Men with Peyronie’s disease usually seek medical attention from Dr. Fenig because of painful erections, penile curvature, or difficulty with intercourse.
Peyronie’s disease is usually diagnosed based on a physical examination because the plaque can be felt when the penis is flaccid or in a non-erect state. Full evaluation, however, may require examination during erection to determine the severity of the deformity. The erection may be induced by injecting medicine into the penis or through self-stimulation. Some patients may eliminate the need to induce an erection in the doctor’s office by taking a digital or Polaroid picture at home. Evaluation also may require an ultrasound scan of the penis to pinpoint the location(s) and calcification of the plaque. The ultrasound can also be used to evaluate blood flow into and out of the penis if there is a concern about erectile dysfunction.
Because the course of Peyronie’s disease is different for each patient, and some patients experience improvement without treatment, Dr. Fenig suggests waiting until the curvature stabilizes for 6-12 months before discussing surgery.
If treatment is indicated by Dr. Fenig, the most common therapies include:
- Medical management to ease pain
- Injection therapy
- Penile stretching devices
- Surgery, which is the gold-standard treatment option
Medical therapy is often used in the acute phase to decrease pain and inflammation, or soften plaque, but it is not considered a long-term solution because the penis usually does not straighten. Studies are inconclusive as to the true benefit of medical therapy for Peyronie’s disease.
Injection Therapy and Penile Stretching
Injection therapy remains a controversial approach. Many injectable compounds have been studied, and they have been found to occasionally reduce the degree of curvature and soften the plaque that causes it. However, many studies have found no benefit to plaque injection. Penile stretching devices are also controversial, although they have gained attention in recent years as a way to decrease degree of curvature and increase the length of the shortened penis.
Surgery remains the mainstay of treatment options performed by Dr. Fenig if other methods fail and the disorder interferes with intercourse or is emotionally distressing. Sometimes stitches can be used to help straighten the penis. Dr. Fenig also uses plaque excision and grafting to replace scar tissue to straighten the penis.
Dr. Fenig has had surgical success in treating Peyronie’s Disease with the following three procedures:
- Excision – this procedureinvolves removing or cutting of the plaque and attaching a graft. This method will straighten the penis and restore some lost length from Peyronie’s disease. Risks of the procedure include numbness of the tip of the penis and decreased rigidity of erections in a small number of patients.
- Plication – this procedureinvolves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, to straighten out the penis. This method is less likely to cause numbness or erectile dysfunction, but it is associated with a decrease in penile length.
- Penile Prosthesis - For patients with Peyronie’s Disease and erectile dysfunction, placement of an inflatable penile prosthesis (penile implant) in the penis is used to increase the rigidity and straighten the penis adequately. Penile prosthesis remains the gold-standard treatment for patients with ED and Peyronie’s disease. In severe cases, if the implant alone does not straighten the penis, Dr. Fenig combines implantation with excision of the plaque and placement of a graft.
Most types of surgery produce positive results, according to the National Institutes of Health, but because complications can occur, Dr. Fenig prefers to perform surgery only on men when curvature is severe enough to prevent sexual intercourse, causes discomfort, or because it is cosmetically unacceptable.
Dr. Fenig sometimes finds that providing his patients with education about the disease and its course is all that is required.