Peyronie's disease is characterized by a plaque, or hard lump, that forms on the penis. It may develop on the upper or lower side of the penis in layers containing erectile tissue. The penis contains balloon-like blood vessels that fill with blood to cause an erection. Scar tissue forming in the balloons cannot stretch as much as the balloons do, so the erected penis bends toward the side with a scar.
Peyronie's disease was first described in 1743 as a form of impotence. Impotence is recognized as one factor associated with the Peyronie's disease, but is not always present. Men most likely to suffer Peyronie's disease often have high blood pressure and high blood cholesterol and uric acid levels, which weaken blood vessel walls.
The plaque often begins as a localized inflammation that may develop into a hardened scar. Generally, when the disease heals within a year or so, the plaque does not advance beyond that initial inflammatory phase. When the disease lasts for years, the plaque often becomes a tough fibrous tissue, and calcium deposits may form.
Men with Peyronie's disease are usually told to live with it unless the erection becomes painful or the bend is so great that the man cannot engage in sexual relations. In general, the goal of treatment is to keep the patient with Peyronie's disease sexually active.
The most favorable nonsurgical treatment for Peyronie's involves injecting medication directly into the plaque in the attempt to soften the hardened tissue and decrease the pain and curvature. Injection medications include steroids, collagenase, verapamil and interferon. It is not yet clear which of these substances works best, although collagenase and verapamil appear the most promising at this time.
If the bend in the penis is so severe that intercourse is impossible, surgery may be recommended. The scarring plaque that causes the bend may need to be removed or cut to straighten the penis, but this usually affects the quality of erections. A penile implant may be inserted to improve erections.
Peyronie's disease often occurs in a mild form that heals without treatment in 6-15 months. It is not clear why this occurs without intervention. However, once a plaque has calcified, it is unlikely to resolve and surgery is the only solution. Because the cause of Peyronie's disease is still unknown and all of its symptoms may lessen or disappear in some individuals, many experts recommend that a man wait 1 to 2 years before considering surgery.
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