Peyronie disease, penile curvature of unknown origin

The disease of La Peyronie is a disease of unknown cause whose main characteristic is the appearance of a curvature in the penis during the erection. In many cases, the patient has a fibrous plaque on one of the covers that wraps around the penis that can be palpated. It usually appears in men from the age of 45 onwards.

The Peyronie, the disease

This process begins as an inflammatory reaction in the layer that envelops the cavernous bodies of the penis called tunica albuginea; this inflammatory response ends up becoming a fibrous and non-elastic scar that causes the penis to curl during erection. It is also possible that this scar does not appear and the patient presents an important curvature.

The origin of this pathology remains unknown, although the most accepted theories speak of an inflammatory process that undergoes the penis during sexual activity which would cause abnormal scarring in a part of it in genetically predisposed individuals.

In theory, it can occur in all men given that we do not know the true factors that cause this process. In case of doubt, it is recommended to visit a Urologist to diagnose us.

Symptoms of La Peyronie

The Peyronie has a number of characteristic symptoms: 

• In the early stages, there may be pain in the erection. Pain begins during the inflammatory phase of the disease and tends to disappear within a few months (3-6 months) of initiation of the process. 
• Curvature of the penis during erection. The bending can occur on the dorsal side of the penis which is the one we see when looking down but can also occur on the lateral or central faces. 
• Erectile dysfunction when curvature is important 
• Narrowing of the penis 
• Decreased penis size

The diagnosis of La Peyronie

The diagnosis is simple because the patient brings photos in erection where the curvature is clearly appreciated; also by inspection, in many cases, the area of ​​fibrosis in the penis can be felt.

An important test is the realization of a penile echo-Doppler with Prostaglandin E1 test , since it allows to evaluate the penis in erection with its vascularization, to evaluate the erection problems, to visualize the size of the plate, degree of curvature, etc.

This disease can not be prevented because we do not know its true origin and the main factors that produce it.

Treatment of La Peyronie's disease

In the medical literature, there are many treatments that have shown no proven efficacy. In the painful phases of the disease, low-intensity shock waves can improve pain.

In complex cases, lateral curvatures, with severe erection problems, the only solution is reconstructive surgery of the penis that allows to disappear the curvature. There are multiple surgical techniques but to avoid significant loss of penile length, biological patches are used that cover the plaque when it is incised or excised. These techniques allow rebuilding the penis with good results. Most of these surgeries should be performed by expert surgeons and dedicated to penile surgery.

The risks of treatment may be loss of penile length, post-surgical hematomas, penile swelling that can last for days or weeks or in some cases, risk of erectile dysfunction. Many of these disadvantages, if they arise, have a good response to various post-surgical treatments.

In patients with erectile dysfunction who do not respond to drug treatments, the only option is the placement of a penile prosthesis with surgery of the curvature. It usually has excellent results.

Collagenase, a biological drug to combat La Peyronie

In 2013, the first medication for La Peyronie disease or penis curvature was approved: Clostridium histolyticum collagenase. It is indicated for patients with penile curvature of at least 30 degrees. Collagenase is a biological drug made from Clostridium histolyticum. This drug acts by undoing the accumulation of collagen or fibrous plaque responsible for curvature.

This treatment is based on several treatment cycles. In each cycle, the drug is injected directly into the plaque that causes the curvature and the procedure ends by performing a modeling of the penis. Sometimes, several cycles of injections are needed.