What is Peyronie’s Disease?
Peyronie’s disease is a painful condition in which a man’s penis develops a curve—typically 45 degrees or greater–due to the accumulation of abnormal scar tissue or plaques inside the penis. Some experts suggest the condition develops when repeated mild trauma to the penis causes minor damage that accumulates over time. The trauma could be from sexual activity, sports injuries, or an accident. Damage causes scar tissue to develop, and the scars (lesions) decrease the ability of the penis to stretch and the organ leans toward the side of the scar. Peyronie’s disease can also develop in a small percentage of men who undergo radical prostatectomy. Other risk factors for Peyronie’s disease include diabetes, age, tobacco use, and presence of a connective tissue disease such as Dupuytren’s contracture, which is common in men with Peyronie’s disease.
According to the American Urological Association, up to 9 percent of men between the ages of 40 and 70 have some degree of Peyronie’s disease, although the number could be even higher because men are too embarrassed to report it. It is much less common in younger men. (American Urological Association)
Peyronie’s disease can cause a significant amount of pain and some penile shortening, as well as prevent men from having sex because of the angle of the penis and/or the pain. Men with this disease often experience much anxiety and distress related to the disorder. Treatment typically is reserved for men who are experiencing pain, are unable to engage in sexual activities because of the curvature, and the curvature is worsening. In about 5 to 12 percent of men the condition disappears without treatment. (Deveci)
Drug Treatments for Peyronie’s Disease
Treatment options for Peyronie’s disease include use of oral drugs and supplements, which have not been well studied. Some of the treatments include tamoxifen, colchicines, potassium aminobenozoate, pentoxifylline, and the natural supplements vitamin E, propionyl-L-carnitine, and omega-3 fatty acids. Thus far, none of these treatment options have yielded good results, except potassium aminobenozoate, which is now available as the prescription drug Potaba. (Kuehhas)
Potaba is an antifibrotic, which means it helps prevent the formation of fibrous tissue that is characteristic of Peyronie’s disease. The drug works by increasing the supply of oxygen in tissues in the penis. You should take Potaba with food. Side effects of Potaba include nausea and loss of appetite, and failure to eat because of these side effects may result in symptoms of low blood sugar (e.g., increased hunger, elevated heartbeat, weakness, sweating, chills).
Another oral treatment that is showing promise is coenzyme Q10 (CoQ10). A total of 186 men with Peyronie’s disease were randomly assigned to take either 300 mg CoQ10 daily or placebo for 24 weeks. At the end of the study, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and International Index of Erectile Dysfunction (IIEF-5) questionnaire results improved significantly in men who took CoQ10 but not in those taking placebo. More importantly, mean plaque size and mean penile curvature degree declined in the CoQ10 group while it increased in the placebo group. Peyronie’s disease progressed in 11 (13.6%) of men in the CoQ10 group compared with 46 (56.1%) in the placebo group. (Safarinejad)
A preliminary study reported in 2001 discovered that acetyl-L-carnitine provided some improvement in curvature and pain for men with Peyronie’s disease. However, no follow-up studies were ever done. (Biagiotti)
Use of penile injections also can reduce the curvature and pain, although multiple injections into the lesions are necessary over several months. The drugs used for injections include verapamil, collagenase, nicardipine, and interferon, all of which can disrupt the protein (collagen) that is key in the formation of the scar tissue. Not all of these drugs are equally effective, however.
Among the studies of penile injections are several that have used verapamil. One study of 156 men reported that about 60% of the patients reported a decrease in curvature and 71% said sexual function had increased. (Levine 2002) In another study, 94 men received an injection every two weeks for a total of six injections. At 5.2 months posttreatment, 18% of the men said curvature had improved, 60% reported stable curvature, and 22% said curvature had increased. (Bennett) Pain improved in all the patients.
