Peyronie's Disease

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The Men’s Clinic at UCLA is a world leader in Peyronie’s Disease (PyD) management and research. 

Dr. Jesse Mills was a principal investigator in the Phase III clinical trial to achieve FDA approval for collagenase clostridium histolyticum (Xiaflex.), an injectable medication used to treat Peyronie’s disease. Since that time, Dr. Mills continues to be a world expert in administering Xiaflex and trains physicians form all over the world on how to effectively administer the drug.

What is Peyronie’s Disease?

Peyronie’s disease is an abnormal bend of the penis occurring during an erection.

The bend develops by plaque accumulating in an area of tissue on the penis. It is estimated that Peyronie’s disease occurs in approximately 1 – 5 percent of men.

Insight into Peyronie's Disease: Cause and Treatment for Penis Curvature

UCLA urologist Jesse Mills, MD, presented a live-streaming webinar to discuss causes and treatment options for Peyronie’s Disease, a type of erectile dysfunction characterized by fibrous scar tissue that forms under the skin of the penis causing curved, painful erections.

What Causes Peyronie’s Disease?

No one knows how a man gets PyD.  About 80% of men have no clue why their penis became curved or deformed.  The other 20% remember an injury during intercourse.  PyD can be genetic.  Fathers and sons, brothers may all have a genetic risk.  It’s not something most men talk about and even may be more difficult for brothers or dads to discuss their condition with each other.

Peyronie's Disease: Diagnosis

Men most often make the diagnosis themselves. Physicians can confirm the diagnosis with a physical exam.  Some physicians will perform x-rays and ultrasounds of the penis to get more information on the scar tissue.  At The Men’s Clinic at UCLA, all men receive a thorough history, physical exam and penile duplex ultrasound to get the most accurate diagnosis possible to provide individualized therapy.

What to expect when diagnosed with Peyronie’s Disease

Some men with PyD will develop overnight severe curvature or bending of the penis, and some men will take months to develop the deformity. It can be painful, especially in the first few months of development.

Specialists divide Peyronie’s disease into two (2) categories: acute and chronic. The acute phase of Peyronie’s disease can last up to a couple of years but most men evolve into the chronic phase in the first year or so after noticing the curvature. Along with curvature or bending, most men will notice loss of penile length that can sometimes be dramatic. Some men claim losing up to ½ of their former erect penis length. Penile shortening occurs because the thick fibers of the penis lose their usually elasticity and ability to stretch with blood flow and, therefore, men find themselves with a smaller erect penis.

Severity of Peyronie’s disease depends on how bothered a man is by this condition. Some men have a bend of over 90 degrees and are unable to penetrate their partner. Some men have a much less severe bend, but are so bothered by the change in appearance of their penis that they avoid sex. If they don’t have a partner, they hesitate to find one, afraid to divulge their condition. Over the last several years, erectile dysfunction (ED) has become a household word. Celebrity spokesmen proclaimed their ED on national television and normalized the condition. This empowered a generation of men to seek treatment. Peyronie’s disease has no celebrity spokesman. It is a disease, for the most part, suffered in silence.

If you or someone you know suffers from Peyronie’s disease, be confident that The Men’s Clinic at UCLA will treat you. Dr. Mills and his associates lead the world in PyD management and research.  Dr. Mills is one of the largest volume Xiaflex injectors since its FDA approval in 2013. 

Peyronie's Disease Treatment at The Men's Clinic at UCLA

Peyronie’s Disease, a disfiguring, bothersome bend in a man’s erect penis, is a complex condition with no clear cause and a multitude of treatment options.  Let’s explore these options.  Treatment strategies will depend on how long the man has had the condition prior to seeking medical advice, how severe the deformity is, how good his erections are and how bothered the man is by the disease.  Further, individual urologists will have different treatment plans depending on their comfort with medical and surgical management of Peyronie’s.

Dr. Mills frequently states the penis chooses the treatment.  In other words, there are many treatments for PyD, from medical management, intralesional therapy like Xiaflex, or surgical therapies.  The severity of the curvature and severity of a patient’s bother determine the best course of treatment. 

Medical Management for Peyronie's Disease

Most Peyronie’s specialists initiate treatment with medical therapy, usually pills or topical creams to the penis.  The history of pill therapy for Peyronie’s includes many drugs, most non-FDA approved.  Many specialists prescribe pentoxyphyline, a drug initially used to improve blood flow to the legs of patients with vascular insufficiency.  In Peyronie’s, pentoxyphyline inhibits some of the inflammatory proteins that lead to abnormal scar formation.  Many clinical trials have demonstrated pentoxyphyline has a modest effect, about a 40% chance of improving the plaque after 6 months of therapy.  It has a pretty good safety profile with not too many side effects.  Older medications like colchicine have fallen out of favor due to lack of improvement and higher side effect profile.  Some urologists prescribe a topical medication called verapamil, a cream you rub into the plaque on the penis once or twice a day.   Some urologists and physical therapists will use an iontopheresis unit to draw the verapamil (and sometimes steroid) deeper into the plaque with an electrical current.  There are a few studies out there that show this may be better than just rubbing the cream into the plaque.

