Peyronie’s disease, also known as CITA (Chronic Inflammation of the Tunica Albugineea), is a rare connective tissue condition affecting the penis. It affects up to four percent of Caucasian males, most frequently aged 40-60 and it manifests as a painful curvature of the penis, accompanied by plaques or lumps.
The causes for Peyronie’s disease are unknown. Possible causes include micro-trauma during sexual intercourse, auto-immune, or genetic conditions. Research has discovered some associations though, such as:
- Peyronie’s disease is more frequent in men with weak erections that have frequent intercourse.
- It is more frequent in patients with auto-immune diseases.
- It is a known side effect of several antihypertensive drugs.
The symptoms of Peyronie’s can start in one of two ways, usually as a sudden pain in the penis which leads to the discovery of a lump in the shaft and eventually a slow, progressive curving of the penis. In the other, less common form, the curving takes place quite suddenly. Regardless of the way it starts, the disease is characterized by a fibrous plaque or lump on the penis, usually greater than 1.5 cm, which causes painful and curved erections. Alternatively, the part of the penis between the plaque and the tip remains flaccid during erection making pain, curvature, and lumps the most common symptoms.
The pain in Peyronie’s disease tends to ease up in time, but the curvature increases, with the exception of a small number of patients who heal spontaneously for unknown reasons. Most treatments for Peyronie have widely varying degrees of success from person to person. Here are the options available:
Vitamin E plus Colchicine slow down the disease while Pentoxifylline reduces plaque size and penis curvature. Sildenafil (Viagra) may bring some benefits, by increasing the blood flow into the penis. Xiaflex (Collagenase clostridium histolyticum) is a drug approved by the FDA for the treatment of Dupuytren’s disease, a similar condition affecting the palms. Some studies have shown Xiaflex to dissolve the plaques, but this use is still experimental.
Surgical treatment is reserved for severe cases or cases that are resistant to medical treatment. For best results, surgery should take place if the disease is stable (is not active or evolving) for 12-18 months. The results vary widely. There are several surgical options: the Nesbit tuck, Tunica duplication, Plaque excision and grafting, Plaque excision and penile prosthesis insertion. These are briefly explained below.
- The Nesbit Tuck: A portion of the Tunica Albugineea, the fibrous layer covering the penis, opposite to the plaque is removed, resulting in a straighter and shorter penis. This requires the patient to be free of erectile dysfunction and the curving of the penis shouldn’t exceed 60 degrees.
- Tunica Duplication: The Tunica Albugineea opposite to the plaque is pulled and sewn to itself instead of being removed. The results are the same as with the Nesbit tuck.
- Plaque Excision and Grafting: The plaque is removed, and a piece of skin is put in its place. It preserves the length of the penis.
- Plaque Excision and Penile Prosthesis Insertion: This is used when patients also suffer from severe erectile dysfunction.
And also, laser thinning of the plaques/lumps is one of the newest surgical techniques being offered to treat Peyronie’s disease.
Some studies have shown improvement with the use of penis stretchers. The use of these devices for Peyronie’s disease is experimental, but it is an alternative worth discussing with your doctor since it has been shown to help.