Peyronie’s disease

Peyronie’s disease (also known as plastic induration of the penis) is characterized by the formation of hardened tissue (fibrosis) in the penis that causes pain and bending of the penis, affecting up to 10% of men. Although the popular conception of Peyronie’s disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. Progression of the disease can lead to shrinking and shortening of the penis and erectile dysfunction. The condition may also make sexual intercourse painful and/or difficult.

The cause of Peyronie’s disease is unknown, but it is generally accepted that minor repetitive trauma can be an etiological factor. Abnormal healing can result in development of hard, thickened scar tissue (plaque) in the tunica albuginea. With repetitive trauma, the plaque may develop tough fibrous tissue (fibrosis) or calcium deposits (calcification) and result in deformity. Recent studies show that tunica albuginea is the main factor of erection, implying that multifocal deformities of tunica lead to erectile dysfunction.

Progression of the disease initially brings pain and various penile sensations (paresthesia), then formation of plaques, finally resulting in deformity (curvature), penile retraction and erectile dysfunction. In most cases there are four main symptoms: painful erection, penile deformities or penile shortening in erection, presence of plaque or indurations on penile corpus, and erectile dysfunction.

Physical examination can confirm presence of hard plaque inside the penis. It may be necessary to inject medication (prostaglandin E1) into the penis to induce an erection for proper evaluation.

Conservative treatment, such as oral medications, local treatment and intralesional injections, is usually poorly effective, particularly if severe deformity is present. Lately, new medication has been available, Xiapex, pretending to be a good alternative in Peyronie’s disease treatment.

WHAT IS XIAPEX?

Xiapex is a medicine used for the treatment of Peyronie’s disease. It contains collagenase clostridium histolyticum, which is a bacterial enzyme that breaks down collagen – one of the body’s many building materials. Xiapex helps to weaken and break down the collagen in the plaque that causes your penis to bend. This, along with gentle stretching and straightening of your penis, may help improve your erection curvature.

Surgical treatment is required in most cases. Preoperative evaluation of penile vascularisation and erectile (dys)function is necessary. There are three options for surgical treatment:

  1. “tunical lengthening procedures”,
  2. procedures including implantation of penile prosthesis,
  3. “tunical shortening procedures”.

First option implies incising the concave side of corpora cavernosa and grafting the defect, and the second one – excising the plaque and implanting the penile prosthesis with or without grafting. Surgical approach depends on presence of erectile dysfunction and severity of disease. We avoid using plication techniques since they can provoke further shortening of the penis. In patients with preserved erection our preference is grafting procedure that guarantees satisfactory result in straightening and lengthening of the penis. Using precise geometrical principles in creating and fashioning the graft with appropriate size leads to precise correction with penile lengthening. Patients with erectile dysfunction that is not responding to conservative treatment are candidates for implantation of penile prosthesis. Postoperative treatment entails physical therapy by vacuum device which is of crucial importance. If significant erectile dysfunction is present, simultaneous implantation of penile prostheses is performed to obtain suitable penile rigidity.

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