Peyronie’s Disease involves often painful curvature of the penis resulting in scar tissue or plaque formation. This can be due to repeated trauma to the penis from sex or activity, however, we still do not know all possible causes of the condition. For many, the visual and aesthetic concern of the penis is more significant than the medical concern. In other words, many men are concerned about how the penis looks rather than its function.
However, many men will see a worsening in their Peyronie’s disease, which may eventually interfere with or disallow sex. If conservative treatments and time have not improved Peyronie’s, we may consider further intervention. Some men will opt for medical management of the disease. While these drugs are not necessarily incredibly effective, they may reassure the patient and allow them to accept some minor curvature as normal and a new part of their lives. Injection therapy is often the next, most appropriate step. Currently, there is one injection used for Peyronie’s that has solid data supporting its use. Xiaflex is injected directly into the scar tissue to soften the plaque and improve both curvature and discomfort.
Xiaflex is administered in 4 cycles and 2 injections per cycle approximately 3-5 days apart. Patients will have between 8-10 clinic visits. Two large randomized controlled trials (IMPRESS 1 & 2) showed 33% improvement in curvature in the medication group. Newer studies show up to 75% of patients may experience 20% or greater improvement of curvature with a longer treatment course (https://pubmed.ncbi.nlm.nih.gov/30672843/).
Alternative Treatments
You may have seen online forums discussing other injection therapies such as steroids, Verapamil or interferon, but there is far less data on these options and results are not consistent. Dr. Kapadia will be happy to discuss proven and unproven therapies with you, during your consultation.
Delving deeper into Xiaflex
Because Xiaflex is FDA approved, it is more often prescribed for PD. This medication, as with any, comes with both benefits and risks, which are discussed during your consultation with Dr. Kapadia. One of the most concerning risks is known as a penile fracture. This is when one of the tubes, running the length of the penis, breaks. The result can be extremely painful and lead to erectile dysfunction. Other than this most significant risk, many patients experience minor side effects including pain, swelling, bruising and more. Each of these risks will be discussed when you meet with Dr. Kapadia
Your suitability for injection therapy will largely depend on other health considerations. Ultimately, we want to minimize the risk of side effects, while maximizing the effect of the injection.
Making The Most of injections
To ensure that the injections like Xiaflex are most effective, patients will be asked to perform what is known as penile modeling – essentially traction exercises on the penis to stretch the softened plaque. This is performed daily, at home, after each injection. You will receive detailed instructions on how to perform these exercises, if your care plan requires it.
Surgical Alternatives
Statistically, some patients will not receive a substantial benefit from penile injections. Other patients with severe deformity may need surgery for their Peyronie’s. Fortunately, there are a few procedures that can significantly improve both the discomfort and impediment to sex that Peyronie’s Disease causes. For example, patients suffering from both ED and Peyronie’s may benefit from a penile implant. Dr. Kapadia is highly experienced in these surgical treatments and offers consultations to men suffering from Peyronie’s Disease from one of our 3 offices in the greater Atlanta area.
The Bottom Line
Peyronie’s Disease affects a significant number of men in the United States, with some estimates of up to 10%. In patients where discomfort is minimal and Peyronie’s is not an impediment to sex, the effect is often more psychological. Even minimal curvature that causes psychological stress can have a significant impact on health. Peyronie’s disease is a condition that does not improve in most cases, if left untreated. It may also continue to worsen for some men. For many men, Peyronie’s represents an inability to enjoy their sex life. For these men, a stepwise approach for treatment is necessary.
For those with more significant curvature that causes discomfort and an inability to have sex or even erectile dysfunction, injection therapy may make sense. However, for those who do not respond to injection therapy, or for those with significant curvature, surgical treatments are potentially very effective.
This is especially true for Peyronie’s patients who are also suffering from erectile dysfunction, or ED. These patients can often have the penis straightened and the erectile dysfunction addressed in one procedure known as a penile implant.
You do not have to live with debilitating Peyronie’s Disease. We encourage you to contact our office to learn more about the potential treatment programs available to you. Dr Kapadia is a specialist in the treatment of Peyronie’s Disease, and has the experience and knowledge to offer the best treatment protocol for your situation.