What Are The Different Kinds Of Surgery What Is A Penile Plication
Broadly speaking, there are two different types of surgeries that are offered. One entails placing sutures inside the penis in order to straighten it called a Penile Plication. These sutures are placed on the opposite side of the scar tissue and essentially act as a way of straightening up the scaffold. The advantages of this surgery are that it is fairly easy to do, has a high success rate, and does not affect erections. One disadvantage is that the surgery can cause some shortening of the penis .
Urologists Located In Wilmington Nc & Southport Nc
If youre experiencing painful erections with a curved penis, you may have Peyronies disease. While men may find it embarrassing to talk about, if Peyronies disease causes performance anxiety in the bedroom along with discomfort, you may need treatment. The doctors at Urology Associates of Southeastern North Carolina in Wilmington, North Carolina, and Southport, North Carolina, offer discreet and compassionate care. To learn more about treatment options for Peyronies disease, use the online tool or call the practice to schedule an appointment today.
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Are There Other Treatments For Peyronies Disease
An alternative option is injections into the scar tissue to soften up the scar tissue. Typically, we use Verapamil for these injections and patients require 6 to 12 injections. In our experience, the injections are more successful in patients who are in the active phase of the disease. In these patients, often times, further worsening of the curvature is halted with the injections. Occasionally these injections will also work for patients who are in the passive phase of the disease.
There also are various creams and lotions that have been used to aid in Peyronies disease. Most of these in our experience are not very successful.
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Treatment Options For Peyronies Disease
Treatment for Peyronies disease focuses on managing the pain, straightening the penis , and rekindling the ability to have sex. In mild cases, the doctor may advise a non-surgical approach.
Usually, the doctor will ask the patient to monitor their curvature and take pain medication if necessary.
A standard treatment option provided to patients is an infection with collagenase clostridium histolyticum. In case of a severe curvature, however, youll need surgical treatment.
Here is how both of these approaches look for Peyronies disease treatment.
What Other Procedures Help Treat Peyronies Disease
Some healthcare professionals recommend shock wave therapy. This is where the low-intensity focused electroshock waves are directed to the plate. The goal is to reduce pain, which can also be achieved with over-the-counter medications.
Researchers have not found any evidence that the shock wave could help improve the curvature of the penis. This treatment can be expensive and is rarely covered by insurance.
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Peyronies Disease Scar Tissue And Urination
Researchers believe that the primary cause of Peyronies disease is some form of injury, either from a traumatic incident or from pressure over time. To repair the damage, the penis will form hard scar tissue that, in turn, reduces its elasticity and size. However, some men with this condition are unable to recall any injury that caused their illness.
While researchers believe the disease is primarily caused by injury, it is also associated with:
- Prostate cancer surgery
Peyronies disease can be characterized by small lumps beneath the skin of the penis. While the University of Utah says that these nodules arent cancerous, they can still affect a mans ability to maintain an erection firm enough for sex. The same source notes that 4% to 13% of the male population currently struggles with this condition. However, because of the social stigma that comes with reporting, this data is likely to be significantly higher.
What Are The Symptoms Of Peyronies Disease
Peyronies disease begins as a small swelling or inflammation, which hardens into a lump on the upper or lower side of the penis. It usually develops over time, but sometimes appears very quickly.
In most cases, you can feel a hard lump at the point where the penis curves.
Peyronies can be painful, reduce flexibility, and in most cases will shorten or create a bend in the penis when its erect. In some cases, the shape of the penis changes so that theres an hourglass deformity or constriction to one side.
In the early stages, you might experience pain when getting an erection. In mild cases, where the lump does not cause the penis to bend very much or at all, it will only have a minor effect on how you experience sexual intercourse.
However, moderate or severe Peyronies can make sexual intercourse impossible because of the shape of the penis, or problems with getting an erection. In some cases, the penis only becomes hard up to the area of the scar and stays flaccid past that point.
You might notice Peyronies after an injury to the penis. People with Peyronies often describe hearing a loud crack, followed by pain and bruising, although in many cases you might not remember any injury happening. Usually this type of injury leads to swelling which becomes red and hot, and will heal by itself within a year. Sometimes, recovery takes longer, and scarring can happen.
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Can I Have Surgery For Peyronies Disease
Mild curvature of the penis caused by Peyronies disease usually does not need treatment. Men in the chronic phase who desire the most rapid results or those who desire a straight penis may be better served with surgery to correct the problem. Surgery is only performed on men whose Peyronies disease makes it hard to have sex. Healthcare providers may have you wait until the scar and curvature have stopped worsening and there has been no pain for around six to 12 months. Surgery should only be performed in the chronic phase.
