Peyronie's Disease has been described since the 18th century. I know of no condition that more negatively affects the sexual thought process of men than Peyronie's Disease. This condition gives many men much anguish. This condition usually is due to an accident to the penis. This can be an accident to the penis during sexual intercourse or masturbation. The penis undergoes significant trauma during intercourse, during usual bumps and bands of life and in addition, as men age the vascular supply to the penis deteriorates. In all events a decrease in oxygen to the delicate tissue deep in the penis results in tissue death which later heals with a scar. Scars in the penis usually can be felt as a "lump." The side of the penis with the scar is shorter in length than the other side. During an erection, like the string on a bow, the penis at becomes bent or curved in the direction of the scar, and there also may be pain as well. As a rule the pain goes away over a year but the curvature remains. A short, deformed penis and impotency are the most important side effect of Peyronie's Disease.

Many treatments have over the years been offered. There is no cure for Peyronie's disease. The treatments tried have been surgical to remove the scar, which in itself heals in scar, impotency and a short penis, to medications, to x-ray and local applications of creams When many treatments are offered to treat one condition it means that none of the above work very well. The latest approach is to try and prevent progression of the condition with intralesional injections of Verapamil. This is an injection directly into the "lump" every other week for 6 months. Evidence-based medicine has demonstrated that this actually stops the progression of the scar but again does not cure Peyronie's Disease. The science also indicates that increasing nitric oxide in the tissues helps the healing process so we often add PDE5's, L-Arginine 400 mgTID and Pentoxifylline 1 gm BID. This represents the latest evidence-based medicine to manage Peyronie's. Treatment with Vitamin E, Potaba andColchicine,Tamoxifen, Carnitinehave been shown to have no benefit.

"I do not recommend any surgical intervention for Peyronie's until impotency results nor until the curvature is so great one can no longer use the penis to penetrate the partner." Any surgical application will result in a shorter penis than when you were a younger man. Before surgery you must come to terms with this fact. If you do not have impotency and only a bent penis then you should not undergo surgery to remove the lump, as impotency likely will result. In this setting you could have placation surgery to make the penis straight but your penis will be made significantly shorter. If you have Peyronie's and impotency you are best served with a penile prosthesis.

John Tuttle, MD