The Limiting Erectile Dysfunction Cause by Peyronie’s Disease

Erectile Dysfunction

The exact cause of Peyronie’s disease, which is prevalent among males between 40 and 60 years old, still eludes experts. Although at the initial stages, the disease manifests as a curvature of the penis due to the presence of a hard area (fibrous plaques), the disease could progress from painful erection to having soft penis or the difficulty to achieve erection (erectile dysfunction). 

Although a person with erectile dysfunction could still achieve erection, due to the growth of the fibrous plaques, there are areas, like the end of the penis, which remain soft. This makes coitus difficult because there is no fullness of the penis at all. ED is often referred to as impotence. 

Unlike any other forms of ED, that which is caused by Peyronie’s disease cannot often be solved by medications such as sildenafil, tadalafil and vardenafil because achieving an erection is prevented by a permanent defect in the tissues inside the penis. 

The best way to treat this kind of ED is to treat Peyronie’s disease itself. Treatments include medication, therapy and surgery.

The Crooked Illness That Is Peyronie’s Disease

Normal penis vs Peyronies disease

Peyronie’s Disease (also known as induration penis plastica or chronic inflammation of the tunica albuginea) is a disorder that causes the penis to curve or be deformed. The deformation of the penile shaft is caused by the growth and accumulation of fibrous plaques in the tissues that surround the corpora cavernosa (the pair of sponge-like regions inside that penis that is filled with blood and is responsible for erection) called tunica albuginea. 

The exact cause of the formation or growth of these fibrous plaques is still unclear; however, experts suspect that it is caused by injury or trauma inside the penis which causes localized bleeding. Another cause of Peyronie’s Disease would be genetic or a combination of both. 

Peyronie’s Disease, which is estimated to affect 5% of the male population, causes a progressive penile deformity. Overtime, this may cause soft penis due to the inability of the venous cavities to be engorged with blood, which leads to an increasing degree of erectile dysfunction. 

Although the disease is common among ages between 40 and 60 years old, there has been reports of cases with males as young as 18 and as old as 80. Existing treatments involve medications, physical therapy and surgery. These treatments, however, does not guarantee full recovery from the disease.

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Tissue Grafts - Treatments of Peyronie’s Disease

Peyronie's disease surgery has more than one answer if the patient is unwilling to accept the loss of penis length that always accompanies the Nesbit.

The procedure entails a total physical removal of the lump of plaque that has developed on the penis and straightening the penis in order to bring it back to the original shape. Doctors and medical examiners tend to advise patients to go accept this approach in cases featuring large plaques or severely bent penises. The surgeon removes the affected part of the Tunica Albuginea and replaces the plaque with a graft material of some type. 

There are several types of grafts that can be used to make up for lost tissue. The first type is autograft tissue, which is tissue taken from the patient’s own body during surgery. This is done mostly to minimize the immunologic response to the graft and to make sure that the body does not reject it.

Surgeons can also use so called synthetic inert substances, such as Dacron mesh or GORE-TEX instead of living tissue. Unfortunately, these artificial compounds tend to cause more scarring and also fibrosis, which is the formation of excessive connective tissue on the penis. In some cases, the doctors resort to xenografts, which are foreign tissues, of human or animal origin. They are widely available in hospitals, but are also prone to rejection by the body’s immune system.

Another problem plaguing grafts is the fact that, sooner or later, grafts undergo postoperative contraction, causing a shortening of the penis and scarring. Therefore, patients should weigh the pros and cons of grafts thoroughly before applying for surgery.

The last resort of many patients who suffer from severe forms of Peyronie’s disease is a penis implant. Years ago, implants were the first choice of many doctors faced with cases of men who could not achieve a proper erection because of Peyronie’s disease, but the advent of new techniques designed to cure erectile dysfunction has made their use less frequent. However, implants are still recommended to men whom erectile dysfunction drugs cannot help.

Penile implants are plastic cylinders, either solid or inflatable, which are placed inside the Corpora Cavernosa. These cylinders are biocompatible in order to avoid triggering a response of the immune system. The surgeon can either place the implants inside the penis and let them do the work of straightening the organ, or they can try to bend the penis against the plaque in order to increase the implant’s chance of successfully correcting the curvature.

