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Peyronie's Disease
Overview
Peyronie’s disease is characterized by the formation of hardened tissue (fibrosis) in the penis that causes pain, curvature, and distortion, usually during erection. The penis is the male organ for reproduction and urination. It is composed of two columns of erectile tissue (the corpora cavernosa); the corpus spongiosum, which contains the tube that carries urine and semen from the body (urethra); and the sheath that surrounds the erectile tissue (tunica albuginea). In Peyronie’s disease, dense, fibrous scar tissue (plaque) forms in the tunica albuginea.
Incidence and Prevalence
According to a report published in 1995 by the National Institutes of Health, Peyronie’s disease occurs in about 1% of men. It is most common between the ages of 45 and 60, but it also occurs in young and elderly men. Prevalence may be higher because of reluctance to seek medical attention for the condition and failure to report in cases with mild symptoms.
Causes and Risk Factors
The cause of Peyronie’s disease is unknown. Cases that develop suddenly are often caused by trauma to the penis (e.g., invasive penile procedure, injury, extremely vigorous sexual activity). Invasive penile procedures include urethral catheterization, cystoscopy, and transurethral prostatectomy.
Cases of Peyronie’s that develop over time may be caused by an inherited abnormality of human leukocyte antigen B7 (HLA-B7), suggesting a genetic link. Also, Peyronie’s occurs more frequently in men with family members who have the condition or a connective tissue disorder (e.g., systemic lupus erythematosus). About 30% of patients with Peyronie’s disease also develop hardened tissue in other parts of the body, such as the hand (e.g., Dupuytren’s contracture) or the foot.
Microscopic examination of hardened tissue in cases of Peyronie’s disease is consistent with cases of severe inflammation of blood vessels (vasculitis), suggesting the condition may have a vascular (i.e., pertaining to blood vessels) cause. Diabetes, which often leads to blood vessel disease, is also considered a risk factor.
The use of the antihypertension medication propranolol (Inderal®) has been found to cause the condition in rare cases. Peyronie’s disease has also been associated with vitamin E deficiency.
Signs and Symptoms
Peyronie’s disease may be mild or severe, and may develop rapidly or over time. Symptoms include the following:
• Hardened tissue (plaque) in the penis
• Pain during erection
• Curve in the penis during erection
• Distortion of the penis (e.g., indentation, shortening)
Plaque usually develops on the top of the shaft, causing the penis to bend upward during erection, but it may occur on the bottom, causing a downward bend. If plaque develops on the top and the bottom, indentations and shortening may occur. In about 13% of cases, plaque does not cause severe pain or curvature, and the condition resolves on its own.
In severe cases, pain and curvature result in erectile dysfunction (impotence). If there are several areas of plaque, incomplete erection may occur.
Diagnosis
Diagnosis of Peyronie’s disease involves taking a complete medical history, including any circumstances surrounding the onset of symptoms, and a physical examination. The hardened tissue caused by the disorder can be felt upon examination (palpable). Sometimes, it is necessary to perform the examination with the penis erect. This is achieved by injecting a vasoactive substance that affects the blood vessels in the penis, causing erection. Photographs (digital or Polaroid) of the deformity may eliminate the need to produce an erection in the physician's office. Calcified plaque can be identified using x-ray or ultrasound.
If the physical examination does not support the diagnosis of Peyronie’s disease, or if the condition develops rapidly, the physician may perform a biopsy. Biopsy involves removing plaque cells for microscopic examination and is used to detect cancer.
Treatment
Treatment options for patients with Peyronie’s disease are limited. The goal of treatment is to reduce pain and maintain sexual function. Surgery is the only effective treatment, and because Peyronie’s may resolve on its own, physicians often advise waiting 1 or 2 years before choosing this option.
Nonsurgical treatment should be implemented within 6 months of the onset of symptoms and before the plaque has calcified. Vitamin E supplementation and para-aminobenzoate tablets (B- complex substance) may be taken for several months. Chemical agents such as a calcium channel-blocker (e.g., verapamil), an enzyme that breaks down connective tissue (collagenase), and steroids (e.g., cortisone) may be injected into plaque or delivered by iontophoresis.
Iontophoresis is a painless method of delivering medication to localized tissue using electrical current. Like electrical charges repel, therefore a positive charge applied to a positively charged solution repels the medication into the tissue. Low-dose radiation (high-energy rays) therapy may reduce pain, but it does not effectively diminish plaque.
Complications
Tissue atrophy may occur with these treatments, and successful results are not well documented.
Surgery
Surgical treatment may be used in severe, persistent cases of Peyronie’s that have not responded to nonsurgical treatment. Procedures involve the removal (excision) of hardened tissue and skin graft, the removal or pinching (plication) of tissue opposite the plaque to reduce curvature (called the Nesbit procedure), a penile implant, or a combination of these.
The removal of plaque requires a skin graft from another area of the patient’s body and may result in a partial loss of erectile function (e.g., less rigidity). The Nesbit procedure reduces the length of the erect penis.
Penile implant involves implanting a device in the corpora cavernosa that increases rigidity. This procedure may be combined with incisions and skin grafts, or plication to effectively reduce curvature.
During the recovery period, patients are prescribed medication that prevents them from having an erection and are advised to avoid sexual activity. Antibiotics are also prescribed to reduce the risk for infection.
Complications
Complications that may develop as a result of surgery include the following:
• Adverse reaction to anesthesia
• Damage to the tube that carries urine and semen from the body (urethra)
• Excessive bleeding
• Infection
• Neurovascular damage resulting in a lack of sensation
• Prosthesis malfunction
• Scar tissue resulting in impotence
Prognosis
The prognosis for maintaining sexual function is good when treatment is started within 6 months of the onset of symptoms.
Naturopathic Treatment
Peyronie’s disease is a condition in which the fibrous connective tissue in the penis thickens. The disease is not fully understood and many cases spontaneously resolve within a year or two. For those cases requiring medical or surgical intervention, treatment may be frustrating and ineffective. Naturopathic treatment may be used in conjunction with conventional treatments.
Nutrition
Proper nutrition and supplements may be helpful. The appropriate diet can improve overall health, boost the immune system, and help the body heal.
• Eat, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel). Eating organic food helps reduce exposure to pesticides, herbicides, and hormones.
• Avoid sugar, dairy products, refined carbohydrates, fried foods, junk foods, and caffeine.
• Eliminate food sensitivities. Use an elimination and challenge diet to to determine food sensitivities.
• Drink ? of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily).
Supplements
• Bromelain (proteolytic enzymes)- Take 750 mg, 3 times daily, on a empty stomach. Bromelain is a pineapple enzyme that can digest proteins (as can all proteolytic enzymes). It helps prevent the deposition of fibrin, which is believed to cause the connective tissue to thicken.
Herbal Medicine
• Gotu kola (Centella asiatica)-Supports healing and normal development of connective tissue.
Note: It may be up to 6 weeks of using bromelain and gotu kola before results are noticed.
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