There are three surgical options to possibly fix your Peyronies disease. These surgeries:
Before surgery, your healthcare provider will need to do an ultrasound on your penis. This will check the blood flow to the penis and see if there is erectile dysfunction . A medicine is injected during the ultrasound to create a temporary erection to see which surgery you might be a candidate for.
How Is Peyronies Treated
The treatment of Peyronies disease is goal-oriented. Once again, it should be stated that it can be vexing to treat. Even though the condition was first described several hundred years ago, there are no easy treatment solutions. The natural history of Peyronies disease is variable. In a third of men it improves, in a third of men it stays the same, and in a third of men it progresses.
A variety of oral medications have been used to try to improve Peyronies. With the recognition that change in the elastic sleeve is caused by an inflammatory process, which in turn is triggered by chemical messages at the cellular level, different medications that can affect those cellular chemical response pathways have been used. Medications tried for Peyronies have included Vitamin E, Potaba , and colchicine. Current studies suggest they may provide only limited benefit. Pentoxifylline may help in a subset of men.
The different pills available to help improve erection, Viagra, Cialis and Levitra, may work for some men. They can lead to a more rigid erection that is easier to get and maintain. However, with the increased blood flow, there may be more tethering of the area involved by the Peyronies disease which may cause more pain or curvature with erection.
Injections into the Peyronies plaque surgery
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What Questions Should I Ask My Healthcare Provider About Peyronies Disease
- What should I do if the bend gets worse?
- Do you expect that this will go away or require treatment?
- How often should I return for a checkup?
- What treatments do you recommend?
- Do you think I should have surgery?
- What kind of surgery do you recommend?
- How can I talk to my partner about this disease?
- Can you recommend a counselor or support group?
- Can you recommend a sex therapist?
A note from Cleveland Clinic
Your sexual health is important and affects your quality of life. Penis health, especially when it comes to shape and size, can be a difficult, awkward conversation to have with a partner or healthcare provider. But, if you want to improve your Peyronies disease, those conversations need to happen. This condition is common and affects upwards of 10% of men, so you are not alone. Dont hesitate to tell your urologist or other healthcare providers exactly what your symptoms are. Be specific. Talk about your concerns and fears. Listen to your healthcare provider. Find the best next step you can take to manage your Peyronies disease.
What Are The Risk Factors For Peyronie’s Disease
A number of factors increase the risk of developing Peyronie’s disease. Not all people with risk factors will get Peyronie’s disease. Risk factors include:
Family history of Peyronies disease
Age: Men in their 50s and 60s are at higher risk for developing the condition
Having a , such as Dupyutrens contracture
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What Causes Peyronies Disease How Does It Affect The Penis
Peyronies disease develops when there is inflammation or scarring which develops in a portion of the elastic sleeve. The cause of this inflammation and scarring is unknown, but some suggest it may be due to microtrauma that can affect the erect penis. The portion of the elastic sleeve with inflammation or scarring does not stretch or expand completely.
Peyronies may present in a variety of ways.
- There may be pain or curvature of erection, which develops due to tethering in the area where the sleeve of the erectile structure loses its elasticity.
- A firm area or nodule can be felt, referred to as a Peyronies plaque.
- There may be incomplete filling which can cause the erect penis to have an hourglass or a coke bottle deformity, or a divot may be present due to incomplete filling.
- The erection may be soft beyond the involved area.
- Some men may have associated erectile dysfunction, meaning the erection is more difficult to get, the erection is less rigid, or they may get the erection but cannot maintain it.
What Is The Difference Between Peyronies Disease And Penile Curvature
Peyronies disease is a type of penile curvature that occurs in adults. Some men can be born with a curvature of the penis and this is called a congenital or chordee curvature.
It is not caused by scar tissue and the condition does not change over time. This may not be noticeable until puberty when a man begins to have more regular erections.
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Treatments For Acute Peyronies Disease
Doctors avoid invasive or surgical procedures if possible. Surgery is usually not recommended for acute Peyronies disease. Nonsurgical treatments could include:
Oral medications and supplements, such as vitamin E, potassium aminobenzoate, tamoxifen, colchicine, and carnitine
Nonsteroidal anti-inflammatory medications , such as ibuprofen or naproxen to relieve pain
Injections of medications directly to the scarred area on the penis to help control swelling and scarring
Penile traction therapy, using mechanical traction or vacuum devices, help stretch the penis and reduce the curve
- Shockwave therapy directed towards the scarred tissue may reduce pain.
