How common is Peyronie's disease?
9% of the male population develop a curved penis this is known as Peyronie’s disease
Can happen at any age but is higher in men older than 35 years of age.
What do men with Peyronie’s complain about?
- Thickened Lump (plaque) in the shaft of the penis
- Bent / curved penis typically in the upward direction may impair penetration
- Penile pain during erection
- Change in penile shape (length and/or girth and/or shape)
- Difficulty in attaining an erection
- Negative psychological impact (stress/ depression)
Is the condition treatable ?
Yes, but this has to be tailored according to the stage of presentation
I heard Peyronie's is classified in 2 stages, can you clarify?
Acute phase
for the first 12 months, the penis bend may continue to worsen, the pain may subside. Between 10 to 13% of patients their plaque may resolve. Various treatment options can be employed to address disease progression within reasonable expectations.
Stable phase
After 12 months, the plaque stops growing and the pain symptoms disappear. At this stage surgery can be considered.
What will you expect from the clinical visit
What treatment can I expect?
Is there a role for oral and/or topical medication, and/or supplements?
There have been many attempts at single and combined approaches none has been proven to have a significant effect on reducing penile curvature or diminishing the plaque size. There may be a role for pain control and potentially reducing the disease progress.
What has been attempted
Vitamin E, Coenzyme Q10 and propionyl-L-carnitine in isolation and combination
This treatment option was found to be ineffective.
Non-steroidal anti-inflammatory medications (NSAIDs)
These are over the counter medications such as Ibuprofen which can help with the management of pain during the acute phase.
Colchicine (Prescription medication)
This medication is commonly used for gout but can deter scarring. This treatment was found to be ineffective for Peyronie’s disease.
Potaba (Prescription medication)
Potentially inhibits the development of plaques. Patients can experience severe gastrointestinal side effects and it is relatively expensive.
Tamoxifen (Prescription medication)
Theoretical potential of inhibiting the scarring; it is not currently recommended for Peyronie’s disease.
Pentoxifylline (Prescription medication)
It might be an effective treatment for Peyronie's disease.
PDE5-Inhibitors (Prescription item)
This is for patients that have concomitant erectile dysfunction and Peyronie’s disease. There are various medications. Consult with your doctor.
Topical treatments for Peyronie’s Disease
Extracorporeal Shock Wave (ESW) for Peyronie’s Disease
Mixed results, and may not be as effective as initially projected.
Transdermal Verapamil Gel (prescription)
The gel is applied directly to the skin twice a day. Limited evidence that it slows progression.
Mechanical Modelling for Peyronie’s Disease
The goal of mechanical modelling is to reduce the curvature. There are three ways how this can be achieved;
1. medical vacuum erection device
2. penile stretching and straightening exercises
3. traction devices
Mechanical modelling is often combined with Xiapex injections (explained later), and following surgical correction (counteracts penile retraction and further loss of length, diminishes any curvature and augments penile blood flow aiding regeneration of tissue).
There is no specific mechanical modelling (penile physiotherapy) protocol
Vacuum pump therapy twice daily for 10 min each
- Gradually pump penis until erection is achieved (avoid over pumping)
- Do not apply any bands
- Keep the erection for around half a minute
- Release (deflate) and repeat again (5times)
Penile stretching exercises
Gradually and gently stretch the penis as far as you can get. Repeat this few times (usually 10 times)
Penile traction device
This is applied for 4-8 hours a day. Patients may find this challenging even though it is considered effective.
I heard about Xiapex Injection, and it can be quite difficult to get. What is Xiapex?
This is a medication administered via injection into the penile plaque by a trained urologist.
What benefit did Xiapex show in treating Peyronie’s?
Xiapex use has shown 35% penile curvature amelioration in penile curvature.
How does it work?
Xiapex leads to an enzyme disturbance on the collagen scaffolding found in Peyronie’s plaque reducing the penile bend.
How many injections do I need?
Typically 3 injections one-month apart each. Further injection can be given but there was no benefit beyond 8.
Can mechanical modelling be applied to improve outcomes?
Your urologist will instruct you to start penile physiotherapy for a month as this was found to be beneficial. One recommends
Vacuum pump therapy twice daily for 10 min each
- Gradually pump penis until erection is achieved (avoid over pumping)
- Do not apply any bands
- Keep the erection for around half a minute
- Release (deflate) and repeat again (5times)
Penile stretching exercises
Gradually and gently stretch the penis as far as you can get. Repeat this few times (usually 10 times)
Penile traction device
This is applied for 4-8 hours a day. Patients may find this challenging even though it is considered effective.
I suffer from Peyronie’s do I qualify for Xiapex treatment?
If you have the following you can explore with your Uorologist Xiapex treatment
- Good erections
- Penile curvature is less than 60 degrees;
- The bend is lateral or upwards
- The plaque is not calcified
- Pain has subsided
What is the next step if all the above fail or if more than 12 months have passed since symptoms started?
Surgery is the way forward. This is typically offered after the disease progression has ceased, hence the curve has become stable.
