The curvature of the penis. Peyronie’s disease
Сontent
Causes of penile curvature
Significant penile curvature may be caused by a congenital anomaly in the development of the cavernous bodies or by the progression of Peyronie’s disease.
The causes of penile curvature can also be hormonal disorders and injuries of the penis.
Often in young people, due to the underdevelopment of the urethra and the surrounding tissues, the formation of the chord of the penis, there is a curvature of the penis downward during an erection. As a rule, this ailment occurs in the adolescent period of 14-18 years. It can significantly affect psychological self-esteem, so it is difficult for guys with congenital curvature to start a sexual life.
If the curvature is more than 20 degrees, it significantly affects the possibility and convenience of sexual activity, leading to physiological and psychological disorders.
Peyronie’s disease
Another cause of penile curvature in Peyronie’s disease (or fibroblastic induration of the penis). In this case, specific fibrous seals (plaques) form on the tunica albuginea of the penis, which leads to curvature of the penis. The penis curves upwards, or to the side. If plaque situates on intracavernosal septa penis doesn’t bend but significantly shortens. Patients with signs of fibroblastic induration of the penis note pain during erection, which is uncharacteristic for congenital deformity
The leading causes of Peyronie’s disease:
- Microtrauma of the tunica albuginea of cavernous bodies;
- Inflammation of the urethra;
- Endocrine problems, diabetes;
- Hypogonadism;
- Genetic predisposition;
- Autoimmune processes, often coexist with contracture of Dupuytren;
- Chronic traumatization of the penis.
Most often, the disease occurs due to traumatization of the penis, which can occur with some techniques of sexual intercourse.
Treatment of Peyronie’s disease is mainly surgical, although there are also therapeutic methods of medicine in the arsenal of doctors (most effective is collagenase ingection (Xiapex, Xiaflex which is produced from bacteria Clostridia or Produced from Human Stem Cells which is possible in Biobank or Laboratory of stem cells). When there is a growth and formation of plaques in the initial stage of the disease (up to 2 years), it is customary to carry out conservative therapy. In some cases, this has a pretty good effect, up to almost complete disappearance of plaques.
Peyronie’s disease is diagnosed based on:
- Examination of the patient — curvature of the penis moderate at rest and pronounced with erection;
- Collection of anamnesis — assessment of the duration of the disease and the characteristics of sexual life;
- Ultrasound of the penis — the study allows you to assess the size and location of plaques and vascular blood flow.
Drug treatment of Peyronie’s disease includes oral and parenteral intake of absorbable drugs, vitamin E, colchicine, pentoxifylline, para-aminobenzoic acid (PABA) together with injections into the plaque of absorbable drugs.
Previously, injections into the plaque of verapamil, hydrocortisone, hyaluronidase were used, but recent studies of the European Society of Sexual Medicine considered them ineffective.
The only drug approved by the FDA (USA) and ESSM for microinjections into the plaque is the collagenase drug Xiapex (Xiapex, Xiaflex).
A course of 4-8 injections of clostridial collagenase can reduce the size of the plaque and the angle of curvature. BUT:
Its disadvantages are pain when administered, frequent allergic reactions, and a high price and deficite of Xiapex in Europe is 3000 euros, and in UAE, Xiapex can be bought for at least 7500 euros (30 000 aed). Thus, the course of therapy will cost 30-60.000 euros, which is mostly inaccessible even for citizens of UAE and Gulf Countries.
Non-operative Peyronie treatment can include electrophoresis and phonophoresis with enzyme preparations.
Very carefully, you need to be with Shock Wave Therapy (SWT) to treat Peyronie. Shock waves do soften the plaque but also damage the cavernous tissue nearby. Often, we observe a softening of the plaque at the end of the course of SWT and then a twofold increase in it three months after the procedure. So we recommend SWT only just before Collagenese injection with combination with PRP (Pletelets Rich Plasma) – it contains high concentration of VEGF (Vascular Endothelial Growth Factor) for stimulation rejuvenating of normal corporal tissue near plaque. Else is rational to combine Peyronie’s disease treatment with injection of stem cell. They renovate cavernosal tissue and improve blood streaming and rigidity.
The criterion for the effectiveness of the course of treatment is
- the reduction of pain and deformation during erection,
- softening,
- removal of plaque in size by 30%.
A complete treatment of plaque sometimes requires at least 2-3 courses of treatment.
Surgical treatment is used for severe curvature of the penis, pain syndrome, or ineffectiveness of conservative therapy.
In our clinic for the surgical treatment of penile curvature are used:
Corporoplication — suturing the long part of the deformed penis is performed. The operation is relatively simple, but its disadvantages are a decrease in the length of the penis and sometimes a deterioration in the blood supply to the penis.
Corporoplasty is a highly effective method of treating penile curvature, can be carried out with a small length of the penis. The essence of corporoplasty is to remove the fibrous plaque and replace it with grafts from the bovine pericardium, own vein, or mesothelium grown from its stem cells. The main advantages of the operation are: removal of plaque, straightening of the penis, and the most crucial plus is lengthening of the penis. In patients with impaired sexual function, the operation of coporoplasty is rationally carried out with
PRP therapy and injections of mesenchymal stem cells for postoperative improvement of erection.
When diagnosing Peyronies disease in older men (over 60 years of age) with impaired blood flow in the penis, it is rational to carry out with corporoplasty or multiple plaques notches an operation to implant a semi-rigid or three-component prostheses Penile Prosthetic Surgery.
The cost of treatment of Peyronie’s disease depends on the degree of development of the disease and, accordingly, the method of surgery to align the penis.
The price Peyronie’s disease surgery is agreed with the attending physician in each case. The cost of removing the plaque is specified in consultation with the doctor after passing the examination and the Peyronie’s tests. It is possible to align the penis; after removing the plaque, you need to install a penile prosthesis. This will also affect the final price of treatment. The exact cost is determined after consultation.
The current cost can be viewed on the >>> Price page
Correction of penile curvature before and after
More «Before/After» photos on our Telegram channel
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