In this condition, an inflammatory process affects the coverings of the erectile sheath of the penis (known as the tunica albuginea). Once the inflammation becomes established, it leads to scarring which is a tough component that doesn’t allow the erection to stretch over the scarred area. As a result, the penis bends on erection, and often our patients complain that it is bent "like a banana". Often the area of scar can be felt and is known as a plaque
The disease occurs in 2 phases – an early phase in which there is inflammation, characterised by pain on erection, followed by a late phase where there is progressive bending of the penis with pain becoming less of a feature.
Although, previously thought to be rare, it is thought to occur in up to 9% of men. There are some associated conditions such as medication (anti-epileptic), other medical conditions (e.g. diabetes, high cholesterol, high blood pressure) – although they are not thought to directly cause it. Additionally, men who have had prostate surgery for cancer also have an approximately 5 fold higher risk of developing this condition.
Some non-surgical treatments have been assessed by various researchers in managing this condition. These studies have limitations which has led to variable results with even the same treatments offered by various specialist groups. It is therefore a field where a strong level of evidence is not available to guide doctors and patients alike.
Most recently however a new drug, Xiapex has been licenced for use as an injection in patients with Peyronies disease and is backed by evidence and research. The drug treatment involves a tiny injection of the drug into the plaque and "modelling" exercises to straigten the penis. Early results are encouraging. Mr Shukla has been in the first set of European experts been trained and approved as a trainer for other specialists. Please see the section below for more information.
Many surgical techniques are available for the treatment of Peyronie’s Disease; they can be broadly separated into two main types. Some of these involve shortening the penis on the opposite side to the bend. In the other form of surgery, the scarred area/plaque can also be incised and a graft placed over the area. All of these types of surgery can result in complications such as shortening of the penis, erectile dysfunction and changes in sensitivity to the glans penis. In some cases patients may require a circumcision particularly if their foreskin is very tight.
A subgroup of patients with pre-existing erectile dysfunction and the more significant bends may require penile implant surgery which deals with both complains - the bend and the erectile dysfunction. As this surgery can be complex, it is essential that patients are thoroughly assessed and counselled on the most appropriate treatment option so that patients are satisfied with the choice of treatment.
We offer a spectrum of surgical and non-surgical treatment options tailored to the individual, taking into account their disease status, their erectile status, other factors such as length and patients’ priorities.
New approved drug available for Peyronies Disease
Earlier this year, based on research and evidence, a new drug Xiapex has been approved and licenced in Europe for injection into the plaque for Peyronies disease and has demonstrated good effect. In combination with modelling exercises, it is hoped that it will reduce the curvature and hence the need for patients to undergo surgery and its complications. It is already in use in the USA and now being taken up in Europe.
Mr Shukla was in the first wave of European experts who were trained in this medication use and is now an approved trainer for other specialists.
Please see the attached patient brochure.
As it is not possible to advise patients on all aspects of the treatment, some salient points are:
1) It is not suitable for all patients and our team will need to assess you condition and suitability. Based on this you may be counselled on the procedure and likely outcomes
2) It involves a tiny injection into the plaque and can result in some bruising / swelling.
Other side effects will be covered at the counselling session.
3) Other injections may be needed as per the response. The number of injections as well the interval between injections will be dependent on the patient response.
4) Modelling exercises are key in reducing your curvature/defomity. Of the various regimes available, the ideal regime of modelling will be discussed and recommended.
From the current data, it appears that there is an improvement of between 35-40 percent of the curvature and may either avoid surgery (and hence the complications of shortening of the penis and erectile problems), or make the surgery needed less extreme.