Step-by-Step Comprehensive Treatment Guide for Erectile Dysfunction (ED)

Peyronie’s disease is a connective tissue disorder of the penis that can be likened to Dupuytren’s contracture of the hand. It is characterized by the triad of bent erections, pain in the penis with erections and palpable penile plaque. Peyronie’s disease is quite common, affecting as many as one in 11 men, despite the lack of public awareness. The penis is composed of the same connective tissue as every other joint in the body. The anatomy of the penis is composed of three cylinders: the paired erectile bodies and the urethra. The erectile bodies (corpora cavernosa) are made up of sinusoidal tissue that fills up with blood during an erection and an outer covering (tunica albuginea) composed of tough fibroelastic tissue. The outer covering determines the size and shape of the erection.

The principal finding in men with Peyronie’s disease is the deposition of scar tissue in the tunica albuginea. All of the clinical symptoms are derived from this event. The curvature of the penis is due to the fact that scar tissue does not stretch as well as normal tissue. The normal tunica albuginea is composed of elastin fibers and collagen. The site of scar tissue from Peyronie’s disease is composed mostly of collagen that can harden to the thickness of bone

Symptoms

Although most men with Peyronie’s disease report that their penis is bent upwards, a variety of other abnormalities are frequently observed, including bends in other directions, complex bends, divots in the side of the penis and hourglass deformities. The palpable plaque is the actual scar tissue that has been deposited on the outer covering of the erectile bodies. This is present in the vast majority — but not all — patients with Peyronie’s disease. The plaque may become calcified, like bone, with severe disease. Finally, the pain experienced with erections is thought to be due to active inflammation in the plaque and usually disappears on its own with time (usually by 12 months).

Erectile function may be adversely affected by Peyronie’s disease. While most patients with Peyronie’s disease report normal penile rigidity during erections, some have trouble maintaining erections due to leaky veins in the penis (a process called veno-occlussive disease of the penis). The disease process of Peyronie’s disease does not normally affect the sinusoidal tissue within the erectile bodies, but it can affect the veins exiting the erectile bodies and prevent their proper closure. The main sexual complaint despite the physical deformity is the bend itself, preventing vaginal intromission or causing pain to the partner.

Causes

The exact etiology of Peyronie’s disease is unknown. There is evidence that it may have a genetic basis. A positive family history is common but not typical. There is an association with other connective tissue disorders, specifically Dupuytren’s contracture, affecting the palms of the hands. The most popular theory today is that Peyronie’s disease is induced by trauma. The trauma may be acute and distinct such as a penile fracture, but more often it is chronic and low grade, such as repeated attempts at sexual intercourse with weak or incomplete erections.

Treatment

The management of Peyronie’s disease is dependent upon the extent of stabilization of the disease state, the severity of the penile defect and erectile function. Medical therapy has been ineffective.

Surgical therapy is employed when there is a significant penile defect preventing sexual relations. Patients with concomitant erectile dysfunction should undergo therapy for the erectile dysfunction first. Patients with bent erections who have been stable for more than six months and prevent sex undergo penile-straightening surgery. This an outpatient procedure with a recovery time of less than one week. The exact method of straightening the penis is determined by the site and severity of the curvature as well as the penile anatomy assessed by penile ultrasonography.

Extracorporeal shock wave Therapy (ESWT)

Low intensity shockwave treatment is used to break up the abnormal scar tissue in the penis. When these waves are directed into the plaque, they can cause the plaque to break down mechanically. The targeted shock waves also aid in the promotion of blood flow to the plaque-affected area, which supports the formation of specific blood cells called macrophages, which lyse or “digest” the plaque.

During the acute or even the stable phase of Peyronie’s disease, ESWT is the most effective treatment for the pain associated with the disease.

Typically, 4-6 sessions are needed to effectively control this condition.

 

When ESWT is used to rectify the bend in the penis, several doctors have noticed an improvement in the curvature of the penis

 

Platelet Rich Plasma Therapy (PRP)-PShot

 

A sample of your blood is spun down in specialised tubes in a centrifuge to produce PRP, a specific golden extract rich in growth factors. Platelet rich plasma, a concentrated blood extract, is then injected into the scar or painful area.

 

The injections aid in lowering the inflammation and promoting tissue repair. PRP is already used by athletes to speed up the recovery from sports related injuries. PRP is also currently being utilised to treat erectile dysfunction and other male sexual health issues.

 

Research indicated that PRP can reduce plaque size by 50%, enhance penis curvature by 50%, and lessen the pain by 80%.

 

Vacuum Erection Device or Traction Device
A vacuum erection device consists of a cylinder connected to a pump. When the equipment is switched on, it creates a suction that draws blood into the penis. This is a specific penis lengthening and straightening device that is worn for 6-9 hours every day.

 

Surgical
Surgery is indicated only in extreme situations.When the Peyronie’s disease has stabilised and the abnormal curvature has reached its peak and is not progressing further may surgery be performed, indicating that the disease is in its chronic phase.

Patients with concomitant erectile dysfunction should undergo therapy for the erectile dysfunction first. Patients with bent erections who have been stable for more than six months and prevent sex undergo penile-straightening surgery. This is an outpatient procedure with a recovery time of less than one week. The exact method of straightening the penis is determined by the site and severity of the curvature as well as the penile anatomy assessed by penile ultrasonography.

 

Prognosis:
The progression of Peyronie’s disease varies among individuals. In most of the cases,symptoms will improve with intervention .

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