What is Peyronie’s disease
Peyronie’s disease is a fibroplastic violation of the position of the penis, followed by curvature, as well as the presence of progressive fibrotic changes. The disease is called the surgeon F. Zhigot de Peyroni, who discovered this disease and began research on treatment in 1743.
Pathology is manifested by curvature of the penis, which develops due to progressive fibrotic processes, manifested by changes in the protein structure of the penis. The disease is usually based on an organ injury, followed by the formation of a hematoma within the tunica albuginea.
The prevalence of Peyronie’s disease is 1-3.7% and is more common in men 40-70 years old. Cases of this disease are described in young men. The fact of a certain increase in the disease after the start of the use of Viagra for the treatment of erectile dysfunction is noted.
According to the classification of diseases ICD-10, Peyronie’s disease is included in the code
Causes of Peyronie’s Disease
Peyrogenigenital injuries are a common theory of the onset of the disease. Microtraumas of the protein shell cause hematomas that lead to fibrous modifications of the tissue of the cavernous bodies. This is Kleiman’s theory. Most of these injuries men get during sex.
In addition, the following reasons are possible:
- vascular diseases;
- hormonal disorders;
- inflammatory diseases of the penis;
- taking certain medications;
- autoimmune disorders.
Risk factors for developing the disease are:
- age: with age, the elasticity of the tissues of the penis decreases, which leads to an increase in the probability of injury;
- heredity: if Peyronie’s disease is present in close relatives, then the risk of the occurrence of the disease increases;
- connective tissue disorders, for example, Dupuytren’s contracture: in people with this disorder, Peyronie’s disease is more common.
Peyronie’s disease classification
There are three types of penile curvature:
In the dorsal form, the genital organ is directed upwards, in the ventral form, curvature occurs downward, and in the lateral form, lateral deformation of the penis occurs.
Also, the curvature of the penis is:
Taking into account the causes of the occurrence, there are:
- acquired: develops as a result of hormonal imbalance or injury;
- congenital: formed as a result of intrauterine disorders.
Stages of Peyronie’s Disease
At the first stage of the development of the disease, the symptoms are either absent altogether or are not expressed by bright abnormalities. As a rule, a man is puzzled by painful sensations that occur during erection.
After the first stage, the gradual deformation of plaques begins, due to which the size and density of the penis changes.
Over time, the curvature and soreness increase. Acute Lasts 6-12 months. In the chronic course, the painful sensations are absent, the sizes and seals of the albugine of the penis are stabilized.
Symptoms of Peyronie’s Disease
The following symptoms of Peyronie’s disease are distinguished:
- curvature of the penis (55-100% of cases);
- pain during erection (70-80% of cases);
- thick plaques, palpable under the skin of the penis (80-100% of cases).
The initial symptom of Peyronie’s disease is painful erection. Over time, the pain becomes more pronounced, the formation of the curvature of the penis. Further, in the connective tissue, yarns are felt, fibrous plaques with sizes of 1.5-2 cm. At the same time, the patient has no sexual life due to strong painful sensations.
There are two periods of the disease:
- pain: patients complain of pain in the penis (both during erection and at rest) – in rare cases there is no pain, and the patient turns to the doctor because of the sensations in the area of the penis;
- functional: a curvature of the penis occurs, which, together with painful sensations, leads to sexual problems – being located next to blood vessels, scars and plaques cause blood circulation problems in the penis and provoke the development of erectile dysfunction.
Peyronie’s Disease Treatment
Apply conservative and surgical treatment. For conservative treatment used anti-inflammatory drugs and agents that prevent the formation of fibrous tissue. Medicines are injected into the penis by injection. Also used drugs that prevent the calcification of painful areas. Also used physiotherapy.
- Potassium aminobenzoate: in the amount of 12 g / day to achieve a therapeutic effect.
- Vitamin E (alpha-tocopherol): 200-600 mg / day in four doses (the dosage is determined by the attending physician) for several months.
- Colchicine: prescribed in the individual scheme, the initial dose is 1 mg.
- Tamoxifen: 40 mg / day, reduces pain in 80% of patients, but this drug does not affect the degree of curvature of the penis.
- ultrasound and vibration treatment methods;
- laser-magnetic irradiation of the affected areas;
- phonophoresis with ronidase, corticosteroids, lidazoy.
If conservative treatment does not bring any results, then surgical treatment is prescribed. The operation aims to eliminate penile curvature and remove plaque. The cure of Peyronie’s disease and its consequences by surgical methods is indicated only if the conservative methods did not produce results for 1.5 years, and also if the growth of protein-coated plaques stopped.
The use of surgery is an effective method of treatment, but at the same time there are drawbacks: the price in comparison with conservative treatment and trauma. The methods of surgical treatment of Peyronie’s disease are divided into three types of operations.
