Treatment for Peyronie’s Disease in Houston, TX
What is Peyronie’s Disease?
Peyronie’s disease is a condition in which the penis forms scar tissue, called a plaque,which can result in a bent (curved) or indented penis. Dr. Clavell is a board-certified, fellowship trained urologist and men’s health specialist, and one of the few men’s health specialists who treats Peyronie’s disease in Houston. Dr. Clavell is also involved in training surgeons both nationally and internationally in regards Peyronie’s disease.
Causes of Peyronie’s Disease
Although a clear cause has not been described, most researchers believe that the disease is caused by repeated injury to the penis due to trauma or aggressive sex. However, most commonly, no specific trauma to the penis is recalled. After the penis has a microscopic (not visible to the eye) injury, the body will send cells to “repair” the injury. On certain occasions, those cells cause inflammation and fibrous scar instead of healthy elastic tissue.
The penis contains two sponge-like tubes called the corpus cavernosum. These are the tubes that fill-up with blood and give rise to an erection. Each corpora cavernosum is surrounded by a sheath or covering of elastic tissue called the tunica albuginea. In
Peyronie’s disease, the tunica albuginea forms scar tissue that does not stretch, and when the corpora fills up with blood during an erection, the penis bends or becomes disfigured.
How Common is it and Who is at Risk?
Research shows a prevalence close to 8%. 1,2 That is, 1 in every 11 men suffer from the condition. Men with diabetes, history of trauma to the penis, low testosterone, and those with history of radical prostatectomy for prostate cancer are at risk of developing Peyronie’s disease.
Common Symptoms of Peyronie’s Disease
Symptoms of Peyronie’s disease include:
- Bend or curve in the penis
- Hardness or lump in the penis.
- Narrowing or shortening in the shaft of the penis.
- Painful erection, or pain during sexual intercourse.
- Erectile dysfunction
Diagnosis and Treatment
Peyronie’s disease is diagnosed with a thorough history and physical exam. Dr. Clavell will ask you specific questions about your medical history, sexual history and timing of your symptoms. Then a physical exam is performed in order to identify any presence of scar tissue in the penis. The penis is palpated when the penis is not erect, to identify the location and amount of scar tissue.
Dr. Clavell may also ask you to bring in photos of your erect penis taken at home. Ideally, a picture of the erection from both ABOVE and THE SIDE are best to determine the degree of curvature and other details that will help identify the best treatment option for you.
In certain occasions, Dr. Clavell may order a penile ultrasound to help characterize the plaque inside the penis. Depending on your erectile function, the penis is injected to cause an erection and better identify the characteristics of your curvature.
Will the penis ever get back to normal?
A previous study evaluated 246 men with newly-diagnosed Peyronie disease and had no medical treatment. 3 The study followed these men for 12 months to report the evolution of the condition. The study showed that at 12 months:
- Most patients (89%) reported complete resolution of pain.
- 12% of patients had improvement of the curvature,
- 40% of patients had no change of the curvature
- 48% had worsening of the curvature.
Non-Surgical Treatment Options
A number of oral medications have been tried to treat Peyronie’s disease. However, research has shown that these are not effective.
- The only FDA-approved medication for Peyronie’s disease is collagenase clostridium histolyticum (called by its brand-name, Xiaflex). It is approved to treat penile curvature and a palpable plaque. Other injectable medications used are Verapamil and Interferon.
- Injection therapy should be combined with penile modeling
- Patients with good erectile function and a palpable plaque that is not on the ventral aspect (bottom side of the penis) are candidates for injectable therapy.
- Penile traction therapy (penile modeling) involves the patient to perform stretching exercises of the penis. Penile traction therapy has been shown to help preserve length post-operatively following surgery. These techniques are used in combination with inject-able medications.
- Dr. Clavell recommends the use of a Vacuum Erection Device as part of traction therapy.
Surgical Treatment Options
Surgery is considered the standard of care for Peyronie’s Disease. If the deformity of your penis is severe or sufficiently bothersome, your doctor might suggest surgery to correct it. Surgery is usually recommended when your curvature has remained stable (without change) for at least 3 to 6 months. There are different types of surgeries that can be offered depending on:
- Degree of curvature
- Degree of bother: how bothered you are by the deformity
- Erectile function
- Penile length: Subjective (patient reported) and Objective (observed on physical exam by your doctor).
A variety of surgical procedures can be used to suture the side without the scar tissue. This results in straightening of the penis. However, this may result in actual or perceived penile shortening. This procedure is usually reserved for patients with good erectile function and adequate penile length.
Incision or Excision with Grafting:
In this type of surgery, your surgeon will make a cut, or incision, in the plaque, which will allow the penis to stretch out and become straight. In certain occasions, the plaque may be removed, or excised. When this is done, a piece of biologic tissue (graft) is sewn into place to cover the defect left by the incision or excision. This procedure is used in cases with severe curvature or deformity and comes with a greater risk of erectile function but less risk of penile shortening.
The penile prosthesis is placed inside the penis and sometimes, is strong enough to overcome a mild to moderate curvature. Penile implant is a good option for patients with both Peyronie’s disease and erectile dysfunction. When the implant is put in place, Dr. Clavell might perform additional procedures to improve the curvature if needed.
What makes Dr. Clavell’s practice unique?
Dr. Clavell provides innovative and state-of-the-art treatments tailored specifically to your needs and goals. He is fellowship-trained in surgical and reconstructive techniques that make him unique in the field of urology. These include:
Historically, surgical procedures for Peyronie’s disease have been done through a circumcision incision with penile degloving, which involves taking down the penile skin from the shaft to expose the corporal tissues. Unfortunately, there have been reports of penile lymph-edema (swelling of the skin) and ischemia
(decreased blood flow to the glans, or head of the penis) after penile degloving more commonly in patients with diabetes and peripheral vascular disease.
Dr. Clavell performs the surgery through a non-degloving approach by making an incision in the natural ventral line of the penis. Theoretically, this approach may decrease the risk of edema and ischemia by maintaining the continuity of the penile skin. Dr. Clavell believes it also provides for a better cosmetic outcome since the natural skin line is incised without the need for a circumcision.
The sliding technique (ST) is a procedure indicated for a select group of patients with significant penile atrophy (shortening) and severe curvature/deformity due to Peyronie’s disease and erectile dysfunction. It is performed in combination with a penile implant and involves extensive dissection and reconstruction of the penis. The sliding technique has several variations, also known as the Modified Sliding Techniqhe (MoST), and Multiple-slice technique (MUST), all of which aim to correct severe penile curvature and/or deformity in combination with a penile implant.
Few surgeons in the world are familiarized with these techniques, and Dr. Clavell is not only familiar, but has authored articles describing a unique approach to performing the ST, MoST and MUST through the Non-Degloving Approach.
What can patients expect during their evaluation and how can they prepare?
Dr Clavell will be evaluate you with a full history and physical exam. We will highly appreciate if you can bring photos of your erect penis taken at home. Ideally, a picture of the erection from both ABOVE and THE SIDE are best to determine the degree of curvature and other details that will help identify the best treatment option for you.
If you are experiencing issues with Peyronie’s disease, pain or curvature of your penis which prevents you from having sex or is causing anxiety, contact Dr. Clavell today to determine which treatment option is right for you.