Penile traction and vacuum erection devices are two therapies many urologists combine with either pill therapy or injection therapy.  The traction devices have to be worn at least 4 hours a day and have to be released every 20 minutes to minimize nerve damage.  A few studies demonstrate improvement in both lost penile length and penile curvature, especially combined with other therapies.  Vacuum devices don’t have quite the same statistical success rates but also don’t have to be worn for so many hours.  Also, if a man has erectile dysfunction associated with Peyronie’s, insurance companies often pay for the device.  

Medical Management for Peyronie's Disease: Xiaflex

Intralesional therapy for Peyronie’s is in the midst of a revolution in therapy.  Urologists have injected verapamil into plaques for years with modest success.  Interferon injections have also been used with similar success.  Neither of these therapies is FDA approved.  However, as of 2013, Xiaflex received FDA approval as an intralesional therapy. Xiaflex, collagenase, is a biological agent that a urologist injects directly into the plaque.  The enzyme digests the abnormal collagen deposits in the plaque to decrease the abnormal force exerted on the penis.  Men in clinical studies had a roughly 40% improvement in their curvature and reported improvements in their distress suffered from the disease.  Side effects of this therapy were usually mild and included temporary pain, bruising and swelling.  A few men in the clinical trials had a penile injury severe enough to need surgical correction.  All of these men regained sexual function post surgery. Dr. Mills at The Men's Clinic at UCLA is a national leader in using Xiaflex, the first drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of Peyronie's Disease.

Surgery Treatment for Peyronie's Disease

Lastly, if medical or office procedures don’t improve a man’s Peyronie’s Disease, there are surgical options.  There are three surgical approaches for the treatment of Peyronie’s Disease.

Penile Plication for Peyronie's: This is the most straightforward surgical approach.  Most often under a general anesthesia, the surgeon makes an incision around the crown of the penis, usually along the man’s circumcision line, if he was circumcised, and pulls down the skin to expose the fibrous coating of the penis where the plaque is.  Usually, the surgeon gives the man an erection in the operating room using an injection medicine.  Once the surgeon observes the degree of curvature, he or she will place a number of stitches opposite the curve to rescaffold the penis against the direction of the curve.  Once the sutures are tied down, the tissue bunches together and pulls against the curve.  In the carefully selected patient, this is a very successful operation.  The main downside to the surgery is men can lose some length.  Therefore, it’s not a surgery for everyone.

Penile plaque excision and graft surgery for Peyronie's: This surgical option is far more involved.  Penile plaque excision and graft surgery involves a similar incision to the plication surgery.  After incision, the surgeon excises the plaque and places a patch. This is where the complexity starts.  The plaque sits underneath a complex neurovascular bundle where the sensation nerves and some of the penile blood vessels run.  One of the trickiest parts of this surgery is to elevate this bundle without cutting any of the fibers to expose the plaque.  Injury to these fibers can lead to penile numbness, impotence and long lasting fluid collections called lymphedema.  The other tough part of this operation is figuring where to get the patch.  Surgeons have tried many materials ranging from tissue harvested from the patient’s own body, artificial materials, animal tissue and lastly tissue harvested from human cadavers.  With this many options and surgeon opinions, one may rightly assume there is no consensus on the best material.  Risks of plaque incision and grafting include temporary or permanent penile numbness, reduced erection strength, scarring and shortening.  In the right surgeon’s hands, however, this represents a powerful and effective treatment option.

Penile Implant for Peyronie's: If a man suffers from both Peyronie’s and erectile dysfunction, a penile implant (link to penile implant) with intraoperative modeling is likely the best surgical option.  Surgeons have been placing implants for over 40 years.  An implant can correct the Peyronie’s deformity because the cylinders will act as I beams to straighten the penis.  Once the surgeon places the implant, he or she can hold pressure over the erect implant and bend the penis against its curve. With the cylinders in place, the penis has a good chance of holding straight once the man heals.

UCLA Advantages for Peyronie’s Disease Treatment

Dr. Jesse Mills and the team at The Men’s Clinic - UCLA Health are at the forefront of treating Peyronie’s disease, both surgically and medically. Dr. Mills was a principal investigator for Auxilium Pharmaceuticals’ late-stage study of XIAFLEX in 2011 and 2012. XIAFLEX is an FDA-approved injectable medication used to treat adult men with Peyronie’s disease who have plaque that can be felt and a visible curve in their penis. XIAFLEX, after injected into the tissue, works to help weaken and break down the plaque. Dr. Mills is a national leader in using XIAFLEX, and it is the first drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of Peyronie's disease.

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