HJAR Nov/Dec 2022

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2022 45 Gail Reede Jones, MD Arkansas Urology When should patients be referred to a urologist? If a patient presents with symptoms that suggest Peyronie’s disease, they should be referred to a urologist for evaluation and treatment as soon as possible. Arkansas Urology provides a Peyronie’s disease di- agnostic questionnaire to aid in condition evaluation. A urologist can usually detect plaques in the penis whether it is erect or not. During an exam, however, the urologist may inject the patient’s penis with a drug that can cause an erection so the degree of curvature can be measured. Treatment options Currently, there’s no cure for Peyronie’s disease, but there are some treatments, which may help lessen symptoms or dis- comfort from the condition. If curvature or deformation of the pe- nis is slight and doesn’t cause problems or pain during sex, patients may not need to be treated at all other than monitoring for changes. For those patients with more pro- nounced symptoms that cause pain, how- ever, treatments are available. Non-surgical treatments for Peyronie’s dis- ease usually involve a trained urologist inject- ing drugs directly into the plaques.According to the NIH, intralesional collagenase injec- tions (Xiaflex) are currently the only FDA- approved treatment for Peyronie’s disease. 3 The treatment is approved for men whose penises curve more than 30 degrees and in- volves injecting an enzyme, which helps break down plaques to reduce curvature. The effectiveness of non-drug treatments for Peyronie’s disease are still being studied but include mechanical traction or vacu- um devices that stretch the penis or force it straight to reduce curving. In cases where the plaques are painful, shockwave therapy may be employed, which channels low-in- tensity electric shocks to the plaque. If other treatment options don’t restore function, or if pain and the inability to have sexual intercourse persist, surgery to remove plaques may be an option. Surgery is usually not recommended until patients reach the Chronic Stage and curvature has stabilized. Surgical options may include removing the plaque and grafting in a more flexible piece of tissue; plication surgery, in which a piece of tissue is removed from the tu- nica albuginea at a spot on the penis directly opposite the plaque to counterbalance the curvature when the patient is erect; or a pe- nile implant. n REFERENCES 1 Johns Hopkins Medicine. “Peyronie’s Dis- ease.” Accessed October 2022. https://www. hopkinsmedicine.org/health/conditions-and- diseases/peyronie-disease 2 Cleveland Clinic. “Peyronie’s Disease.” Reviewed Aug. 17, 2020. https://my.clevelandclinic.org/ health/diseases/10044-peyronies-disease 3 National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases. “Penile Curvature (Peyronie’s Disease).” Last re- viewed August 2019. https://www.niddk.nih.gov/ health-information/urologic-diseases/penile- curvature-peyronies-disease RESOURCES https://arkansasurology.com/mens-sexual- health/penile-curvature-peyronies/ Gail Reede Jones, MD, joined Arkansas Urology in 1996 after working in private practice in Little Rock. Jones is certified by the American Board of Urology and is amember of theAmericanMedicalAssociation, American Urological Association, Arkansas Medical Society,Arkansas Urologic Society,ArkansasMedical, Dental and PharmaceuticalAssociation,and Pulaski CountyMedical Society.She is on theMedical Board of the Arkansas Prostate Cancer Foundation. Peyronie’s disease has two stages: 1. Acute phase: Usually lasting between six and 12 months, this is the period when lesions first develop and cause the penis to begin to curve. Most pa- tients notice something is wrong early in this phase, though discomfort talking about the genitalia may cause many to delay seeking help. Some may incor- rectly believe they have cancer due to the hard lesions that can be felt through the skin and pain in the erect or flac- cid penis. 2. Chronic phase: Within a year, the scar tissue usually stops growing, which halts the advancing curvature or de- formation of the erect penis. Pain also tends to subside for many patients dur- ing this time but may continue, particu- larly when erect. What causes Peyronie’s disease? The root causes of Peyronie’s disease are unknown, but research suggests that the condition may be caused by previous in- jury to the penis. Accidents, sports injuries, or sexual trauma, like repeatedly attempt- ing sexual intercourse with weak erections, may be potential causes for scar tissue to initially form. However, around 80% of those diagnosed can’t recall a specific injury to their penis. 2 Peyronie’s disease may also have a genetic component, as a family history of the con- dition is sometimes present, though not al- ways. There’s also research to suggest those with other connective disorders may be at slightly increased risk of developing the dis- ease, including scleroderma, tympanoscle- rosis, Dupuytren’s disease or plantar fasciitis.