Nicardipine is in the same drug class as verapamil, and studies indicate injections of this drug also are somewhat effective at reducing plaque size and improving both pain and penile curvature in some men. In one study, for example, 74 men were randomly assigned to take either nicardipine or placebo for a total of six injections given every two weeks. Plaque size was significantly reduced only in the nicardipine group, although penile curvature was significantly improved in both the nicardipine and placebo groups. (Soh)
Use of interferon has resulted in mixed results, with low rates of improvement and a high incidence of side effects. Collagenese injections, however, have been more promising. An early study showed 64% of men improved after 4 weeks of treatment (Gelbard), while a more recent study noted a statistically significant improvement in penile curvature and plaque size. (Jordan)
Nonsurgical and Surgery Treatments for Peyronie’s Disease
A nonsurgical treatment approach that uses shockwaves has been controversial. Shockwaves are used to treat and break up kidney stones, so numerous studies have looked at how effective this approach could be in breaking up the plaque in the penis. Extracorporeal shock wave therapy (ESWT) for Peyronie’s has yielded mixed results. A recent study published in June 2010 reported on 157 patients who received an average of 3.5 ESWT treatments. One-third of the patients achieved significant reduction in curvature, while more than 90 percent of the men reported good reduction in pain and 6 percent had complete pain relief. No significant difference was seen in sexual function. (Busetto)
In a double-blind, placebo-controlled study one year prior, however, the results were not as promising. One hundred men were randomly assigned to either ESWT or placebo. At 12 weeks after treatment, mean plaque size and mean penile curvature degree had not changed in the ESWT group and showed a slight increase in the placebo group. By week 24, both mean plaque size and mean penile curvature were significantly higher in the placebo group compared with the ESWT group. This suggests ESWT may protect against disease progression.
Another nonsurgical option for treatment of Peyronie’s disease is penile traction. Only a few small studies have been conducted, and the results have been conflicting. Penile traction involves wearing a device with extender rods on the penis, whose purpose is to gradually straighten and extend the penile shaft. Men typically should wear the device for at least 2 hours per day, but more is recommended. Every few weeks, the rods are lengthened by a slight amount.
In one study, 10 men completed 6 months of penile traction therapy and reported improvements in both length (0.5 cm to 2.5 cm) and curvature of the penis (mean, 22 degree improvement). No side effects were reported, and the men were satisfied with the results and had an improvement on their International Index of Erectile Function scores. (Levine 2008) A subsequent study, however, also lasting 6 months, did not yield the same results. The 15 men in the study used the penile traction device for a mean of 5.5 hours daily but did not see a significant decrease in penile curvature, although there was some improvement in mean flaccid penile length (1.3 cm). (Gontero)
Surgery is an option if the curvature is severe or prevents sexual activity. Before surgery is performed, however, the curvature should be stable (not gotten any worse) for at least three months and other treatment options should have been explored, as there is no standard surgical procedure for treatment of Peyronie’s disease. Possible procedures include shortening one side of the tunica albuginea (the fibrous structure that plays a significant role in achieving an erection), lengthening one side with graft material, or implanting a penile prosthesis for men who have severe erectile dysfunction caused by Peyronie’s disease.
See also
Bromelain Supplement for Peyronies Disease
Testosterone and Erectile Dysfunction
Causes of Erectile Dysfunction
Treatments for Erectile Dysfunction
Peyronies Disease and Prostate Cancer Treatment
Side Effects of Prostate Cancer Treatment
Prostate Cancer Treatment and Erectile Dysfunction
After Prostate Surgery, Now What?
References
American Urological Association: http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=50
Bennett NE et al. Intralesional verapamil prevents the progression of Peyronie’s disease. Urology 2007 Jun; 69(6): 1181-84
Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie’s disease: a preliminary report. BJU Int 2001 Jul; 88(1): 63-67
Busetto GM. Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: long-term results. Arch Ital Urol Androl 2010 Jun; 82(2): 128-33
Deveci S et al. Defining the clinical characteristics of Peyronie’s disease in young men. J Sex Med. 2007;4:485–490
Gelbard MK et al. The use of collagenase in the treatment of Peyronie’s disease. J Urol 1985; 134:280–83
Gontero P et al. Use of penile extender device in the treatment of penile curvature as a result of Peyronie’s disease. Results of a phase II prospective study. J Sex Med 2009; 6:558–66
Jordan GH. The use of intralesional clostridial collagenase injection therapy for Peyronie’s disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 2008; 5:180–87.
Kuehhas FE. Peyronie’s disease: nonsurgical therapy options. Rev Urol 2011; 13(3): 139-46
Levine LA et al. Experience with intraplaque injection of verapamil for Peyronie’s disease. J Urol 2002 Aug; 168(2): 621-25
Levine LA, Newell M, Taylor FL. Penile traction therapy for treatment of Peyronie’s disease: a single-center pilot study. J Sex Med. 2008;5:1468–1473.
Palmieri A et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie’s disease. Eur Urol. 2009;56:363–369
Safarinejad MR. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. Int J Impot Res 2010 Sep-Oct; 22(5): 298-309
Soh J et al. Nicardipine vs saline injection as treatment for Peyronie’s disease: a prospective, randomized, single-blind trial. J Sex Med 2010 Nov; 7()11): 3743-49
