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Peyronie’s Correction

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Peyronie’s Disease

What is Peyronie’s Disease?

Peyronie’s (pay-roe-NEEs) disease is a condition in which fibrous scar tissue forms in the deeper tissues under the skin of the penis. This causes curved, painful erections. It also can make the penis shorter while erect. Peyronie’s disease is not caused by cancer.

How does Peyronie’s disease Occur?

1

Though the exact cause is unknown, many cases of Peyronie’s appear to be due to a traumatic episode.
For example, bending of the penis in an awkward angle during sex or when trying to have sex with a poorly erect penis.

2

Injury to the smooth muscle of the penis results in small tears in the muscle fibers and the layer supporting it.
The body senses microtears and attempts to repair them by sending more blood to that area.

3

If you have poor blood flow, like in the setting of erectile dysfunction, then the area of injury cannot get enough oxygen.
This lack of oxygen causes the area of injury to die resulting in scar tissue formation.
During the initial active phase you may experience pain and changes in curvature.
During the stable phase, the pain has resolved, and the curve has been unchanged for at least 6 months.

How is Peyronie’s Disease treated?

Active Phase

Patients in the active phase have a plaque that is still changing. During this phase, the goal is to increase blood flow to the plaque and to limit further curvature development. Additionally, while the plaque is still soft, we recommend treatments to try to mold the penis to straighten it out.
Medical Treatments:
- Daily use of a PDE5 inhibitor [i.e. Cialis (tadalafil), Viagra (sildenafil)] is used to promote erections and accordingly blood flow to the plaque.
- Daily use of a Vacuum Erection Device (VED) is used to stretch the plaque and promote additional blood and healing factors to the plaque, further promoting healing. We recommend you use this device for 5 minutes 1-2 times a day. The goal is to maintain an erection inside the cylinder. A VED is available for purchase at our center.
- Daily use of a traction device will further stretch the plaque in the opposite direction in an attempt to reverse the curve. The most popular traction device is the restoreX traction device (https://www.restorex.com). This device can be used for up to an hour daily when the penis is not erect (in a flaccid state).
- Xiaflex is a collagenase (plaque breaking medication) that is used in conjunction with penile molding to reverse your penile curve. It involves two injections into the area of scar — performed in the office every 6 weeks.
Surgical Treatments:
- These treatments are typically reserved for patients in the stable phase of their Peyronie’s disease with bothersome curves.

Stable Phase

The goal during this phase is to correct any penile curvature or deformity to a point where it allows for sexual intercourse without discomfort.
Medical Treatments:
- Xiaflex injections can be used to try to breakdown the scar and reverse the curvature. Patients must have a 30 degree or more curvature and a visible (on ultrasound) or palpable plaque in order to be a candidate for treatment. This is typically a 24 week treatment process.
Surgical Treatments:
- Penile Plication: This treatment involves placing stitches on the opposite side of the curve on the penile shaft to even out the penis and correct the curve. This is a minor treatment with a 2-3 week healing time. This can result in penile shortening.
- Plaque incision and grafting: This treatment involves cutting the scar and adding graft tissue to fill the space created. It often requires lifting of the penile nerves and may be associated with loss of penile sensation or worsened erectile function.
- Tunical Expansion: This treatment involves making microscopic cuts throughout the penile shaft to try to release and elongate the surrounding tissue. This treatment is not covered by insurance and does require elevation of the penile nerves. While associated with possible nerve injury, this treatment has a lower theoretical risk of nerve injury. It is also known to restore penile length loss associated with Peyronie’s disease.
- Extratunical Grafting: This is an advanced technique used for patients with hourglass defect but no distinct curvature related to their Peyronie’s. It involves placing a graft under the skin, over the defect to hide the penile deformity.
- Penile Implant Surgery: Penile implant surgery is the gold standard for patients with both erectile dysfunction and Peyronie’s disease. The rigidity of the inflatable penile implant generally allows for correction of the curve and the penile implant itself allows you to get full control of your erections. Penile implant surgery is often combined with plaque incision or tunical expansion in attempts to further correct the curve and/or restore lost penile length.