Peyronies disease serve bending of the erect penis

PEYRONIE’s DISEASE – SEVERE BENDING OF THE ERECT PENIS

The French surgeon François de la Peyronie first described Peyronie's disease in 1743. It manifests itself as a severe bending of the erect penis. Men should be aware that it is perfectly normal for penises to bend or curve somewhat. The bending of the erect penis in Peyronies disease is much more severe, can be painful, and often prevents sexual intercourse.

Peyronie's disease is characterized by a hard lump of scar tissue, or plaque, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. Cases of Peyronie's disease range from mild to severe. Symptoms may develop slowly or appear overnight. It is unclear exactly what causes Peyronie’s Disease. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple's physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bleeding.

The plaque itself is noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress might prohibit sexual intercourse.

One study found Peyronie's disease occurring in 1% of men. Although the disease occurs mostly in middle-aged men, younger and older men can acquire it. About 30 percent of people with Peyronie's disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. In some cases, men who are related by blood tend to develop Peyronie's disease, which suggests that familial factors might make a man vulnerable to the disease.

Men with Peyronie's disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie's patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

Many researchers believe the plaque of Peyronie's disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. A chamber (actually two chambers known as the corpora cavernosa) runs the length of the penis. The inner-surface membrane of the chamber is a sheath of elastic fibers. A connecting tissue, called a septum, runs along the center of the chamber and attaches at the top and bottom. If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury. The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood-flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.

Treatment

Because the course of Peyronie's disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often try treatments whose effectiveness has not been proven. Some researchers have given men vitamin E orally and have reported improvements. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, belonging to the family of B-complex molecules. Researchers have injected chemical agents such as verapamil, collagenase, steroids, and calcium channel blockers directly into the plaques. These interventions are still considered unproven. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy of healthy tissues.

Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are removal or expansion of the plaque followed by placement of a patch of skin or artificial material and removal of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function. The second method causes a shortening of the erect penis. Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis.

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