Topic: Peyronie's Disease
Question: What are the treatments for Peyronie's Disease ?
Answer: A urologist may treat Peyronies disease with nonsurgical treatments or surgery.
                
The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronies disease often resolves on its own without treatment.
                
A urologist may recommend changes in a mans lifestyle to reduce the risk of ED associated with Peyronies disease.
                
Nonsurgical Treatments
                
Nonsurgical treatments include medications and medical therapies.
                
Medications. A urologist may prescribe medications aimed at decreasing a mans penile curvature, plaque size, and inflammation. A man may take prescribed medications to treat Peyronies disease orallyby mouthor a urologist may inject medications directly into the plaque. Verapamil is one type of topical medication that a man may apply to the skin over the plaque.
                
- Oral medications. Oral medications may include      - vitamin E    - potassium para-aminobenzoate (Potaba)    - tamoxifen    - colchicine    - acetyl-L-carnitine    - pentoxifylline    - Injections. Medications injected directly into plaques may include      - verapamil    - interferon alpha 2b    - steroids    - collagenase (Xiaflex)
                
To date, collagenase is the first and only medication specifically approved for Peyronies disease.
                
Medical therapies. A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include
                
- high-intensity, focused ultrasound directed at the plaque  - radiation therapyhigh-energy rays, such as x rays, aimed at the plaque  - shockwave therapyfocused, low-intensity electroshock waves directed at the plaque
                
A urologist may use iontophoresispainless, low-level electric current that delivers medications through the skin over the plaqueto decrease plaque size and curvature.
                
A urologist may use mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.
                
Surgery
                
A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when
                
- symptoms have not improved  - erections, intercourse, or both are painful  - the curve or bend in the penis does not allow the man to have sexual intercourse
                
Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronies diseasesuch as shortening of the penis. Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms before having surgery because the course of Peyronies disease is different in each man.
                
A urologist may recommend the following surgeries:
                
- grafting. A urologist will cut or remove the plaque and attach a patch of skin, a vein, or material made from animal organs in its place. This procedure may straighten the penis and restore some lost length from Peyronies disease. However, some men may experience numbness of the penis and ED after the procedure.  - plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. Plication cannot restore length or girth of the penis and may cause shortening of the penis.  - device implantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronies disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.
                
A urologist performs these surgeries in a hospital.
                
Lifestyle Changes
                
A man can make healthy lifestyle changes to reduce the chance of ED associated with Peyronies disease by
                
- quitting smoking  - reducing alcohol consumption  - exercising regularly  - avoiding illegal drugs
                
More information is provided in the NIDDK health topic, Erectile Dysfunction.
(Source: NIDDK)