Peyronie’s disease is a condition characterized by the formation of fibrous scar tissue, known as plaque, within the penis. This plaque can lead to a range of issues, including curvature, pain, and other deformities during an erection. The scar tissue is inelastic, unlike the normal tissue of the penis, which causes the changes in shape. Understanding how this condition progresses through its distinct stages is important for effective management.
The Acute Stage
The acute stage of Peyronie’s disease is marked by active inflammation and the ongoing formation of plaque within the tunica albuginea, the fibrous sheath surrounding the erectile bodies of the penis. During this period, individuals may experience pain, which can occur both with and without an erection. This discomfort is thought to be due to the active inflammation in the developing plaque.
A noticeable and often worsening curvature or indentation of the penis is a common characteristic of this phase. The scar tissue is still forming and potentially expanding, leading to unpredictable changes in penile shape, length, or girth. Some men may observe an “hourglass” deformity or other abnormal bends.
This acute stage lasts between 6 and 18 months. During this time, the disease is still developing, and symptoms may progressively worsen.
The Chronic Stage
The chronic stage of Peyronie’s disease begins once the inflammation has subsided and the fibrous plaque has matured and hardened. This phase starts after 12 to 18 months from symptom onset, or when symptoms have been stable for at least 3 to 6 months. During this period, the plaque is no longer actively growing, and the penile curvature or deformity becomes fixed.
Pain associated with erections lessens significantly or resolves completely during the chronic stage, although some individuals may still experience discomfort, especially during an erection. The hardened plaque, which can sometimes calcify, does not stretch like normal tissue, resulting in a stable and permanent curvature. This fixed deformity can lead to erectile dysfunction, as the plaque can interfere with the penis’s ability to fill adequately with blood or cause buckling during intercourse.
Treatment Approaches Based on Stage
The stage of Peyronie’s disease plays a primary role in determining the most appropriate treatment decisions. In the acute stage, the focus is on reducing inflammation, alleviating pain, and preventing the progression of the curvature. Treatment involves non-surgical interventions aimed at stabilizing the condition.
Oral medications, such as tadalafil or pentoxifylline, may be used to improve blood flow and reduce inflammation, though their direct impact on curvature is limited. Intralesional injections, where medication is directly injected into the plaque, are another option; examples include collagenase clostridium histolyticum, verapamil, or interferon. Penile traction therapy can also be used in the acute phase to help prevent length loss and limit curvature progression.
For the chronic stage, when the plaque is stable and pain has resolved, treatment shifts towards correcting the fixed curvature and restoring sexual function. Non-surgical options, such as continued traction therapy, may still be considered for milder cases or as an adjunct to other treatments. Surgical interventions are recommended for more severe and stable deformities that significantly impact sexual activity.
Surgical procedures include plication, which shortens the unaffected side of the penis to straighten it, or grafting, where the plaque is removed and a tissue patch is used to lengthen the curved side. For men who also experience severe erectile dysfunction, a penile implant may be recommended, as it can help both achieve an erection and straighten the penis. The choice of surgical approach depends on the degree of curvature, penile length, and erectile function.