How painful is Peyronie's disease
Induratio penis plastica
Induratio penis plastica (IPP, Peyronie's disease): With increasing age, the more frequent curling or kinking of the penis during erection. The cause is hardened and scarred connective tissue plaques in the area of the penile cavernous bodies on the back of the penis. In addition, retractions, hourglass-shaped constrictions and penis shrinkage occur, and those affected often develop erectile dysfunction as well.
A large number of drugs and procedures are available for the treatment of induratio penis plastica, the effects of which are assessed differently by experts. The course of the disease cannot be foreseen, it ranges from the rare spontaneous healing to the need to implant a penile prosthesis.
- Painful erection and increasing curvature at the beginning of the disease
- Less painful in the later phase, but permanent curvature and erectile dysfunction
- Palpable hardening in the penis shaft and at the transition between the penis shaft and glans
- Erectile dysfunction (impotence) and / or inability to enter the vagina.
When to the doctor
In the next few days if
- the above complaints occur.
The induratio penis plastica is based on an intermittent disease of the erectile tissue. It begins with painful erections and palpable nodules and leads to increasing curvature of the penis. The pain usually improves within a year, but the curvature often persists or increases.
The predisposition to induratio penis plastica seems to be innate. In order to develop clinically, further triggers must probably be added: The cause is suspected to be the smallest injuries, so-called microtraumas. A risk factor is therefore more frequent and violent sexual intercourse in unusual positions or forced masturbation.
Spontaneous healing occurs in ~ 15% of cases. In the other cases the disease progresses; the longer it lasts, the more often an accompanying erectile dysfunction develops in addition to the curvature. Most of the diseases come to a standstill after 2–3 years.
In addition to the curvature of the penis, there has often been a curvature of the hands for a long time due to thickening and shortening of the tendons in the palm of the hand (Dupuytren's disease). Other diseases that are often associated with an induration penis plastica
Initially, the suspicion is based on the description of the patient's complaints. In order to prove and document the curvature of the erection, the doctor often arranges for a photo documentation, e.g. B. after self-stimulation or SKAT.
The doctor recognizes the connective tissue plaques and their possible calcifications on ultrasound. If erectile dysfunction is present, Doppler sonography helps to detect possible circulatory disorders.
If there is little or no pain during sexual intercourse, the majority of experts believe that no therapy is necessary.
Several medications and methods are available in the event of significant pain and impairment of sexual intercourse. Opinions as to which procedure is effective when, however, are very inconsistent. In addition, the number of possibilities shows that the one "sweeping" therapy has not yet been found. Here is a selection from the most commonly used methods:
Oral drug therapy. It can alleviate the discomfort; Whether the curvature improves is controversial:
- Aminobenzoate (Potaba®) reduced the plaques in studies and has a prophylactic effect against the curvature (an already existing curvature is not improved). However, aminobenzoate has little effect on pain.
- Acetyl-L-carnitine reduces pain and is said to improve curvature.
- Phosphodiesterase-5 inhibitors are supposed to improve the curvature and stop the progression of induratio penis plastica if taken over a long period of time.
- Experiments with NSAIDs, vitamin E and tamoxifen were disappointing, they could not prove any effect in studies.
Local injection of substances in the plaques:
- Cortisone (e.g. dexamethasone) is often used, but its effect has not been established.
- Verapamil inhibits the fibroblasts (these are the cells that make up the connective tissue) and increases the production of collagen-splitting enzymes (collagenases). However, the effect is controversial, the results of various studies are contradicting.
- Interferons also inhibit the fibroblasts and increase the production of collagenases. They reduced pain and improved curvature and sexual function in several studies, at least in the short term.
- In one study, collagenases resulted in a small improvement in curvature.
Extracorporeal shock wave therapy. It relieves the pain under erection, its influence on the curvature is evaluated contradictingly.
Penis stretchers can support therapy with oral medication in individual cases. Regular stretching of the penis using a vacuum apparatus is also recommended by some doctors.
Operative therapy. The majority of experts recommend surgical correction only as a last resort after the failure of conservative treatment, because the success of the operation is not certain and complete impotence can then occur. Therefore, if at all, an operation is only performed if the disease has been stable for at least a year, i.e. no new hardening has occurred. Otherwise there is a risk of the corrected penis kinking again after the operation.
Penile prosthesis. If the patient suffers from erectile dysfunction that is so severe that it cannot be successfully treated with SKAT, no improvement can be expected from surgery. Here doctors usually recommend a penile prosthesis.
The course of an induratio penis plastica cannot be foreseen. In up to 15% of cases there is spontaneous healing, in 40–50% of those affected a severe curvature of the penis develops with an angle of up to 100 °.
AuthorsDr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 10:58
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