THE Peyronie's disease is one benign condition characterized by the appearance of hard plates on the body of the penis, which cause bending and angulation of the penis during erection, as well as pain during sexual intercourse. Bending and angulation can be so extensive that it either becomes penile penetration impossible or be caused erectile dysfunction. Practically, the man is trapped in a situation where on the one hand he has a penis that he does not recognize since it has changed form and on the other hand it is not functional for sexual intercourse.
The exact etiology is not known. Penile injuries during intercourse and penile fracture have mainly been blamed. Other causes are microbial agents, autoimmune diseases, diabetes mellitus, arterial hypertension, systemic vascular disease, and even some neoplasms. Peyronie's disease can affect any male, but the most common decades of onset are the 5th and 6th.
THE diagnostic approach includes a complete medical and sexual history looking for possible injury, duration of symptoms, sexual behavior, painful erection, presence or absence of co-morbidities. The clinical examination is always performed with the penis relaxed and erect after an injection of a vasoactive substance into the penis. The illustration of the problem is mainly achieved by a special examination which is called dynamic ultrasounda (triplex) penis.
THE treatment of the disease initially is pharmaceutical, with a variety of active substances being used such as verapamil, tamoxifen and vitamin E. The goals of medication are to stop the progression of the disease, maintain or enhance erectile function and reduce penile flexion. In addition to medication, the use of low intensity is now applied as a non-invasive treatment option shock waves in the penis with quite encouraging results in the international literature.
When the lesion has stabilized and when penile flexion makes sexual intercourse impossible, the treatment of choice is surgery. Many penile straightening techniques are applied with or without removal of the plate, with or without graft placement. Surgical straightening is the only treatment that will return the man to the penis in the form he knew it before the problem started. It is the permanent solution to the problem.
THE specialist andrologist based on the extent of the problem, the anatomy of the penis and the existence of accompanying problems, he will choose the appropriate personalized surgical treatment. As much as a penile surgery seems difficult and dangerous, in an experienced surgical team it is one safe solution for the treatment of Peyronie's disease.
