Peyronie’s disease is a condition characterized by the development of fibrous
plaques or nodules in the substance of the penis.
It was named after an eighteenth century French surgeon,
Francois Gigot de La Peyronie and afflicts about 1 percent of the adult male
population. Did he do his research at the local ‘pissoire’?
The problem for the sufferers is that when erect, the penis
has a bend in the shaft and this may be painful. Sometimes the bend is such that
intercourse may be impossible. Which is probably where we got the limerick which
goes
“There was a young man from Ghent,
Whose penis was exceedingly bent,”
And for the next three lines you will have to ask me in
private. This is, after all, a family newspaper.
The deformity may be an upward curve, which is the most
common. However, it may be bent downwards or sideways. After first being
noticed, the curvature or other deformity may gradually worsen over the first
six to 18 months. At a certain point in time, the deformity will no longer
worsen, but will continue to recur with erections.
Research about the effectiveness of nonsurgical treatments
for Peyronie’s disease is limited. Surgery to correct a curved or bent penis is
usually recommended if the deformity is severe or prevents satisfactory sexual
activity, but success is limited.
The scar tissue, or plaques, associated with Peyronie’s
disease can be felt under the skin of the penis as flat lumps or a band of hard
tissue. If this is you, then you should consult a surgeon, even if just to allay
anxiety and fears.
The cause of Peyronie’s disease is not well understood, but
one school of thought is that it follows a wound to the penis that does not heal
properly. The wound is most likely minor trauma to the penis during sexual
activity. For example, the erect penis might be bent during intercourse, or it
could also be the result of an accident or sports injury.
Another school of thought is that it may be a hereditary
condition. If your father or brother has Peyronie’s disease, you have an
increased risk of the disorder.
There is also Connective tissue disorders. Men who have a
connective tissue disorder appear to have a greater risk of developing
Peyronie’s disease. For example, Dupuytren’s contracture - a cord-like
thickening across the palm that causes the fingers to pull inward - is common in
men with Peyronie’s disease, and it too has a genetic component.
The prevalence of Peyronie’s disease increases with age. The
‘injury’ school claims that age-related changes in tissues may cause them to be
prone to injury, less likely to heal well, or both. However, since Dupuytrens
becomes more obvious with aging as well, I still tend to lean towards the
genetic Connective tissue disorders as the cause.
Surgical treatment includes the Nesbit procedure. This
operation, or its various modifications, corrects bending by plicating
(gathering) the convex or outer side of the bend. Counteracting the relative
shortage of tunica albuginea on the concave side straightens the penis, though
length is reduced slightly as a consequence. Still, this procedure is less
likely to cause erectile dysfunction than tissue grafting, and remains the first
choice for moderate bends without associated diameter reduction. It is the best
way to surgically correct congenital curvature.
The other surgical option is Tissue Grafts. These procedures
involve the replacement or expansion of scarred tunica albuginea with grafts of
healthy tissue from another site. Originally, grafts were used to repair the
defect that remained after excision of a Peyronie’s plaque. More recently,
surgeons have been using grafts to expand the contracted scars (or plaque)
without excising them. Though some calcified plaques still require removal, this
non-excisional approach seems less disturbing to erectile function, and less
likely to cause postoperative impotence. Despite this risk, grafting remains the
most versatile reconstructive technique, particularly suited to correcting
severe bending and/or diameter constriction.
So that is the Peyronie’s disease situation. Irrespective of
the uncertain cause, there is treatment if the condition is affecting your
lifestyle. And finally, it will not correct Brewer’s Droop.