Nesbit first described the method of surgical treatment of congenital curvature of the penis. The operation consists of incision of the albugine on the side of the curvature, as well as folding (plication) with sutures on the opposite side. Variants of the Nesbit operation technique in Peyronie’s disease.
- Plikatsiya: on the opposite side in the area of curvature of the penis superimposed folding seams on the protein shell.
- Korporoplastika: on the opposite side of the curvature is a longitudinal section of the albugine membrane, which is sutured in the transverse direction, which leads to straightening of the penis.
Surgeries such as Nesbit are simple to perform, are not accompanied by serious complications, and are indicated for patients with a sufficient length of the penis and a slight or moderate degree of curvature of the penis. Penis size becomes a contraindication, since this type of surgery results in shortening of the penis.
With a large amount of plaques or significant curvature of the genital member, it is required to cut or excise the plaque and replace the resulting defect with another tissue. Although the choice of material depends on the experience and preferences of the surgeon are more often used:
At the same time, the patient’s own tissues are used (more often, the area of his own vein). The disadvantages of this technique: the need for a second incision and a tendency to contracture and scarring of the flap.
Apply Dacron or Gore-Tex. The disadvantage of the method is chronic inflammation, which leads to erosion and continuing fibrous process, extending beyond the implant.
Biomembranes (pig skin or submucosa of the pig intestine)
Xenografts are ready for use, after opening out of the package, they help the development of their own collagen, they are not subjected to hardening.
Prosthetics are used in patients with Peyronie’s disease, accompanied by severe penile curvature and persistent erectile dysfunction. Prosthetics helps to correct the curvature of the penis on the prosthesis using plastic replacement techniques and restore erectile dysfunction.
Postoperative case management
In the postoperative period, periodic squeezing of blood from the penis is performed, a pressure bandage for 48 hours, a Foley catheter for a day. Antibacterial therapy begins in the operating room with intravenous administration of antibacterial agents and continues from the second bottom in the form of pills for up to 21 days. Patients are advised to abstain from sexual activity for 6-8 weeks.
Extracorporeal shock wave therapy (ESWT) in Peyronie’s disease
A lithotriptor is used for treatment, the intensity of which is one thousand pulses per treatment session. The maximum power used is twelve to thirteen kV. The course of treatment involves weekly use of ESWT from two to twelve weeks. There is no need for anesthesia during extracorporeal shock wave therapy.
For ESWT, the patient lies on the couch with his stomach down, while the penis is located on a special treatment pillow of the lithotriptor and is pressed against the plane under the natural influence of the patient’s weight. The pressure of the cushion increases and gradually reaches its maximum. In this way, the formed plaques are affected.
As a result of carrying out several sessions, the pain in men disappears at the moments of arousal, the penis takes on a natural look, the plaques become smaller and not so dense. An ultrasound examination of the blood flow to the penis becomes much smaller than the vessels surrounding the plaque.
Results are achieved with early treatment of the disease. In the period of up to a year, the tissues are relatively healthy, there are no cardinal changes in them yet. Also, constructive treatment is affected by the absence of conservative therapy.
If after the onset of the disease more than two years have passed, the patient has been given intracavernous injections, which have provoked complications, this treatment bears no benefit. In this case, the first thing required surgical intervention. Extracorporeal shock wave therapy does not give an instant effect and takes time.
Folk remedies for Peyronie’s disease at home
Folk remedies complement the treatment prescribed by the doctor. Use the following recipes:
- 20 g of chestnuts chop, pour 1 tbsp. warm water and boil for 15-20 minutes, then strain and take before meals. Optionally add honey.
- Herbal tincture is made from sage leaves, oregano, burdock and primrose. Cut herbs, add boiled water, insist for 24 hours, strain through cheesecloth and take before meals.
- Baths with sage are made as follows: dried sage (500 g), pour boiling water (10 l), you need to take such a bathroom for half an hour.
Diagnosis of Peyronie’s Disease
Diagnosis of this disease involves the use, in addition to the initial palpation of the tissues of the penis, a complex of modern techniques:
- Ultrasound helps to determine the size, location and degree of calcification of plaques in the protein shell.
- CT (computed tomography) and MRI (magnetic resonance imaging) are used in cases where the plaques are not visible on the ultrasound.
- Spiral computed tomography provides a picture of the disease, including information on the density of pathological areas. It is used if surgical treatment is indicated.
- X-ray helps to see the condition of the penis.
Peyronie’s disease prevention
Since the cause of Peyronie’s disease are, as a rule, microtraumas, obtained during sexual intercourse, then to prevent the curvature of the penis, restrained sex, not too risky positions, and the rejection of sexual contact in a state of intoxication are necessary.
It is required to treat concomitant diseases, such as arterial hypertension, diabetes mellitus, etc. The use of drugs in cardiovascular diseases only after consulting a doctor.