By: Dr. Brian Christine,
Director of Erectile
Restoration, Prosthetic Urology, and Male Genital Aesthetic Surgery
Every clinic session in my schedule
invariably includes several new patients who have been referred or who have
sought me out themselves to address curvature of their penis during
erection. Most often these men suffer
from a condition called Peyronie’s disease (occasionally I will see a young man
who has congenital curvature of the penis, but we’ll save that for another
blog). First described in 1741 by the
court physician to King Louis XV of France, this condition is believed to
affect 9% of the men in the U.S., but exact demographics are difficult to
confirm due to likely under reporting by men who are embarrassed about their
condition. The curvature of the penis is
often so severe as to make sexual intercourse painful or impossible. While Peyronie’s disease is not life
threatening, it most certainly has a negative impact on the patient’s quality
of life.
In Peyronie’s disease, the elastic fibers of
the tunica albuginea of the penis are replaced by collagen during an initial
inflammatory process. This process is in response to injury to the tunica
during sexual activity; occasionally, there is a single dramatic event that
starts the disease but more often the inflammation and collagen replacement are
brought about by repeated micro injuries.
The tunica albuginea must stretch to accommodate the increased blood
flow into the penis during an erection, and the fibrous tissue mass of
Peyronie’s disease (referred to as a “penile plaque”) has much less ability to
stretch. The result is an erection that is curved, most often dorsally. Even a moderate curve can cause buckling of
the penis during penetrative intercourse.
Curve of any degree is often times regarded as a disturbing disfigurement
by the patient leading to emotional distress.
A number of forms of non-surgical treatment
have been used in Peyronie’s disease.
Oral or topical vitamin E, oral and topical steroids, and trans-dermal
iontophoresis have all been tried, but there is no controlled data on efficacy
that supports their use and none have FDA approval. Surgery has been the most effective treatment
to date, with high success rates; incision of the peyronie’s plaque or
plication of the tunica albuginea offer good functional and aesthetic outcomes.
Recently, the FDA approved the use of
collagenase for the treatment of Peyronie’s disease. Marketed under the name Xiaflex (Auxilluim
Pharmaceuticals, Inc), this drug has already been used to treat Dupuytren’s
contracture. The collagenase enzyme is
injected into the peyronie’s plaque during a series of treatments in the
urologist’s office, and the patient is instructed how to manually stretch the
penis in a process called modeling. In a
large, multi center study about 65% of Peyronie’s patients experienced significant
improvement in their curvature with a low rate of adverse effects.
I am really very excited that Xiaflex has
been approved. It is being released to a
limited number of urologists, and I have patients who have been waiting for its
arrival. The first patients will be
treated in January. For patients with Peyronie’s disease, indeed, there is new
hope around the corner.
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