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Peyronie’s disease / syndrome treatment (penile fibromatosis)

What is the Peyronie’s disease / syndrome treatment (penile fibromatosis)?

Peyronie's disease, is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis.

A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.

Peyronie's disease is a disorder affecting the penis that can cause:

- a lump within the shaft of the penis;

- pain in the shaft of the penis;

- abnormal angulation of the erect penis (“bent” penis).

Not all of these features are necessarily present, but, typically, a man would first notice a tender lump in the penis, which might later be followed by bending of the penis when erect, sometimes at very odd angles. The flaccid penis is not usually deformed.

Although the popular conception of Peyronie's Disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. Sometimes the condition may also make sexual intercourse painful and/or difficult.

Drug treatment is a controversial area, as only limited evidence of the effectiveness of drug treatment exists. However, such treatment is worth considering in men with early or active Peyronie's disease, that is when the lump is expanding or is painful. The aim is to reduce pain, lump size and the eventual deformity.

Because the development of Peyronie's disease varies so much between individuals, a wise strategy is to adopt a conservative approach to treatment and avoid early surgical intervention. Surgery should be done only to correct penile deformity in men with stable Peyronie's disease that has been present for at least a year and has not changed whatsoever for at least three months.

The indications for surgery are:

- unacceptable difficulty with penetration during sex;

- pain during sex for either partner that is a consequence of the penile deformity.

Unacceptable cosmetic appearance of the erect penis is not a good reason to have surgery unless it is causing severe and intractable psychological distress.

What is the procedure?

Usually, Peyronie’s surgery is performed on an outpatient basis under general anesthesia, and can last up to two and a half hours. Surgery is performed by urologist, and a second doctor, a plastic surgeon, may be needed when specialized grafting techniques are used.

There are several surgery types:

- plaque excision and grafting. This involves simply cutting out the plaque from the tunica albuginea and filling the defect with a skin graft from the abdominal wall, however, results are often disappointing;

- plaque incision and grafting. Incising (cutting through) the plaque, either with a scalpel or laser, and then filling the defect with a graft has the advantage of preserving the tunica and maintaining penile length;

- corporoplasty. a) Plication of the corpora: plication of the corpus cavernosum (in simple terms, stitching a small tuck into the corpus) on the opposite side to the plaque may improve deformity but will shorten the erect penis; b) Nesbit's operation: this operation involves removing a section of corpus cavernosum on the opposite side to the plaque, then suturing the edges together. This corrects the deformity but, again, will result in penile shortening. In both of these procedures, circumcision will also normally be performed, as foreskin problems frequently follow these operations in uncircumcised men;

- another surgical option is to implant a device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, implantation is combined with one of the other above mentioned surgical procedures.

What kind of result can you expect?

Most types of surgery produce positive results. But because complications can occur, and because many of the effects of Peyronie's disease - for example, shortening of the penis - are not usually corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature severe enough to prevent sexual intercourse.

Recovery period and recommendations

During the recovery period, patients are prescribed medication that prevents them from having an erection and are advised to avoid sexual activity. Antibiotics are also prescribed to reduce the risk for infection.

Possible side effects and complications

Surgical side-effects are possible resulting in loss of rigidity (hardness) or inability to maintain an erection (impotence), due to permanent surgical alteration of blood flow in the penis, pain greater than before surgery, as well as permanent loss of sensation that makes sexual pleasure a thing of the past. Also excess scar formation can occur from the surgery.

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