well researched. And no prophylactic methods have yet been developed. But the course of the disease from the first pain symptoms to the appearance of penile deformity is well documented.

The condition presents as fibrosis or scarring of the tunica albuginea of the penis and develops as a result of minor penile injury during intercourse.

Due to the fibrosis or forming of the plaque some parts of the penis lose their elasticity. Shortening of the plaque leads to penile curvature. 
 
 

Initially the pain is to do with the inflammation at the site of injury but this goes away after several weeks but it can take up to eight months for the inflammation to subside. But as a result, the tunica albuginea affected by the plaque starts losing elasticity which leads to its deformity.

“The most advance diagnostic tool can never replace your eyes, ears and fingers”
Professor Z. Vineberg.

Diagnosing Peyronie’s disease

Diagnosing Peyronie’s disease is very simple: all you need to do is palpate the penis. Research shows that ultrasound, even using the most advanced equipment or MRI scans and other costly tests won’t always detect the plaque which can easily be identified by a doctor simply by using their fingers.

PALPATION OF THE PENIS IS A MUCH MORE RELIABLE METHOD THAN MRI AND ULTRASOUND

It is important to know that the doctor has to assess the level of deformity or curvature of the penis. So here is a very important advice: take a photo of your erect penis from the top, from both side and from the bottom before you visit your doctor.

Diagnostic methods we use for Peyronie’s disease

Palpation

Simple and accessible method of diagnosis which allows us to locate the plaque and determine its size. It is often the case that no Peyronie’s disease is diagnosed and we are simply dealing with erectile dysfunction.

Photos

We always ask our patients to photograph their erect penis from the top, left, right and from the bottom to enable us to assess the degree of the curvature. We will not be able to properly assess the deformity without the photographs. 

Blood vessels ultrasound

This test allows us to identify hidden causes of erectile dysfunction not connected to Peyronie’s disease. They can be arterial and venous and this is why this test is compulsory.

Biochemical analysis of blood

Diabetes sometimes can cause this condition to develop and this is why we always perform a blood test that checks glucose levels as well as glycohemoglobin.

Urine test

A standard test that allows us to detect any hidden problems in the urinary system. We are specifically interested in detecting any present inflammation. 

Blood test

This is a very simple test but it helps rule out certain conditions such as leucosis or leukaemia and detect a number of hidden or underlying problems.

“I will follow that system of regimen which, according to my ability and judgement,
I consider for the benefit of my patients and abstain from whatever is deleterious and mischievous.”
Hippocratic oath

Peyronie’s disease treatment: numbers and facts

Tablets for Peyronie’s disease

In the early stages of the disease when the plaque is not yet “ripe” many clinics attempt prescribing “Peyronie’s disease tablets” to their patients.  The leading treatments include large doses of vitamin E and Pentoxifylline. French association of urology offers proven data concerning the lack of effectiveness of such treatments.

Injections into the penis

The search for various drugs that will soften the plaque is constant. Steroids and a cardiological drug verapamil are among those used. The effectiveness of these methods does not exceed 10-17% according to various data obtained from specialised associations. One drug, Xiapex gives some hope but there is no conclusive clinical data about its use available as yet.

Ionophoresis and remote ultrasound treatment

These are two not very effective but expensive ways to try and soften the plaque and return the tunica albuginea to its normal elasticity. But yet again these methods appeared very hopeful but evidence-based medicine is ruthless: their effectiveness does not exceed 10-15%.

WE DO NOT PRESCRIBE “TABLETS FOR PEYRONIE’S” DUE TO THE LACK OF THEIR PROVEN EFFECTIVENESS  

Extender

This is probably the only therapeutic way of treatment that offers a noticeable effect. According to a number of trusted sources with French Association of Urology among them the use of the extender is effective in 60% of the cases provided the plaque has not matured. 
There are two important points:

1. Wearing the extender should be done over a long period of time, 6 months to one year which can be uncomfortable.
2. In the presence of a “ripe” plaque the extender method is not indicated as attempting to stretch an already fully formed plaque will most often simply lead to it increasing in size.

Peyronie’s disease surgery

The main problems of Peyronie’s disease are plaque and curvature of the penis. It is more problematic when erectile dysfunction is also present. 
What should a patient diagnosed with Peyronie’s disease do? According to the data from the French association of urology over 83% of patients will sooner or later have to have some sort of intervention and not all of them will be for aesthetic reasons.

Which surgery to chose?

If the curvature is significant and in the presence of a well-formed plaque there is only one way to cure it. And it is surgery. The question is: which one to chose?

Nesbit procedure

This surgery is offered most often and its aim is to apply stitches to the opposite side of the plaque which corrects the curvature. The disadvantages of this surgery are as follows: The plaque remains and penis is shortened by 1 to 5cm. We offer this surgery only when we are certain that the shortening will not be severe.

Grafting

This is the most complicated and highly technological operation. The plaque is surgically removed and a patch is placed on the site of the defect. We most often use the patient’s cheek mucosa for this purpose due to the qualities of this tissue: it is elastic, takes well to the site and is easy to harvest. A vein can also be used.

Prosthetics

This intervention may have a frightening name but is indicated for use in patients who suffer from severe erectile dysfunction. Two silicone cylinders are inserted into the penis which are inflated using a concealed pump positioned inside the scrotum. This creates an erection.

Surgical treatment of Peyronie’s disease

We offer high quality surgery to the patients with Peyronie’s disease in Moscow. Extensive experience in treating this condition and patient follow up allow us to achieve the best results.

Our Advantages

Professional Approach:  Up to date diagnostics methods of penile curvature causes. 

Our team: Specialised science based surgical andrology team.

Board of doctors for your safety, consisting of a urologist, micro-surgeon and anaesthetist.

Equipment: Specialized microsurgical Karl Storz unit.

Comfort: no queueing or waiting for a consultation and premium inpatient facility.

Safety: we only use methods recommended by professional associations such as EAU and AAU.

Result: Removal of curvature and return to normal sex life. 

We are also GCP certified, which confirms we provide the highest standards of diagnosis and treatment. 

Certificates

Участник мастер-класса по андрохирургии

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Our Guarantees

- We guarantee your safety by using modern and highest quality anaesthesia manufactured in Austria or France. 
- We DO NOT USE low quality equivalents of any drug which significantly lowers the risk of any complications.
- Use of Karl Storz microsurgery microscope guarantees the integrity of the testicular artery for all my patients. 
- Andrology surgical work placements in Austria and Italy together with extensive experience in andrology surgery ensure absence of complications. 
- We DO NOT REFER our patients to unknown clinics for follow up and further treatment and provide outpatient follow up as well as inpatient treatment.

Every patient is provided with a discharge summary with detailed recommendations and an official sick leave certificate
Information for foreign patients:

If you require treatment for penile curvature in Moscow please contact us. We will arrange admission to hospital on the day of your arrival and carry out all necessary investigations and tests and carry out the penile curvature surgery on the following day.  You will be able to return home the day following the operation. 

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