Peyronie’s Disease

I’ve seen a lot of ads on TV recently for a new treatment for Peyronie’s Disease. Have you ever heard of Peyronie’s disease? I suspect not unless you have it or are the partner of a person who does. It’s not something the general public is much aware of, and the ads don’t really say what it is. It’s like erectile dysfunction. Before Viagra, few had ever heard of ED or used that term in conversation, but now it’s commonplace. Peyronie’s disease may become a household term, but it’s less likely because it’s frequency is much less than ED. In fact, there are about 200,000 new cases annually, and 6 men in 100 have it. BUT the same anatomic structure involved in ED is affected in Peyronie’s Disease (PD).

Peyronie’s Disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections. The curve can be minor and insignificant or it can be severe enough to prevent penetration during sexual intercourse. Erectile dysfunction and pain are often associated problems as well as anxiety and stress-related symptoms. The penile shaft is made up of three tubes, two of which are sponge-like tissue with millions of small sacs that fill with blood during an erection. Repeated trauma or athletic injury to the penis cases fibrous scar tissue to develop in the “spongy” tissue. This scar tissue does not stretch during an erection so it causes a bend in the penis. When the penis is not erect, the examining physician can feel firm nodules in the penis formed by the scar tissue.

There does appear to be a hereditary component to Peyronie’s because it runs in families. Being over the age of 55 is a risk factor and men with connective tissue disorders often have it. Most patients aren’t able to remember a specific incident which lead to their Peyronie’s so trauma alone is not the cause.

So what on earth can a fella’ do if he has Peyronie’s? Many treatments have been proposed from vitamins to extensive surgeries, but it appears the newest and most effective treatment is Xiaflex. Collagenase is an enzyme which breaks down collagen, the major component found in Peyronie’s plaques. When Xiaflex (Collagenase clostridium histolyticum) is injected directly into the plaques, it breaks down the build up of collagen that causes the curvature. Thus the curvature will soften, and with forcible bending (modeling) of the penis in the direction opposite of the curvature, penile straightening will be restored. The injections are done on each of two days 1-3 days apart (one cycle), and up to four cycles six weeks apart are recommended. This treatment has recently been approved by the FDA.

Other treatments are injections of vitamin E, vitamin B (Potaba), tamoxifen (an anti-estrogen agent used to treat breast cancer), verapamil (a blood pressure drug) and Interferon injections, and iontophoresis (electric current administration of verapamil and cortisone through the skin of the penis). Should all of these somewhat non-invasive procedures fail, numerous surgical techniques, beyond the scope of this blog, are used.

In many cases, Peyronie’s Disease gets better on its own, but for those in which it persists, there appears to be hope where little existed previously. Of course there is risk to any of these treatments, but I think many men are willing to take that risk.

Dr. G’s Opinion: From what I can gather, Xiaflex must work relatively well, and it must be the treatment to which recent television ads allude. But being naturally skeptical, this ad barrage may be a marketing ploy to get the drug prescribed so Endo, it’s manufacturer, can recover some of its research and development costs. In forty years of practice I didn’t see very many men with Peyronie’s so I don’t think it’s all that prevalent. But it may be more common nowadays than I think. So until I can talk to urologists and get their opinion on the efficacy of Xiaflex, I’m going to reserve judgement.

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