Treatment of Peyronie's Disease

Because the plaque of Peyronie's disease often shrinks or disappears without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments that have unproven effectiveness.

Some researchers have given men with Peyronie's disease vitamin E orally in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-amino benzoate, a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as collagenase, dimethyl sulfoxide, steroids, and calcium channel blockers directly into the plaques. None of these has produced convincing results. Steroids, such as cortisone, have produced unwanted side effects, such as atrophy, or death of healthy tissues. Perhaps the most promising directly injected agent is collagenase, an enzyme that attacks collagen, the major component of Peyronie's plaques.

Radiation therapy, in which high-energy rays are aimed at the plaque, also has been used. Like some of the chemical treatments, radiation appears to reduce pain, yet it has no effect on the plaque itself and can cause unwelcome side effects. Currently, none of the treatments mentioned here has equaled the body's natural ability to eliminate Peyronie's disease. The variety of agents and methods used points to the lack of a proven, effective treatment.

Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are: removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.

Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.

Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie's disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.