Peyronie's Disease is an acquired injury of the penis that leads to curvature, narrowing, or both. The most common cause of the disease is a sexual injury that leads to a scarring of the tunica albuginea (the tough outer covering of the erectile body). After injury, the scar that subsequently forms causes a shortening of this covering. If this shortening is in the longitudinal axis, it will curve at erection toward the side of the scar. If the scarring is lateral, it can cause narrowing on the side of the penis. If the narrowing is on both sides, it can cause a waist to occur in a shape of an hourglass. Patients often describe a lack of blood flow beyond the waist, but this is not the case. It is simply the effect of the scar.

Most cases of Peyronie's Disease will stabilize by six months post-injury. There are three indications to intervene, which have to do with form and function. If the patient is not rigid enough to penetrate, if the curvature is so severe it prevents intercourse, or if the patient is so psychologically bothered, we intervene.

The interventions range from least invasive to most invasive. In the early stages of the disease, we have used a cocktail of medicines to try and help with healing and stability of the plaque. Vitamin E has been used, but its efficacy is not proven. We use medicines that are nitric oxide donor and promote healing. These include PDE 5 inhibitors like Viagra, Cialis and Levitra, Pentoxifylline and L-Arginine. Injections have been used to help with plaque reformation and stabilization. While it is possible to become worse, it is not the routine in my hands. We give injections every two weeks for 12 weeks (six injections) that now consist of verapamil, an antihypertensive agent. At the end of 12 weeks, the patient is reevaluated. Collagenase, a compound that breaks down collagen, is presently in clinical trials.

If these non-invasive and minimally invasive interventions fail, then surgery is offered. The surgery takes three forms. The simplest involves straightening the penis by making the two sides equal in length. The surgery is straightforward, and works well in the absence of a waist. In the case of a waist, very hard plaques and extensive disease, then incision of the plaque and, less commonly, excision is done. The defect is repaired with harvested vein, cadaveric fascia, or alternative substitutes. Results vary, and the patient's satisfaction often depends on expectation, understanding, and preparation.

In patients with erectile dysfunction and Peyronie's Disease that is not responsive to oral medicine, urethral suppositories, and penile injections, a prosthesis is offered. These devices are inflatable and semi-rigid. The insertion of the prostheses, especially inflatable, along with the modeling techniques (straightening the penis at the time of prosthetic insertion) can provide straightness and rigidity. It is important to direct any and all questions and concerns to the doctor before any surgical intervention is performed.