Patients must be aware that surgery is an invasive procedure that is better put off until other approaches have been found ineffective. Premature or inadequate surgery has a high rate of failure or recurrence of the disease. While, it is true that patients who have undergone successful surgery are usually satisfied with the results, it only takes a simple mistake to botch an operation and with surgery there is no going back at all. Try other methods first!

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Keywords:

Peyronie's disease surgery, peyronie disease pictures, penile curvature

Types of Peyronie’s Disease Surgeries

There are basically two major choices the surgeon will make from, if he or she is left with no option but to get your penis straight by surgical means. They are suited for simple but severe degree curvature. They are; 

a) Penile Plication Procedure 

• At present this procedure is done under local anaesthesia.
• There is cutting and shortening of convex or side opposite to curvature with placement of permanent sutures on convex side. 
• Even at surgery you can see more straighter penile shaft of yours. 
• Nerves and vascular structure are spared so sensation to penis is retained which is important element in sexual intercourse. 
• Whole procedure may not take longer than 45 minutes. Length of penis not much effected. 
• Return to work in one day. Resume enjoyable sex in just 5 weeks.

b) Penile Plaque Grafting Done under local or general anaesthesia. 

• Incision on plaque with or without excision. 
• Placing graft, from your own vein, or cadaver pericardium, both have very good take and they don’t have contractures complications, plus they have tensile quality. 
• There is gain in length too. 
• Procedure is 3-4 hours long.
• Return to work in 3-4 days. 
• Satisfactory sex in 8 weeks. 
• Just have to wait a bit longer! 

c) Latest Innovative Surgery for Peyronie’s Disease 

• Its double dorsal-ventral patch graft combining plaque incision and grafting. 
• Its penile lengthening procedure. This is best part which resolves penile shortening. 
• It combines double dorsal-ventral patch graft with intestinal tissue meaning grafting done circumferentially along with prosthetic implant. 
• You will gain length in your penile shaft of about 3.2 cm, which will give you more confidence while indulging in sex. 
• Operation time is almost three hours. 
• So far it has shown very promising result. Best part is more enjoyable intimacy post operatively than with other procedures but still this procedure has to gain popularity. 

As for bottle neck and hour glass curvature, surgeries are very complicated and beyond scope of present discussion.

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When To Decide A Surgery Therapy For Peyronie's Disease

Don’t Hurry For Surgery! 

Curvature of penile shaft development may lead one to decide for a surgical procedure. But it’s too early to go for surgery, because surgery is the last option and there are plenty of options available to avail. Do you feel that you will not be able to have normal sex ever? There are two reasons to wait and see the change or reduction in the curvature. First is that the curvature of penile shaft has taken some time to develop curve shape. So wait to get it resolved or reduce with time. Secondly, going through standard protocol is more adequate to get sex life back as before, with reduction in pain during sex, and more straighter penis.

The Standard Treatment Protocols for Peyronie’s Disease 

When you have noticed that your sex life is getting miserably painful and relationship with your partner is somewhat stressed out. It’s the time when you should look for some medical advice. Your doctor will examine and check for the degree of curvature and your complaints. At that stage the advice you will receive may be one or combination of following treatments.

1) Peyronie’s Disease Waiting Period. For spontaneous resolution of plaque which may occur during the period lasting from six months to a year. So it’s the safe period and one should expect for good.

2) Peyronie’s Disease Medical Treatment. During waiting period certain agents may be prescribed. This again depends upon the severity of curvature and complaints. Included are Vitamin E, colchicine, potaba, (PABA), verapamil /collagenase injection intralesionally. The period of treatment again will be from 6 to 12 months.

When Surgery is advised for Peyronie’s Disease? 

When after the stipulated period of medical treatment, your doctor observes no improvement but worsening of your Peyronie’s disease, he may advise a surgical correction procedure as an option. The criteria he would be keeping in mind for your Peyronie’s disease surgery are as follow;

• If the curvature is greater than 60 degrees? 
• Latency period of six months to a year elapsed between disclosure of curvature and surgery. This is to let situation stabilize with some medication given prior. 
• Erectile dysfunction, inability to sustain erection of penis due to curvature and associated severe pain.
• Bottle neck deformity. 
• Hour glass deformity.