Peyronie's disease - Non-surgical options

Understanding Peyronie's

One of our specialists - Wendy Hurn, Consultant Nurse, wrote about a non surgical option for treating Peyronie's disease:

Introduction: Until recently there has been little option for men who have developed Peyronie´s plaques. Wendy Hurn looks at an innovative device that has changed the way these men are treated with remarkable results. In clinical practice we are seeing more men present with curvature of the penis due to Peyronie´s plaques. Peyronie´s Disease is a condition in which a fibrotic scar develops within the tunica albuginea of the corpora cavernosa, and may result in curvature of the erect penis.

Peyronie´s Disease affects approximately 0.5% of men worldwide, although curvatures are far more common. The scar most commonly involves the dorsal aspect of the penis, although it can extend laterally or occur on the ventrum in some cases. Calcification is present in approximately 30% of patients and indicates that the scar is mature.

Treatment options

These plaques can cause discomfort, embarrassment to the man and often pain to his partner when sexual intercourse is attempted. This in turn may result in erectile dysfunction and relationship breakdown if the problem is not resolved. Previously, the first line of treatment was to "watch and wait" to see if the curve resolved itself or, if it became worse, a daily high dose vitamin E may be given. Treatment with vitamin E would be a long-term treatment, usually given over the course of almost a year, but may not provide any positive results. In recent years this treatment is now thought to be unsafe due to its effect on the blood pressure leading in some cases to stroke and cardiac events.

Surgical treatment options to remedy the condition are available. They include application ("folding") procedure where the "long side" is shortened. In another approach, a skin graft can be placed in the area of the scar to lengthen the short side. However, given the potential risks and side effects, these may not always be the most appropriate option. The innovative Andro-Penis, by AndroMedical S.L., is an alternative to these treatments and is proving to have very positive results. The Andro-Penis is a mechanical penile traction device, which worn over calculated time periods, reduces plaque thickness, thus straightening the penis, and effectively reducing penile deformity during erection.

Currently there are 25 patients using the Andro-Penis who have been seen in the Andrology clinic at Bristol Royal Infirmary, UK. These men have varying degrees of deviation and most are three months or more into the treatment and are wearing the device during waking hours daily. There has been a marked improvement of between 30-45% in the degree of angulation, with reduction in discomfort and the ability to resume sexual intercourse in most cases. The patients are continuing to wear the device and will be reviewed at six months of treatment.

Case study 1

C is a 51 year old who developed an area of fibrosis on the dorsal aspect of his penis three years ago. Having unsuccessfully tried Vitamin E treatment, he did not wish to have surgery. His marriage failed after he was unable to have penetrative intercourse for over a year. He was seen in clinic and an injection of alprostadil revealed a penile deviation of approximately 70º with a fibrotic thickening easily identified. Wendy Hurn, Urology Specialist Practitioner Bristol Royal Infirmary UK Peyronie´s Disease - a non surgical option for treatment Wendy Hurn, Urology Specialist Practitioner Bristol Royal Infirmary UK Peyronie's Disease - a non surgical option for treatment An Andro-Penis was fitted and used daily as instructed. C was seen in clinic after three months and the fibrotic plaque had lengthened and decreased in width, while the penis itself had lengthened by approximately 1.2cm. The patient reported that the curvature had decreased by approximately 20º. He was seen again at six months and improvements had continued with a further increase in length if 1.52cm, plus a decrease in the size of the plaque. Alprostadil injection revealed a 25-30º curvature without discomfort or difficulty in penetration. He will continue to wear the device for a further two months and be seen for review.

Case study 2 F is a 62 year old man who suffered a radical prostatectomy for carcinoma of the prostate gland three years ago. He suffered no long-term issues following this but had noticed that his penis had retracted and when he did get an erection it had a 45º bend.

Conclusion

The treatment of Peyronie´s Disease will be one of choice between the patient and the specialist. For those who can't or won't undergo the surgical option, the Andro-Penis is a real alternative. It gives the patient autonomy and allows them to take some control of the situation, while getting positive results. It is extremely important when discussing the options that this is considered an effective and viable treatment and the practitioner will themselves realise the potential of this device after seeing the positive effects that it can have on their patients