Peyronie’s disease (PD) is a condition that causes curvature of the penis during an erection. If you suffer from this disorder, you know it can be embarrassing and interfere with intimacy. Men who have Peyronie’s come from all over the U.S. to seek treatment from Dr. L. Dean Knoll in Nashville. As a recognized leader in reconstructive surgery, he performed the first surgical penile graft in the world to correct penile curvature using a collagen-based biomaterial derived from porcine small intestines.
Experts estimate that Peyronie’s disease impacts about 10% of men between 40 to 70 years old. It occurs when plaque, or scar tissue, develops in the penis. The condition may be caused by injury to the penis during sexual activity or from a sporting accident. Genetics may also play a role in plaque formation.
Penile scar tissue feels like lumps under the skin. This may cause painful erections, abnormal curvature, indentation, loss of girth and/or shortening of the penis, and erectile dysfunction.
While plaque may appear anywhere on the penis, it most often forms on the top side of the penis. Plaque on the topside of the shaft causes the penis to bend upward during erections, while plaque on the underside of the shaft causes it to bend downward. In some cases, the plaque develops on both the top and bottom, which leads to indentation and shortening of the penis.
In many cases, men with Peyronie’s disease find it difficult to have sexual intercourse due to pain, curvature of the penis, or poor erections.
In some cases, Peyronie’s disease may resolve itself over time. The majority of men, however, will require treatment. The good news is that PD can be treated. There are a number of effective treatment options, including nonsurgical solutions.
Injection therapy can help reduce the curvature of the penis. In appropriate patients, Dr. Knoll will use Xiaflex® (collagenase clostridium histolyticum), the first nonsurgical treatment for Peyronie’s disease approved by the FDA. Candidates include men with a palpable plaque in the penis that causes a curvature of at least 30 degrees during erection.
Injected directly into the plaque, Xiaflex works by weakening and breaking down the scar tissue, which helps straighten the curve in the erect penis. You may need up to 4 treatment cycles 6 weeks apart.
Each treatment cycle consists of 2 injections on separate days, administered 1-3 days apart. Injections are followed by stretching and straightening exercises, performed by your health care professional as well as by yourself at home. Dr. Knoll will let you know how many treatment cycles you will need and discuss side effects of the medication.
Excision/Incision: This procedure involves removing or incising the plaque/scar tissue and attaching a graft. It’s a method that straightens the penis and may restore some lost length. Risks of the procedure include temporary numbness of the penis and decreased rigidity of erections in a small number of patients. This surgery is typically the best option when the penile curvature is severe or the shaft has become very narrow.
Plication: This surgery involves removing or pinching a piece of the tissue that covers the erection body from the side of the penis opposite the plaque, to straighten out the penis. It’s a method less likely to cause numbness or erectile dysfunction. However, it is associated with a decrease in penile length. The ideal candidate has mild or no ED and mild-to-moderate penile curvature.
Penile Prosthesis: In this procedure, an inflatable penile prosthesis (penile implant) is placed to create rigidity and straighten the penis adequately. Penile prosthesis is considered the best treatment for patients with both erectile dysfunction and Peyronie’s disease.