Peyronie’s disease is a penile disease characterized by a penile plaque formed within the penis and leading to pain or deviation in the penis. The patient feels that a tumor of mass has grown within the penis that may even preclude intercourse. This plaque has been proposed to be formed due to micro trauma during sexual intercourse.
The Symptoms can be:
- Feeling of a tumor or lump over the penis
- Pain in the penis especially on erection
- Deviation of penis
- Inability to have intercourse due to deviation or erectile dysfunction.
There are two phases of this disease, an active phase in which the plaque is tender and keeps growing in size and a stable phase in which there is no pain and no further growth in the size of the plaque. There are different protocols of management of the different stages. It is therefore important to identify which phase of the disease we are dealing with.
Active Phase: In this phase the disease is growing or evolving which means that the plaque is painful and changing its shape. Steps to reduce the size of the plaque such as injection therapy or surgery are futile at this stage as there is active inflammation and the plaque may worsen or regrow despite therapy. This leads to failure of the therapy. In the active phase treatment is aimed at reducing pain and inflammation rather than trying to make the plaque vanish. In many cases the plaque may reduce in size on its own.
Chronic Phase: Once the digestion of blood and fibrosis has completed the disease enters the chronic phase in which the size of the plaque stabilizes and the pain subsides. The deformity increases and becomes fixed. In this phase surgical intervention can be planned and disease can be removed in entirety.
Evaluation of Peyronie’s Disease
The condition requires proper examination and investigations before beginning treatment. Dr. Raman Tanwar evaluates the extent, number and location of the plaques and treatment is guided by the age and degree of sexual activity and motivation of the patient. If there is persisting pain in the plaque, there is need to bring down the ongoing inflammation. Only when the disease becomes stable and there is no more growth of the plaque can more aggressive management towards cure be started.
The management of the acute stage includes painkillers and supplements. The changes in the plaque are evaluated clinical by weekly visits. Extracorporeal shock wave lithotripsy can be used to manage acute pain.
In the stable phase three lines of treatment exist namely medical management with Vitamin E, Colchicine and Potaba, Injection therapy with Verapamil and Kenacort and excision of the plaque. Medical supplementation therapy bears poor results and long term therapy is required. It is however effective for many patients and a reasonable step to start with. It is a good option for patients with low grade disease, soft plaque and rare sexual activity. Intralesional Injections for peyronie’s disease is effective but long term results are doubtful. Every week an injection is given with a very fine needle into the plaque. The duration of the course is for 6 weeks (Total of 6 injections).
Surgical management requires that the penis is degloved and the plaque excised by shaving it off or by putting a graft. This procedure requires 1 to 2 hours and is a safe and minor surgery. To know more about the management of peyronie’s disease please book an appointment with Dr. Raman Tanwar. Dr. Tanwar has extensive experience in the management of peyronie’s disease and performs surgeries for its correction on a routine basis.