Peyronie’s Disease – What is It?
Peyronie’s disease is an issue with the connective tissue in a man’s penis that leads to the growth of plaque or hard calcifications and/or the build-up of scar tissue in the corpora caverosa (the two cylinder-like structures that run the length of the penis). These plaques cause the penis to curve in different directions or to look bent, and can also cause loss of girth, shortening of the penis, and even pain. Depending on where the plaque forms, the penis will either bend upward or downward. Peyronie’s disease often makes it very difficult, or even impossible, for a man to have intercourse.
Medical Treatment for Peyronie’s Disease
Medication is injected directly into the area where the plaque has formed to reduce the plaque as well as diminish pain and curvature of the penis.
- Xiaflex is an FDA approved nonsurgical treatment for Peyronie’s disease. This medicine works by decreasing the plaque that causes the curvature of the penis. Xiaflex is approved for use in men with plaque in the penis that causes a curvature of at least 30 degrees during erection. The injections are given in the doctor’s office and most men receive up to four treatments.
Surgical Treatment for Peyronie’s Disease
Surgery remains the gold standard for treating Peyronie’s disease. Dr. Kramer performs a Peyronie’s disease penile implant which includes:
- Ventral phalloplasty:
- Every patient is offered a plastic surgery closure of the scrotum. The closure of the skin between the penis and scrotum is performed in a cosmetically pleasing manner so that the attachment point is as low as possible in the scrotum. This maximizes the length of the penis.
- The skin closure is performed with dissolvable sutures (not staples) in the midline of the scrotum which makes the incision essentially invisible.
- A drain is typically not used.
- Tip placement is maximized, making the penis point straight rather than the downward sloping and leaning penis that may be seen in alternate techniques where the tip of the implant ends up being too short. The implants completed by Dr. Kramer are straight.
Penile Implants for Peyronie’s Patients
In placing a penile implant, a Peyronie’s disease plaque can cause a few distinct challenges:
- It could be intrinsic to the corpora (erectile body) within the lumen. In this scenario, the plaque may be filling the space within the corpora where the normal, spongy smooth muscle should be.
- The plaque can be on the perimeter or attached to the outside wall of the corpus cavernosa. This plaque will cause the penis to curve and bend, but will not be a challenge when trying to dilate the corpora.
The plaque within the corpora, known as corporal fibrosis, can cause penile deformities, penile curvature, and ED. Dr. Kramer’s methods can be seen in his many videos showing how he manages the tough plaque and fibrotic tissue to get the tips where they need to be. In cases where the plaque is along the outside of the corpora, then modeling must often be done once the device is placed to straighten the penis.
Modeling is a procedure employed in about 10-15% of Dr. Kramer’s penile implant procedures. Modeling is bending the penis with the prosthesis inflated to straighten it. Different options can be pursued during surgery depending on the degree of curvature. These include manual manipulation of the penis, placement of graft material, or plication.
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