Of all the health topics that men are uncomfortable discussing, Peyronie's disease ranks pretty high on the list. While it's not a household name, Peyronie's affects as many as one in 10 men. And while surgery has long been the most effective solution, there's a promising new development that's just been approved for patient use.
"Peyronie's disease is curvature of the penis during erection," says Brian Christine, Md of Urology Centers of Alabama, "and it's often so severe as to make sexual intercourse painful or impossible. While it's not life-threatening, it most certainly has a negative impact on the patient's quality of life."
That unwanted curvature is sometimes caused congenitally, but Christine says the percentage of those cases is virtually negligible. By far the most common cause is an injury to the penis during sexual intercourse.
"The inner penile tissue is very elastic," he says, "so that it can get an erection and stretch to accommodate when the blood flows in. But sometimes a lot of torque and strain can cause tearing of those elastic fibers at a micro level, in a region called the tunica albuginea. When the injured tissue heals, it's replaced by a much less elastic tissue we call plaque. Because that fibrous mass is less elastic and doesn't stretch, the curvature occurs."
The disease, first described in 1743, is named for French surgeon Francoise Gigot de la Peyronie, court physician to King Louis XV. Past treatments have also included an injection of the drug verapamil every two weeks for a series of six to 10 treatments, but surgery remained the most effective solution.
While patients often can remember the exact incident when the bruising occurred, the damage that causes curvature can also accrue gradually over a period of time.
Surgery has long been what Christine calls "the mainstay" for repairing such damage. There are two types: one involves surgically cutting out the plaque that's preventing the penis from straightening; the other, known as "plication," corrects the problem by putting a series of stitches on the opposite curve, which are then tied to pull the penis straight.
The degree of curvature determines which type works best, Christine says, and both have their pluses and minuses. Removing the plaque can cause scarring, and some 20 percent of patients develop a degree of erectile dysfunction. The downside of plication is that a small loss of penis length can occur, usually between a half to a full centimeter, as the tradeoff for straightening.
"For some men, the Peyronie's is a functional issue," Christine says, "preventing the penis from fitting into the vagina. But it can also cause issues with self perception and sexual intimacy, making men feel their penis is unpleasant to look at, even if the problem is not as dramatic as it is in the medical textbooks."
Non-surgical treatments are sometimes tried, he says, mainly oral or topical vitamin E and oral or topical steroids. But none of the methods have FDA approval and studies on their efficacy have shown that they have no more effect than a placebo.
But a promising new type of non-surgical treatment recently approved for Peyronie's uses collagenase, an enzyme that breaks down the collagen of the penile plaque. The new drug, called Xiaflex, is used in a series of medical injections to soften up the scar tissue, combined with what's called "modeling" of any remaining plaque by teaching the patient a series of manual stretching exercises.
In a large multi-center study, some two-thirds of patients see significant improvement in their Peyronie's after a series of three or four injections.
Christine's practice at Urology Centers of Alabama also includes erectile restoration after dysfunction, prosthetic urology, and penile surgery.
So far, the new Xiaflex has been released for use by a limited number of urologists. "I'm excited about its approval, and I have patients who had been waiting for its arrival," says Christine. "It's a very effective treatment for a really common problem and it should be a real help, probably the best we'll have. Men and their physicians should understand that it has been successful. So hope is around the corner."