Treatment for Peyronie’s disease
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Peyronie’s Disease: Pearls of Wisdom that Every Patient Needs to Know
It is important to recognize that not everyone with Peyronie’s disease requires active treatment but everyone should be evaluated by an experienced urologist as soon as symptoms are recognized.
Early treatment may prevent disease progression and worsening of symptoms. Early treatment may be more effective in reversing symptoms of Peyronie’s disease.
Treatment of Peyronie’s Disease is Rather Complicated.
Treatment options depend on the following factors:
- How long have the symptoms been present? Usually, surgery is reserved for patients who have had Peyronie’s for at least 1 year and no change in symptoms for at least 6 months. There are some exceptions.
- If Patient’s symptoms are interfering with function (ability to have sex)
- Quality of Erections – good erections allows for more treatment options. Erections that are not adequate with use of Viagra or Cialis, or injections of Trimix/Prostaglandin E1, usually would require penile implant surgery.
- Presence of penile narrowing ‘waist’ or ‘hourglass” appearance – if the narrowing is severe, surgical treatment with graft insertion is usually necessary to address the problem.
- Penile plaque: whether it can be felt (palpable or not?), Peyronie’s plaque size, and whether it’s calcified (hard)
General Treatment Facts About Peyronie’s Disease that You Should Know
It is important to know that in some men with Peyronie’s disease the curvature resolves spontaneously. It usually occurs within the first year of disease onset. However, this is rather rare – more often the curvature may look better because erections become less hard and as a result, the curvature is less noticeable. If erections get less hard and curvature lessens as a result, it’s a sign that the disease process got worse.
For men with symptomatic Peyronie’s disease treatment options include observation, intralesional injections of verapamil, interferon, or collagenase (Xiaflex). Topical verapamil does not appear to be of significant benefit and is not currently recommended. Oral medications can also be used to treat Peyronie’s disease. Potaba tablets are useful for penile pain however they are somewhat difficult to take.
Mechanical stretching devices (traction devices) may also benefit men with significant curvature. Penile traction devices decrease the curvature angle, help with pain, and can increase penile length.
Treatment of Men with New Symptoms of Peyronie’s Disease
Early active treatment may be beneficial even for men with minimal symptoms as it may prevent disease progression.
In general, after evaluation, which should include induction of artificial erection, penile doppler ultrasound, and measurement of penile curvature and penile plaque, as well as evaluation of erectile function, choices depend on the quality of erections, penile curvature, and presence of a palpable plaque.
If erections are good and the plaque is palpable, injection therapy is advisable: Xiaflex, verapamil, interferon.
If the plaque is not palpable, injection therapy is not an option. If erections are good, penile traction therapy is advised. If the plaque becomes palpable, injection therapy can be added. If there is no change in symptoms after 6 months, penile plication can be performed if there is no significant ‘hourglass’ appearance.
In patients with good erections, once the disease has been present for around a year, with 6 months of no significant worsening of symptoms, surgical options can be considered which include penile plication, plaque excision with grafting and a penile implant.
In patients with severe erectile dysfunction and moderate to severe Peyronie’s disease, a penile implant can be performed early.
If symptoms and curvature are still present and symptomatic after initial treatment, treatment options listed below under “Long-standing >1 year Peyronie’s Disease apply.
Men with Long-Standing >1 Year Peyronie’s Disease
For men with long-standing stable Peyronie’s disease who have minimal symptoms (very mild curvature) and who are not bothered by these symptoms, supportive care and observation are usually all that is necessary. This usually includes men with mild Peyronie’s disease who do not have pain or difficulty with erections or intercourse with the problem present for >1-2 years and no significant changes in the past 6-12 months.
If erections are good, there is no or minimal narrowing of the penis, and the plaque is small and not too calcified and erections <70-90 degrees, injection therapy with Xiaflex, verapamil or interferon can be tried.
If erections are excellent but there is a significant narrowing of the penis or the curvature is severe >70-90 degrees, penile plaque excision with grafting is advised.
If erections are not very good and the curvature is severe or the plaque is large and calcified, penile implant in conjunction with penile plication or plaque excision with grafting is advised.
Surgical Treatment Options for Peyronie’s Disease
Men whose curvature is too severe for treatment with penile injection therapy or if the plaque is too large and too calcified may not benefit from plaque injection therapy. Men with severe Peyronie’s have the option of surgical treatment for Peyronie’s disease. Surgical treatment options include penile plication, grafting, and insertion of a penile implant or penile prosthesis.
