• Peyronie's Disease
Peyronie's Disease (PD) is a common pathology between men from 40 to 65 years old, which causes a tortuosity in the penis, making it difficult and sometimes even invalidating sexual intercourse. Although the prevalence is bigger in patients over 40 years, it's more common nowadays the diagnosis with younger patients. It's observed that the Peyronie's Disease causes a large impact in the life quality of the patients, with large psychological effects. The PD corresponds to the presence of fibrous plaques in the tunica albuginea of the corpora cavernosa. These boards have varying sizes and positions, from minor and therefore difficult to understand, to large and multiple that compromise almost every tunica albuginea.
In some cases, the onset is acute, with pain during erections or the perception of palpable plaques accompanied by penile deformity. For other patients, the onset is slower and the deformity will accentuating gradually as fibrosis of the corpora cavernosa which can progress to calcification. There is a prevalence of Peyronie's disease in diabetic patients.
The origin of this calcification is not defined exactly, but can be attributed in part to small and repeated traumas occurring during sexual intercourse, micro trauma during nocturnal erections or direct trauma in individuals who have some pre-disposition. A common symptom is the appearance of a lump that can be felt under the skin of the penis causing an erection quite painful and sometimes leaving the head of the penis loose. As this disease is progressive, it becomes necessary to make it a treatment as soon as possible. In the acute phase, it is characterized by pain, painful erections, penile curvature during erection and palpable board during the physical examination.
The Peyronie's Disease (PD) may be treated in first option with clinical treatments. In certain cases, may be necessary the surgery when the PD leads to a penis' curvature which prevents or compromises a vaginal penetration and the disease that is stable for 6-12 months.
It's only thought of surgery when the clinical treatments do not have success and the patients continues to have difficulty in having relations and after the stabilization of the penis deformity (bend, constriction or indentation and thinning) and the plaque(s) along with the pain disappeared when the penis becomes erect for at least 6 months.
The curvature is always related to the penis size difference of one side and the other. To correct this difference there are two alternatives: either shorten the longer side or lengthen the short side which requires the use of grafts. The technique shortens the short side is called plication or type Nesbit procedure and should be used in patients who have the penis with adequate penile size. Decreasing the size of the penis depends on the expected direction of the degree of curvature that the patient has. After surgery the patient should return to sex, according to medical guidelines so as not to damage the penis again, that is, will be a gradual return. This type of surgery does not usually cause erectile dysfunction to be the least invasive of all.
The technique for lengthening short side should be used in patients who have concerns about the penis size or the curvature is too sharp. The part where the incisions removed and the plates were made must be covered with tissue. This type of surgery is more reserved for patients who have major deformities of the penis, but they have good quality erection despite the deformity since it presents greater risks cause erectile dysfunction than the technique of plication. This stretching technique also results in opening of the tunica albuginea covering the cylinder therefore responsible for erection is a technique that should only be done by very experienced specialists.
The implantation of penile prosthesis in patients with dysfunction Erectile complete and DP offers cosmetic and functional results similar to other patients with erectile dysfunction that requires prosthesis implantation.
According to the Consensus of 2005 SBU, shock wave therapy is not recommended as "Because there have been studies showing positive results, shock wave therapy should not be given or used until arise positive evidence in relation to its result".
Studies show a prevalence and significant association between erectile dysfunction and Peyronie's disease. Some men with Peyronie lose the ability to keep blood in the penis and it cannot get a good erection. The fact that the man did not have a sufficiently rigid erection unfortunately allows the penis to bend during sex increases the chances of micro-traumas. There is always the need to deal with the problem Peyronie DE if any, preventing such injuries.