Peyronie’s Disease: An Uncomfortable Truth, but New Hope
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.