Treatment of Peyronie’s disease
Although the disease puts great emotional strain on most patients, the decision to take surgical measures should not be made in haste. Spontaneous improvement of induratio penis plastica within one year without any medical intervention is reported in the literature in 10-15% of the cases.
In more than 90% of the cases, the symptom of pain disappears spontaneously within one year. In this respect, extracorporeal shock wave therapy (ESWT) may have a beneficial effect. Medication is used frequently, but is limited as regards efficacy. Common medicines include 4-aminobenzoic acid potassium salt taken regularly 4 times a day as well as vitamin E or verapamil ointment applied externally. Although these medicines have not been investigated in large-scale studies, their positive effects have been reported repeatedly. Before taking any surgical measures, the condition should be stable for at least 6 months to prevent reoccurrence after the surgery. The surgery is aimed at restoring the length of the penis.
A distinction is made between two basic surgical techniques:
- Tuck techniques compensate the curvature by shortening the unaffected side of the penis, accepting a shortening of the whole penis
- Techniques involving incision and excision of the plaque necessitate covering the defect with replacement tissue. We use TachoSil® for this purpose.
The choice between the two surgical techniques is not always easy and should always be made on a case-by-case basis. To a greater or lesser extent, both procedures involve the risks of erectile dysfunction, impairment of sensory function and shortening. For this reason, surgical intervention is only indicated if the penile curvature is significant and if the patient’s ability to have sexual intercourse is considerably limited.
Further treatment options are expected to be available in the future. At present, the use of a medicine is being investigated that is injected into the plaque, thereby dissolving it and correcting the curvature of the penis.
Whether and when these treatment options will be available to us and our patients remains to be seen.