Peyronie’s disease is an acquired curvature that occurs in the penis due to the presence of fibrous plaques within the penile tissues. It occurs with minor injuries to the penis, which may happen during sexual intercourse or masturbation, which heal abnormally, leading to the formation of fibrous scars instead of healthy elastic tissues. These scars on the penile shaft cause tension in the surrounding tissues, resulting in the curvature of the penis towards the site of scar formation. Penile curvature can make erections painful and weaken over time, making sexual intercourse difficult, or even impossible.

How common is Peyronie’s disease?

The actual number of men suffering from Peyronie’s disease is estimated to be more than 1 in 10 men, and the chances of developing Peyronie’s disease increase with age, especially among diabetic patients. However, men in their twenties and thirties can also develop Peyronie’s disease, but at lower rates.

What are the signs and symptoms of Peyronie’s disease?

Signs and symptoms of Peyronie’s disease may include:
1. Abnormal curvature of the penis.
2. Deformity in the natural shape of the penis.
3. Uneven enlargement of the penis.
4. Painful erections and pain during intercourse.
5. Difficulty achieving or maintaining a full erection, leading to sexual weakness that may be unresponsive to medication.
6. Presence of a lump or hardness in the penis due to scar tissue, which can be felt beneath the skin.

These symptoms may develop slowly or appear quickly and can be mild to severe. In many cases, the pain decreases over time, although the penile curvature remains.

What are the causes of Peyronie’s disease?

The causes behind this disorder are multiple, including chronic diseases that affect tissue vitality, such as diabetes, as well as aging and cellular senescence.

Who is most at risk of developing Peyronie’s disease?

Family history of Peyronie’s disease:
Peyronie’s disease may run in some families. For example, if a father or sibling has Peyronie’s disease, the chance of developing the disease also increases.

Aging:
The chances of developing Peyronie’s disease increase with age. Age-related changes in penile tissues can make them more susceptible to injury and less likely to heal properly.

Diabetes with erectile dysfunction:
Diabetes is a risk factor for Peyronie’s disease as it is associated with vascular impairment. Adequate blood supply is essential for effective healing of routine injuries that occur in the penis. Impaired blood flow can weaken the body’s healing process and lead to scar formation after minor injuries.

Treatment of prostate cancer with surgery:
The chance of developing Peyronie’s disease increases after prostate cancer surgery. This may be related to sexual dysfunction that usually occurs after prostate cancer surgery or with the prostatectomy itself.

What are the complications of Peyronie’s disease?

● Inability to have sexual intercourse due to penile curvature.
● Erectile dysfunction.
● Emotional distress, depression, or anxiety about sexual function or the appearance of the penis.
● Strained relationship with a partner.

Peyronie’s disease or acquired penile curvature differs from congenital penile curvature in that it is prone to progressing over time and is susceptible to increased curvature in the future.

What are the diagnostic steps for Peyronie’s disease?

Medical and family history:
Professor Dr. Ahmed Zaazaa, MD, Consultant in Andrology, will ask about your medical and family history. These are examples of some questions:
• When did the symptoms start?
• Is there pain during erections or at other times?
• Are there problems with erections or sexual intercourse?
• Does anyone in the family suffer from acquired penile curvature?
• What medications does the patient regularly take?
• Are there any other medical conditions?

Physical examination:
The doctor can usually feel scarring in the penis, whether it is erect or not.

Imaging:
For an accurate diagnosis of the extent of fibrous plaques and its impact on the cavernous tissue function of the penis, the doctor may order additional tests, such as ultrasound imaging, to better evaluate the tissues.

How is Peyronie’s disease treated?

Surgery is the definitive treatment for Peyronie’s disease when other treatment options are ineffective in advanced cases. The treatment of Peyronie’s disease depends on the severity of symptoms, the degree and direction of penile curvature, and whether it is accompanied by erectile dysfunction.

The goal of treating acquired penile curvature is to achieve a straight or nearly straight penis, reduce pain, and restore and maintain the ability to have sexual intercourse.

Types of surgical procedures:
1. Plication technique:
The plication technique is done by shorting the unaffected side of the penis, resulting in the straightening of the penis. However, this may lead to penile shortening. This procedure is usually performed for patients with good erectile function, mild to moderate curvature, and an appropriate penile length. The procedure takes about an hour, and sexual intercourse can be resumed after 4 to 6 weeks. This technique may temporarily correct the condition, but fibrosis may recur after the surgery, leading to decreased erectile rigidity.

2. Incision or excision with grafting:
In this type of surgery, the surgeon makes an incision in the scar tissue, allowing the penis to stretch and become straight. In certain cases, the scar tissue can be excised, and a graft taken from the patient’s own body can be used to cover the area where the incision or excision was made. This surgery is used in cases of severe curvature or deformity. It maintains the length of the penis, but one of its drawbacks is that it can significantly weaken erections. Therefore, it can be applied in cases where erectile dysfunction is already present, combined with penile prosthesis implantation.

3. Penile prosthesis implantation:
Penile prosthesis implantation is considered the optimal choice for patients with Peyronie’s disease, characterized by penile curvature or deformity accompanied by erectile dysfunction or impotence.

So, when does penile prosthesis implantation become necessary for treating acquired penile curvature or Peyronie’s disease?
Penile prostheses are an effective option in the following cases:
• Severe erectile dysfunction and a lack of response to medication.
• Inability to tolerate the side effects of these medications.
• Noticeable deformity of the penis.
• Loss of ability to engage in sexual intercourse.

Implantation of the male implant:

Treating erectile dysfunction in Peyronie’s disease or acquired penile curvature through implantation of penile prosthesis is the ideal option in cases that are unresponsive to medical treatment and are expected to worsen over time, to increase the rigidity of the erect penis as well as improve the curvature without shortening the length of the penis.

The penile prosthesis enhances erectile function and treats the acquired curvature, making the shape of the penis even and natural after the procedure. It also prevents the progression of acquired penile curvature and penile shrinkage in the future.

Penile prosthesis implantation is performed using the “No Touch Technique,” ensuring maximum sterility. It is a precise outpatient surgery, and the patient can resume sexual activity within 4-6 weeks after the procedure. To learn more about penile prostheses, click here.

In general, there are effective surgical procedures to deal with Peyronie’s disease or acquired penile curvature. Therefore, patients should consult specialist doctors such as Prof. Dr. Adham Zaazaa, Consultant in Andrology, and Pioneer of Penile Prosthesis Surgery in Egypt and the Middle East.