Medications & Supplements To Treat Peyronies Disease
It is this anxiety, and not necessarily physical deformity, that tends to drive men to seek non-surgical treatment. Unfortunately, there are very little data to support the use of oral remedies for Peyronies disease, but many men find the concept of simply accepting a minor curvature of the penis and not seeking some form of prospective therapy unacceptable. A partial list of such remedies would include Potaba, colchicine, Vitamin E, marketed herbal remedies, Coenzyme Q, and most recently Pentoxyfylline and L-Arginine. Dr. Engel does not discourage a man from trying these remedies as long as they are not overly expensive or cause side effects . Pentoxyfylline, an old anti-hypertensive named Trental, has the most recent literature with some data supporting its use. Vitamin E is the simplest thing for a man to try. But in reality, Dr. Engel believes that it is time and ones own body that will determine if the plaque will worsen, remodel, stabilize or calcify.
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What Causes Peyronie’s Disease
Because Peyronies disease results from scar tissue pulling the penile tissue into a curve, the most common cause of the condition is injury to the penile tissue. This could be the result of or traumas, but it also can be caused by vigorous sexual activity. The injuries, often micro injuries that are not noticed, heal but then more scarring occurs following more injuries.
Other possible causes include:
Family history of Peyronies disease
- Some medications, such as beta blockers, interferon and phenytoin
What Are The Signs And Symptoms Of Peyronies Disease
The signs and symptoms of Peyronies disease may include
- hard lumps on one or more sides of the penis
- pain during sexual intercourse or during an erection
- a curve in the penis with or without an erection
- changes in the shape of the penis, such as narrowing or shortening
These may develop slowly or appear quickly and can be mild to severe. In many cases, the pain decreases over time, although the curve in the penis may remain.1 Problems with intercourse or ED can occur during either phase.
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What Is The Best Treatment For Peyronies Disease
Collagenase clostridium histolyticum injections directly into the penile tissue are currently an effective way of treating Peyronies disease through a pharmaceutical approach.
At the moment, this is the only medication that the FDA has officially approved for use in treating this disease. It is important to note that the patient has to meet specific criteria before being given this medication.
Doctors sometimes provide interferon injections to assist with breaking down the fibrous tissue that develops in the patients penis. Some doctors also prescribe verapamil, which is an oral drug that can treat hypertension.
Although drug therapy may help men with more severe forms of Peyronies disease, it is worth mentioning that there havent been enough studies to assess their efficacy and mechanisms of action. Some drugs prescribed for this person besides verapamil include oral vitamin E, colchicine, tamoxifen, potassium amino-benzoate .
If conventional treatment options do not yield effective results, a doctor may advise the patient to consider surgery. There are different ways we can use surgical procedures to assist in restoring erectile function and reducing the bending that Peyronies disease causes in the penis.
What Questions Might My Healthcare Provider Ask To Diagnose Peyronies Disease
- How long have you noticed the curve in your penis?
- Have you lost length and, if so, how much?
- Is having sex difficult?
- In which direction does your penis bend and roughly how many degrees?
- Are you in pain currently or during sex?
- Does your partner have pain during sex?
- How strong are your erections? Do you have erectile dysfunction ?
- Does anyone in your family have Peyronies disease or Dupuytrens contracture?
- What medications are you taking?
- Do you have any other medical problems or conditions such as diabetes or an autoimmune disorder?
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Injections To Treat Peyronies Disease
It is prescribed for men whose penile curvatures are greater than 30 degrees but less than 90 degrees. It breaks down scar tissue to improve curvature.
This is the most effective injection available and is given as a series of two injections per week for eight weeks.
Interferon is a protein that helps control swelling and scarring. In theory, it slows the rate of scar tissue formation by producing an enzyme.
This medication can be taken orally to treat high blood pressure, but when injected into La Peyronies patch, it has been shown to relieve pain and curvature in the penis.
Medical And Family History
The urologist will ask about your medical and family history. Some questions might be
- When did your symptoms begin?
- Do you feel pain during an erection or at other times?
- Do you have erection problems or problems with sexual intercourse?
- Does anyone in your family have Peyronies disease or other medical conditions?
- Are you taking any medicines? If so, what are they?
- Do you have other medical problems or conditions?
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What Is Peyronie’s Disease
Peyronies is a disease where scar tissue in your penis causes it to bend, curve or lose length or girth. You may be able to feel the scar tissue through the skin or you may have pain in a specific part of your penis as the scar tissue forms. During an erection, your penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition dont have a curve, but might have an area of indentation or hourglass appearance.
Most men dont have perfectly straight erections. Just because there is a little curve in your penis, that doesnt mean you have Peyronies disease. Men who have had a curvature their whole lives do not have Peyronies disease.
In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. Your penis will bend downward if the scar is on the bottom, and sideways if the scar is on the side. In some cases, the scar develops on both the top and bottom of the shaft, which can cause the penis to become dented or shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the center of an hourglass. About one in three men with this condition may have calcium in the scar tissue that can make it feel like bone.