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A. The word curvature describes any type of curving body part. It is common for an erect penis to curve slightly. Penile curvature, however, describes an erect penis with an abrupt curve that can cause pain and interfere with sex.
Some men are born with this condition (congenital penile curvature). In others, it develops over time. Penile curvature that develops later in life is called Peyronie’s disease.
A. Congenital Penile curvature: Your erect penis has always been bent. Usually the penis is bent downwards, and this is noticeable as soon as young man becomes sexually mature. Congenital curvature is associated with other problems of the genital organs and is usually recognised during early childhood.
Acquired Penile curvature: You may experience pain in your penis and/or be able to feel hardening of the tissue as the curve forms. Peyronie’s disease is considered a wound healing disorder. At some point during sex or other activity, the penis has been injured, and the tissues do not heal properly. Excess scar tissue forms in the layer (tunica albuginea) that surrounds the spongy erectile tissue (curvature). This causes too much collagen to build up and form fibrous plaque (hard lump) in the penis. Although usually described as rare, both types of penile curvature are likely more common than previously thought.
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A. In Peyronie’s disease, repetitive injury and trauma are believed to cause inflammation in the penis. The tissues surrounding the swelling bodies of the penis do not heal properly, causing the formation of a fibrous plaque (fibrosis).
In the beginning (first phase), you might feel pain and nodules under the skin. Over the course of several months, you will notice curving of the penis and the formation of hard plaque (second phase). Although the pain will decrease and mostly disappear, the resulting curvature can cause painful erections and may prevent sexual penetration and intercourse.
Symptoms can include:
After the initial first phase, the curvature stabilises in about two-thirds of patients within several months. In a few patients (about 5%), Peyronie’s disease goes away without being treated.
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A. Diagnosis and treatment are similar for congenital penile curvature and Peyronie’s disease. There is no clear function or angle of curvature that demands treatment. Personal aesthetics, pain, and the inability to have sex are reasons for treatment.
Treatment can include:
It is important to determine whether disease is still active. This will influence medical treatment or timing of a surgery. The disease is considered to be stable when pain has gone away and penile curvature has not increased for at least 3 months.
A. A wait-and-see approach may be recommended if:
You will have to see your doctor regularly or if you notice any changes. If symptoms are severe or worsen over time, your doctor might recommend medication or surgery.
A. Drug treatments are typically used for early stage disease or for patients who are unfit or unwilling to undergo surgery. The goals of treatment with medication include:
Although many drug options are available, they may not work for you. You can talk with your doctor about suitable options. Drug treatments can be divided into:
A. Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex. Most health care providers suggest putting off surgery until the disease has stopped getting worse, and the patient has been pain free for at least 3 months.
There are 3 types of surgery:
Surgery may correct the curvature of your penis, but it carries risks. Penile extending devices have been reported to improve length after shortening operations if used for several hours a day over the course of months. The type of surgery will depend on:
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A. Nesbit procedure: The Nesbit procedure is widely used to correct both congenital and Peyronie’s disease. Under the skin, the plaque is cut away, and the defect is covered with a patch of tissue from the other side of the penis. This technique shows good results but can make the penis shorter by, on average, 1 to 1.5 cm. Men with mild or no erectile dysfunction, mild to moderate penile curving, and a long penis, are better candidates for this surgery.
Plication procedure: The plication procedure is similar to the Nesbit procedure, but it is simpler to perform. Sutures opposite the plaque are inserted to straighten the penis. The sutures used will not absorb, and so stay in place. Results are comparable to the Nesbit procedure.
A. The surgeon cuts or splits the plaque to ease tension and may remove some of it. The remaining space is then filled with a graft. Your surgeon will help you decide which type of graft should be used.
Autologous tissue grafts: Grafts can be made of tissue taken from another part of your body during surgery. Because they are living tissue, they usually grow into the surgical site well. A drawback is that the surgeon must make a second cut to harvest the graft.
Nonautologous allografts: Sheets of tissue made commercially from human or animal sources are well tolerated as graft material by most patients. Before use, the tissue is sterilised and treated to prevent infection. These grafts allow the body to grow healthy tissue and are slowly absorbed by the body.
A. If medical treatment does not resolve erectile dysfunction, your urologist may recommend a penile prosthesis. For men with Peyronie’s disease and moderate to severe erectile dysfunction, an inflatable pump or moldable silicone rods placed inside the penis will usually straighten the penis and allow it to get stiff enough for sex.
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http://www.mypeyronies.com/index.html
http://www.mypeyronies.com/what-is-peyronies-disease.html (YouTube video)