Peyronie's disease is caused by scarring of the tunica albuginea or membrane that surrounds the muscle of the penis. There are multiple theories, although the exact cause of the disease remains unknown. It is characterised by a penile bend, lump and pain on erection. There are characteristically two phases of the disease; An acute phase lasting about 3-6 months and then a chronic phase lasting up to about a year during which the disease usually stabilises.
There are a number of medical therapies that have been advocated for the treatment of Peyronie's Disease. The problem is, because that we do not understand the natural history and the cause of the disease, there is an extensive array of medical treatments available. However, it is believed that most cases of Peyronie's Disease result from either sexual and or repetitive trauma to the penis but equally may also be related to vascular disease. Some of the medical treatments that have been used in treatment of Peyronie's Disease include Vitamin E, Potaba, colchicine or Verapamil. These treatments have been used with variable success. In most instances Peyronie's Disease does not require any surgical treatment. The only indication for surgical treatment is the inability to penetrate and have intercourse, or difficulty with intercourse. Usually this occurs if a bend is 45 degrees or greater, although it can occur with lesser bends such as those where it bends to the side. More recently, a novel drug called Xiaflex, which is a collagenase has undergone trials and appears to be promising for the treatment of Peyronie's disease, although is currently unlisenced in the UK.
Many surgical techniques have been advocated for the treatment of Peyronie's Disease. Some of these involve shortening the penis on the opposite side to the bend, the so called Nesbit's procedure, or plication procedures. Grafting of the scarred area is also possible but it is important to note that the plaque is usually incised and a graft placed over the area. All of these types of surgery can result in complications; the most common complications are shortening to the penis, erectile dysfunction and changes in sensitivity to the penis. In some cases patients may require a circumcision particularly if their foreskin is very tight. Mr Minhas specialises in these surgical treatments and has performed a large number of both grafting and plication (including Nesbit's procedure) operations for Peyronie's Disease (link to published outcome data). He has also published extensively in this area and is a recognised expert and specialist in this field.
In some cases, patients who have pre-existing erectile dysfunction and had medical treatments in the past to correct this, and who also suffer from Peyronie's Disease, may require a penile implant. Penile implants or prosthesis are the treatment of choice, in so far that they not only straighten the penis but they also deal with the erectile dysfunction. However, patients who are candidates for penile implants in Peyronie's Disease need extensive counselling before such surgery.
When patients have surgery for Peyronie's Disease the penis is degloved through a circumferential incision around the head of the penis. An artificial erection is induced with saline. At the time of surgery, a catheter is inserted into the urethra to ensure that patients are able to void after surgery and furthermore there is no damage to the urethra (‘water-pipe') during such surgery. The catheter is usually removed the following day unless the urethra is mobilised to correct the bend.
Patients are then asked to abstain from sexual intercourse for approximately six weeks after surgery so that the reconstruction has time to heal. After surgery it is Mr Minhas' policy to commence drugs such as Cialis or Viagra to try and stimulate and stretch the penis post operatively. In some cases a vacuum erection device may be used to stretch the penis to try and reduce the risk of penile shortening.
If you're experiencing symptoms of peyronie's disease, please call 020 7224 5089 or use the appointment form to book a consultation.