Peyronie's Disease: Curve of the Penis
How is occurs:
The exact reason why a curve to the penis began is often difficult to determine. Some patients will report the curve after a rough sexual event. Other patients find that it starts after beginning injection of medication in the penis for erectile dysfunction. A genetic component is also possible especially in combination with Dupuytren’s contracture of the hand. In most cases of penis curvature, scar tissue does not let the penis enlarge with erection. This might stop the ability for sex to happen.
How many men have this problem?
The number of men presenting with symptomatic Peyronie’s disease is about 1%, but many experts feel the full number of men with a curve to the penis is likely closer to 5%. Fortunately, most men do not have pain or trouble with sex because of the curve.
Will it get worse?
Most cases of Peyronie’s disease have an early time when pain is present with erection. This then stops and the curve stays stable. Nearly 33% of men may never have pain. In general, most patients see the penis curve stay stable or improve after the pain goes away.
Many men have trouble with erections (erectile dysfunction) with the penis curving. It is important to treat both problems for the best success.
What testing needs to be done?
In general, a normal office visit is needed in all cases. Often men are asked to bring photos revealing the best erection they can get at home and showing the curve from above and the side. This helps determine what will be the best treatment. Occasionally more specialized tests such as ultrasound, plain x-ray, or even MRI are used to better assess the curvature.
What is the best treatment?
The best treatment will be different for each patient. It is important to find an urologist with the ability to do multiple types of surgery to ensure the treatment is the best option for you. Both medicine and surgery treatments are available.
Many medications have been used with none being the best. Vitamin E, Potaba, cholchicine, fexofenadine, verapamil, carnitine, and several cream preparations have all been used with success. A penis vacuum erection device used every day has shown some helpfulness, as has a mechanical penis stretching device. These often take months for a difference to occur.
For the best surgery results, no pain should be present and the curve not changed for 6 months. There are a number of surgeries available and best performed with knowledge of a patient’s ability to get an erection. In general, the opposite side can be plicated (pulled to match the curve), the scar can be removed, or a penile prosthesis may be placed.
What happens after treatment?
Most men are quite happy with the results after treatment. Post-operative guidelines can be found on this website.
Recovery Guidelines After Peyronie's Disease Repair
Most patients recover fairly quickly after the procedure but the swelling may take weeks to resolve. Pain should improve in the first week after surgery.
We highly recommend the following guidelines to help healing:
Ice packs may be used to limit scrotal and penis swelling after surgery especially in the first 48 hours. Be sure not to leave the ice in direct contact with the skin for much time.
As mentioned, it is normal to have a scrotum swelling after surgery. Contact your surgeon if the swelling is severe (larger than a big orange) or if you are draining a large amount of fluid (soaking several pads per day). Scrotal support in the form of a jock strap or tight underwear will help limit swelling.
A small amount of blood may stain the dressings for 72 hours after surgery. This problem will resolve spontaneously. For the first few days, by adding two or three gauze pads to the surgical site, you will aid the healing process and help keep your clothes clean.
You may begin to shower between 48 and 72 hours after surgery. Allow the water to wash over the incision but do not scrub the incision. Tub baths are not recommended in the first 7 days after surgery. Swimming should be avoided during the first week after surgery. Sitz baths are useful to decrease swelling and discomfort beginning about 7 days after surgery.
Stitches will dissolve and do not need to be removed.
In general you will be sent home with a few days of pain medication. Use this only as needed. After 48 hours, most patients can take extra strength Tylenol or ibuprofen for pain.
Most patients can get around the house for light activities within a day or two of their surgery. Some patients, especially those with skin grafts, will be limited in their activity for 1-2 weeks. You are advised to wear a scrotal support (jock strap) for a week and decrease vigorous activity for two weeks after surgery. You may return to work when comfortable, but you should limit heavy lifting (greater than 20 pounds) or any extended walking or running. Be sure to ask your surgeon about any restrictions prior to discharge from the hospital.
This depends based on the type of surgery performed. Most patients need to wait until at least most swelling has gone away. Be sure to ask your surgeon about when you can resume sexual activity.
When to Notify the Physician
Contact your surgeon if the swelling is severe or if you are draining a large amount of fluid (soaking several pads per day). Other reasons to contact your surgeon after penile reconstruction include worsening pain after 48 hours, increased redness or tenderness around the incision site or a fever of greater than 101.