Some men only need one of these procedures however sometimes more than 1 surgical treatment is performed in the same patient to achieve an optimal outcome. For example, a man may benefit penile implant insertion with grafting and plaque incision when the curvature is severe and there is a constricting band.
Peyronie’s disease has 2 stages: the early active phase which is the first year when the symptoms occur and the second dormant stage.
Studies report that as many as 13% of men experience spontaneous Peyronie’s disease resolution without treatment in the first year. However, this needs to be put into perspective. Some men feel an improvement in curvature because erections become less hard as a result of Peyronie’s. When erections are less hard, the curvature is less noticeable.
If the symptoms are minor and do not affect the quality of life, observation is sufficient. If the symptoms are significant such as difficulty with erections, pain, significant curvature then non-surgical treatment options are advisable.
There are many non-surgical treatment options available. The evidence for their benefit is often less than satisfactory. Only a few available non-surgical treatments stand out:
Xiaflex (collagenase) injections and injectable verapamil. Interferon Injections appear beneficial but expensive, not widely available, and not widely used. Xiaflex for Peyronie’s disease has good efficacy and is the preferred treatment for men with moderate to severe disease.
Penile Traction devices may also be used. Manual penile remodeling may also be beneficial. Potaba is helpful to some men with painful erections but is challenging to take. Shockwave therapy can help with penile pain.
I do not recommend Colchicine, tamoxifen, vitamin E or topical verapamil as there is a questionable benefit and some risks involved.
Peyronie’s Disease Classification: Acute and Stable Phase
Peyronie’s disease has traditionally been classified into two stages: the active phase and the stable phase. The relevance of this classification is that surgical treatment is not advisable during the “active phase” of the disease but there are some exceptions.
The first phase is called the acute or active stage and refers to the first 12-18 months after the appearance of symptoms or curvature. During this phase, the disease process is evolving. In some men with active phase disease, the disease occasionally can go away spontaneously (this happens in 10-15% of men – but maybe an illusion in some cases); however more commonly disease progresses and gets worse. Thus early evaluation and initiation of treatment are advised to limit disease severity. Appropriate treatment options during the active phase of Peyronie’s disease include penile traction therapy and injection therapy.
The second stage of the disease is called chronic or stable phase. This usually refers to a disease that has stabilized after the initial 12-18 months after the appearance of symptoms or with at least 6 months of no change in symptoms. It is unlikely that symptoms improve spontaneously in men with a stable disease however the curvature and symptoms may get worse.
Why Choose New York Urology Specialists for Treatment of Peyronie’s Disease?
- All treatment is performed by a board-certified urologist experienced in treating men with symptoms of Peyronie’s disease including penile curvature, narrowing of the penis, shortening of the penis, pain in the penis, and ED.
- We are one of the few practices in the region to offer a full range of options for treatment of Peyronie’s disease, sexual and erection problems in men.
- We offer diagnostic testing in our office which avoids hospital costs.
- Extensive Experience: Thousands of men have treated successfully using medical therapy (Xiaflex, Verapamil injections, Interferon), shockwave therapy for penile pain, penile plication, plaque excision and grafting, and penile implant surgery.
- Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
Scheduling Appointments for Peyronie’s Treatment at New York Urology Specialists
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Peyronies Disease and ED Are Treatable in Nearly Every Man
At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of Peyronie’s disease and erectile dysfunction. We understand the challenges that Peyronie’s disease and ED create for our patients, their relationships and their self-esteem. We help you find a treatment for Peyronie’s disease that fit your needs, lifestyle, and your preferences.
Urologists are doctors specializing in the treatment of men with sexual problems including Peyronie’s disease and erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED. We offer medical and surgical treatment for Peyronie’s disease and erectile dysfunction.
We Treat Some of the Most Complex ED Problems Including:
- Hourglass narrowing of the penis
- Shortening of the penis and loss of penile length
- Penis curvature with worsening erections
- Peyronies disease in men with diabetes and weak erections in men with diabetes.
- Peyronie’s disease and erectile dysfunction in men with prostate cancer after radical prostatectomy
- Erectile dysfunction in men with Peyronie’s disease
- Erectile dysfunction in men for whom Viagra and Cialis do not work.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods. We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.
He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.
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This post is also available in: Spanish