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Peyronie's disease is described by abnormal penile curvature that is acquired through the development of a hard scar tissue, or plaque. A plaque may often be felt under the penile skin and, during an erection, causes a bend on that side of the penis. Erections may be painful in the early phase of this condition and the degree of curvature may worsen until the plaque stabilizes and pain resolves. A plaque may occur anywhere along the penile shaft causing curvature in any direction, and there may be more than one plaque. Curvature caused by Peyronie's disease can prevent penetration during intercourse, cause pain during sex, cause narrowing of the penis, and cause distress to both partners. Many men are often embarrassed to discuss this condition with their healthcare providers and are not aware of treatment options. Because patients may be reluctant to discuss this condition, the prevalence of Peyronie's disease is difficult to estimate, but has been reported in as much as 1 to 10 percent of men, and in men of all ages.
Peyronie's disease can often be diagnosed based on physical examination and clinical history alone. Prior to consideration of treatment options, it is important to confirm the severity of curvature, size and location of the plaque, and presence or absence of changes in penile blood flow. These can be evaluated using penile duplex ultrasound in the office. Dr. Carrasquillo is trained in the performance of penile duplex ultrasound for the evaluation of Peyronie's disease and erectile dysfunction.
Oral treatments have been used in the past including vitamin E and pentoxifylline. Neither of these treatments is demonstrated to be superior to placebo in clinical trials.
Injection therapies directly into the plaque have also been studied. Xiaflex® is currently the only FDA-approved medical treatment for Peyronie's disease and can safely be administered in the office over a series of treatment appointments. It is approved for treatment of a palpable plaque associated with a curvature of 30 degrees or more at the start of therapy. Treatment involves injection of an enzyme which breaks down collagen fibers in the plaque allowing the plaque to gradually soften and the curvature to reduce over time. Dr. Carrasquillo is certified for the office administration of Xiaflex®.
Surgical correction of Peyronie's disease may be indicated when penile curvature is severe or for patients who cannot undergo treatment with plaque injection therapy. Surgical options include penile plication to bend the erection in the opposite direction, plaque incision/excision to remove scar tissue, and penile prosthesis, also called penile implant. Dr. Carrasquillo can review the risks and benefits of each type of procedure and guide you through which options are most appropriate for your specific case.