Hey guys, my name is Dr. Sam.
I've been asked by a few of you lately to make a
video on Peyronie's disease.
Now this is a big topic, but I thought I'd run
through with you the symptoms of
Peyronie's disease, the cause
and some of the treatments that have the best
evidence in 2020.
Obviously, this won't be everything,
but hopefully, I can give you
an easy-to-understand overview.
So let's get started!
What is Peyronie's disease?
Peyronie's disease is when you have a
curved or bent penis, that usually only
affects the erect penis.
It was first described by a French surgeon in 1743,
who named the condition after himself.
What are the symptoms of Peyronie's disease?
Usually, the first thing men notice
is that they have painful erections.
Then, over a few months,
the penis starts to curve or look bent
when it's erect, but looks normal when soft.
The bend can happen upwards, downwards
or to the side.
After a year or so,
the bending of the penis will stop
and stay the same.
At this point the pain
usually resolves.
In about 13% of men,
the symptoms go away completely without
any treatment.
Who gets Peyronie's Disease?
For whatever reason, it tends to
start around the age of 52 to 57 years.
However, Peyronie's disease may present
at any time in adulthood and has been
reported in patients as young as 21.
It used to be thought that Peyronie's
disease is very rare affecting about
0.4% of men.
(That's what we were taught at med school)
Nowadays studies have
shown that it actually happens in 3 to 9
percent of all men.
What causes Peyronie's disease?
Scar tissue forms along the shaft of the
penis which changes the shape of the
penis while erect.
Why this happens is
still unknown, but a common theory is
that there has been a history of trauma
to the penis or repetitive micro-trauma.
Which can happen just with sex.
Also, Peyronie's disease is seen more
commonly in people who have: diabetes
high blood pressure, high cholesterol,
Dupuytren's contracture, which is where
you get a band like thickening on the
palm of your hand.
Smoking (in people who smoke) and
people who drink too much alcohol.
It's also seen in men who have
hypogonadism, which is when the body does
not produce enough testosterone.
Lots of research has been done into whether
there is a genetic link for Peyronie's
disease.
But scientists have not identified it yet
and this does not mean
that there is not a genetic link.
But it probably hasn't been discovered yet.
Treatments of Peyronie's Disease.
Right, onto treatments!
Now, because I like to
think of things in a simple way,
I want to break down the treatments for you
into three easy categories.
Which are devices, medicines and surgery.
Devices.
There are traction devices,
which are usually made of metal and plastic
that are worn for about two to eight hours
a day in order to gradually straighten out
the curved penis.
These haven't been well studied unfortunately
and tend to be uncomfortable to use.
However, they are not invasive so are very safe
and it might be something you want to try.
Next up are vacuum devices,
which are similar to traction devices
and are worn at home.
It gradually straightens out the penis.
Again, there aren't many decent studies
that have looked at whether vacuum
devices actually help Peyronie's disease.
But there are a few but there aren't any
risks with them.
So a trial with or without other treatments
would be reasonable.
Finally, there is shockwave therapy,
which sounds scary but
it's not.
It's also known as ESWT.
This uses sound waves produced by a very
large machine and is done in a hospital
or in a clinic situation.
There are no randomized studies that support
a benefit of shockwave therapy in
improving the penis shape or plaque size.
However, it may speed up the recovery
from pain in early Peyronie's disease.
Medicines.
These come in the form of tablets,
topical treatments to the skin and
intralesional injections.
So, tablets - there are a heap of them that have been
researched for Peyronie's disease and
unfortunately none of them work.
So please don't waste your time using them.
If you want to look at a good paper
summarizing this I'll link it in the
description below.
Topical treatments
this is where a medicine like verapamil
is applied to the skin and the evidence
for this treatment again is pretty weak,
and I would not be rushing
out there to try it.
But, lastly, there is intralesional injections
and this is where proteins or enzymes
are injected into the bent part of the penis which
break down the plaques that cause
that curve.
Some of these treatments have been
shown to be beneficial.
Yes!
Verapamil, interferon alpha 2B
and the strongest evidence of all is for
collagenase, which tradename is Xiaflex.
These intralesional injections help both
with pain and curvature.
Surgery.
Surgery is usually offered to men when the
symptoms have been there for at least
three to six months and there has been a
change in the shape of the penis,
that limits sexual intercourse.
There are various surgical options,
with the most common procedure being something
called "Tunical Plication".
I'd recommend that you speak to an experienced
Urologist if you are thinking about surgery.
As each operation carries risk for you
as an individual and you want to see a
specialist who does a lot of these
procedures regularly.
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