PEYRONNIE’S DISEASE:

PEYRONNIE’S DISEASE:

Dear Sumner:

I have a very upset man with a bent penis. Jack, who is 48 years old, has noted over the past couple of months that when he has an erection, there is some associated discomfort and his penis bends upward at an angle of about 30 degrees but he is still able to have intercourse without difficulty. I am not sure how much of his discomfort is emotional rather than physical. He is worried about the possibility of the deformity getting worse, I have told him that I believe he has Peyronie’s Disease, and I tried to assure him that this was not a life-threatening situation. He responded that I seemed to be downplaying the seriousness of his problem. How can I reassure him more effectively? Or perhaps even more importantly, what measures are available for treating this disease?

Dear Gwen:

I had the opportunity to talk with both Jack and his wife about this problem. I was able to assure them that we are dealing with a benign (non-cancerous) process that is usually self-limited. However, I did explain that Peyronie’s Disease can produce variable sizes of plaques from very small to fairly large with accordingly variable degrees of bend to the penis (during erection). In Jack the plaque has developed on the upper side of the penis, causing it to bend upward. The etiology for the plaques’ development is not known although it is likely some type of inflammatory process. As you pointed out in your letter, Jack is able to engage in intercourse although he experiences some discomfort with the erection. I explained to Jack that the inflammatory process generally reaches a plateau after about one year with no further plaque formation along with resolution of the discomfort and since a certain percentage of the lesions may actually regress spontaneously, I generally do not institute active therapy during that first year.

Therapy is a “mixed bag.” Since the etiology of the lesion is, thus far, not known, a variety of non-surgical therapeutic approaches have been tried, ranging from topical and injectable steroidal and non-steroidal anti-inflammatory preparations to radiation and ultrasound treatments. The results of these approaches have been sub-optimal. I have become a bit of a skeptic since, if there is improvement, it is difficult to know if the improvement is from the treatment employed or from the natural course of the disease process. If the penile bend prevents satisfactory intercourse, then surgical intervention is offered. Since Jack‘s erections are quite rigid, if surgical straightening of the penis were to be done, it would not be necessary to insert a penile prosthesis.