Peyronie’s disease

Peyronie’s disease is a non-cancerous condition of penis which mostly affects men above 40 years of age. Peyronie’s disease can lead to formation of hard plaques in penis, erectile dysfunction and penile curvature.

Congenial penile curvature is different from Peyronie’s disease. Congenital penile curvature is usually by birth, but most men with congenital penile curvature first notice the bending of the penis (penile curvature) after puberty when they start noticing their penile erections.

Peyronie’s disease was first observed by Fallopius and Vesalius in 1561, but it was not until 1743 that the disease was fully described by Francois Gigot de la Peyronie. This is not a sexually transmitted disease. This develops due to microtrauma and abnormal wound healing in penis although the exact cause is not known.

Peyronie’s disease has two phases: acute (initial) and chronic (stable).

The initial acute phase lasts from 3 months to 12 months which is usually associated with pain. Penile curvature and plaques (nodules) start to appear in penis in this phase.

The chronic stable phase is when the disease stabilizes. It may lead to erectile dysfunction, stabilization of curvature and formation of hard calcified plaques in penis.

Penile doppler scan with a penile injection will usually reveal the site of plaque and degree of curvature.

What are the causes for hard rock-like lump in penis?

Depending on the family history, risk factors and circumcision status, the hard lump on the penis could be Peyronie’s disease or Penile cancer. Early consultation with an expert andrologist will confirm the diagnosis to initiate early treatment.

Does Peyronie’s disease go away?

Peyronie’s disease can lead to hard nodules (plaque), erectile dysfunction, and bending of the penis (penile curvature). A study from New York revealed that out of the 246 men with peyronie’s disease and bent penis (penile curvature), only 12% had some improvement, 40% remained stable and 48% had worsened (Mulhall J et al, 2006). So 88% of men with Peyronie’s disease will NOT see spontaneous improvement. Hence requires early and prompt evaluation.

Is Peyronie’s disease harmful or dangerous?

Peyronie’s disease per se will not endanger the life but can lead to very unsatisfactory sexual life which in turn can lead to strained relationships and depression.

Treatment options:

• Watchful waiting and follow-up
• Oral medications
• Penile traction devices
• Penile injections
• Penile plication
• Plaque incision / excision and grafting surgery
• Penile implant surgery

Is there a pill for Peyronie’s disease?

Pills are usually prescribed in the initial painful acute phase to reduce pain and assist in better healing or scar remodeling inside the penis. No pill can cure peyronie’s disease.

Which is the best treatment for Peyronie’s disease at home?

Penile traction therapy is a device which the patient himself can use at home to correct the penile curvature to an extent which facilitates comfortable vaginal penetration. Dr Pramod Krishnappa has extensive experience in penile traction devices and has published the results of a novel Penimaster PRO penile traction therapy in British Journal of Urology-International (BUI 2018) [PMID: 30365247] during his fellowship in Spain.

What are the injection therapies available for peyronie’s disease ? Is collagenase (Xiapex / Xiaflex) available in India ?

Collagenase injection is very expensive and currently available only in the United States of America (USA) [last update April 2023], it was withdrawn from Europe in Nov 2019 due to unknown reasons. Verapamil injections can be tried but is not followed at most centres due to poor outcomes when compared to collagenase injections. Interferon injections are almost given worldwide for the treatment of peyronie’s disease. Please refer to the article published by Dr Pramod Krishnappa in Sexual Medicine Reviews 2022: “Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature”

Can vacuum device help in Peyronie’s disease ?

There are only two good quality studies highlighting the role of vacuum device in Peyronie’s disease . Both studies have reported very dismal satisfaction rates of only around 51%.

Is surgery safe for Peyronie’s disease?

Surgery is done when the penile curvature is too severe (more than 30 degrees) or when erectile dysfunction is too severe, and not responding to all non-surgical treatments or both. Various surgeries include penile plication, plaque incision grafting and penile implant surgery. Combined penile curvature correction and penile implant surgery can be done in same sitting for better results. Dr Pramod Krishnappa has published a detailed review article on “Surgical Management of Peyronie's Disease with Co-Existent Erectile Dysfunction” in Sexual Medicine Open Access Journal 2019.

Who is the best doctor for Peyronie’s disease?

Dr Pramod Krishnappa is the best andrologist dealing with Men’s’ Sexual Health and Male Fertility. He has been trained extensively in high volume Andrology centres in Madrid (Spain), Belgrade, Budapest, Chicago, and New York. It is preferable to consult a urologist who is exclusively trained or specialized in Andrology to seek treatment for Peyronie’s disease.

Dr Pramod Krishnappa is one of the very few andrologists of India to have published maximum number of research papers on Peyronie’s disease.