Penile curvature (Peyronie's disease)
Which are the symptoms?
The clinical picture of a patient with this disease is characterized by the presence of significant penile cruvature, which may or may not be associated with penile pain during erection. Generally, it is possible to clinically appreciate the presence of a hardened area on the penile lining tissues. Erectile deficit varies depending on the clinical picture.
- Penile curvature during erection
- Penile pain
- Presence of a penile plaque
- Erectile dysfunction
How is it diagnosed?
The diagnosis of this pathology is purely clinical. Through penile palpation it is possible to locate the penile plate(s) responsible for the curvature. The evaluation of the degree of curvature is performed with the penis erect and usually grounded by iconographic documentation provided by the patient himself, or during immediate examination in the clinic with drug-induced erection. It is also necessary to perform an ultrasound of the penis with dynamic Doppler (EcoColorDoppler dynamic penile) for precise location of the plaque, the study of its ultrasound characteristics and the evaluation of proper vascularization and hemodynamics of the penis during erection.
How is it treated?
Therapy of La Peyronie's disease is related to the stage of the disease. During the acute phase, conservative medical treatments are suggested, mainly aimed at controlling pain and possibly preventing worsening of the degree of curvature. Low intensity shock wave treatment (LISWT) has proved to be particularly effective at this stage. Once the pathology has reached the chronic phase, with the stabilization of the curvature, the patient can be directed to other types of treatment. Conservative management may involve the use of Vacuum devices during surgical treatment. The surgical procedure is called "penile corporoplasty" and may in some cases involve the application of synthetic tissue patches. In patients with severe form of erectile deficit not responsive to drug therapy, the proposed surgical intervention involves the implantation of a penile prosthesis. The surgical treatment is not free from possible complications and therefore is usually reserved for cases in which the curvature exceeds 30 degrees, and only when it is actually a cause of discomfort for the patient and limitation to his sex life. More recently, patients in chronic phase of the disease, with a curvature of at least 30 degrees, have been given a chance to get treatment based on the injection of collagenase of Clostridium Histolyticum (Xiapex®) inside the penile plate responsible for the curvature with the aim of making this plate less retracting the surrounding tissues and therefore reduce the curvature.