Peyronies disease (curvature of the penis)

90 degree curvaturePenile deformity or curvature (Peyronies disease) has many different treatment options including initial observation until pain in the penis resolves. A small percentage of men’s curvature may resolve without any treatment.

If treatment is required this can be with oral medication, injection treatment, EMDA, Lithotripsy, Surgery.

Oral treatments include Vitamin E, Potaba, Colchicine, Tamoxifen.

Injections include steroids, verapamil, xiaflex, Interferon alfa-2b

Xiaflex

• A treatment cycle consists of two XIAFLEX injection procedures and a penile modelling procedure.
• For each plaque causing the curvature deformity, up to four treatment cycles may be administered. Each treatment cycle may be repeated at approximately six-week intervals.

• At-Home Penile Modelling Activities There are 2 types of at-home penile modeling activities. One is a gentle stretching activity; the other is a gentle straightening activity. Patients will do these for approximately 6 weeks after each treatment cycle. Patients should perform the penis-stretching activity daily, three times per day, with a non-erect penis.

• For the stretching activity, instruct the patient to:

1. Grasp the tip of the penis with the fingers of one hand and hold the base of the penis with the fingers of the other.
2. Gently pull the penis away from the body to its full length.
3. Hold the stretch for 30 seconds.
4. Let go and allow the penis to return to its normal, unstretched length.

• Patients should perform the penis-straightening activity no more than once per day only if a spontaneous erection occurs. If the patient does not have a spontaneous erection, he should not attempt the penis straightening.
• For the straightening activity, instruct the patient to:

1. Gently attempt to bend the shaft of the erect penis in the opposite direction of the curve, but not so forcefully as to produce significant pain or discomfort.
2. Hold the penis in this more straightened position for 30 seconds, then let go.
3. Perform this no more than once per day, if a spontaneous erection unrelated to sexual activity occurs.

Emda (electromotive drug administration) also known as iontophoresis.  Electrokinetic transport of charged molecules is used to enhance the transdermal application of a drug.

Eswl (Extracorporeal Shockwave Lithotripsy) An alternative approach has been to try to disrupt the plaque by means of mechanical force using extracorporeal shockwave therapy

Surgery – is undertaken when other treatments fail or when there the man has an abnormal erection associated with the penile curvature.

Surgical procedures include a Nesbitts Procedure, Lue 16 Dot Procedure, Plaque incision or excision and graft, penile prosthesis.

Erection Problems:

Treatment can include

• Advice on healthy lifestyle and modification of risk factors such as obesity etc
• Psychosexual counselling
• Oral therapy with medication such as Viagra, Cialis, Levitra
• Topical therapies – vitaros cream, muse intraurethral therapy
• Injection therapies – caverject
• Vacuum pump
• Surgery – penile prosthesis

Ejaculation problems (premature ejaculation)

• Psychosexual Counselling
• Medical treatment with local anaesthetic creams (lidocaine),
• SSRI inhibitors such as paroxetine, fluoxetine
• Viagra, Cialis, Levitra
• Other less common agents include opioids (tramadol), beta adrenergic agonists (Pindolol)