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I
have problems with penile curvature (Peyronie's disease). What will an
evaluation include?
(more
FAQs below)
If your penis has developed a curvature, this may be the result of scar
tissue having formed. This may effect the quality of your erections.
A first appointment should typically be between 45 and 60 minutes. It
should include:
· History: Your physician will
first take a history. He will particularly focus on whether you have had
any history of penile trauma. He will also ask for any other medical conditions
you may have which may make you more likely to have developed this problem.
He will need to know when the curvature began to develop. He will also
ask you to quantify the curvature. It may
also be very useful to take a Polaroid picture both from the side and
from the top while erect as possible as this will give important visual
information about the amount of curvature you have developed.
You will also need to have an idea as to how much the curvature
is getting in the way of your successfully having intercourse. You will
also need to have a feeling as to how much, if any, the rigidity of your
erections have been altered.
· Physical Examination: Your
physician will then do a focused physical examination on the penis and
testes. Specifically, your physician will be looking for evidence of scar
tissue on the penis. You may even be able to feel this yourself by squeezing
your penis gently through your fingers along its length and seeing if
there are any hard nodules in the penis. The physician will also check
the sensation of your penis with a biothesiomer (a test which measures
how intense vibrations need to be for you to sense them.)
· Laboratory Testing: Your
physician will usually check some of your hormone levels by taking blood
from your arm.
· Treatment: Your physician
will usually begin conservative treatment if you have presented within
six months of developing a curvature. The natural history of this curvature
is that 1/3 of them will resolve, 1/3 of them will stay constant, and
1/3 of them will progress. The curvature needs to be stable for a total
of six months before a final treatment can be determined. Also, any pain
that you may have been having with erections, (which often comes with
the development of a curvature) must be stabilized before you can begin
treatment.
Your physician may start you on Potaba. He may also start you on Vitamin
E and/or Vitamin E oil. Some physicians are currently using more experimental
techniques. These may include injecting the plaque with certain substances,
taking oral colchicine, or attempting to keep the penis straight by using
a vacuum erection device to create erections.
· Definitive Treatment: Once
the curvature has stabilized for six months and there is no pain in the
penis or with erections, the determination of treatment can begin. This
will be determined by two factors. First, your physician will assess the
amount of curvature you have. Many men are born with small amounts of
curvature that cause them no problem. Even a fair amount of curvature
may still enable successful intercourse without discomfort to either partner.
Thus, the presence of a curvature does not necessarily mean that an operation
is warranted. Some men do have such significant curvature that it is difficult
to penetrate successfully and without discomfort to one or both partners.
These curvatures need treatment.
Second, the degree of erectile dysfunction that the patient has, separately
from the curvature, must also be assessed. Many men have preexisting moderate
amounts of erectile dysfunction. The scar tissue that causes the curvature
may cause a worsening of erectile dysfunction. There is no point in straightening
out the penis if the surgery will not result in rigid erections that are
adequate for penetration. Thus, the erectile dysfunction and whether or
not it can be treated (separately from the problem of the curvature) must
also be assessed.
Once these two parameters have been assessed adequately, the decision
can be made. See the chart below in terms of the various decisions.
Erectile Function
(Adequate rigidity obtained and maintained)
YES - No treatment necessary.
NO - Treat like all patients with erectile dysfunction.
Curvature
(Successful intercourse without pain obtainable
with this degree of curvature)
YES - Consider surgery tocorrect curvature.
NO - Consider implantation of a penile prosthesis and straightening at
the same time.
If there is reasonable erectile function, (adequate rigidity obtained
and maintained) as well as a curvature that is not significant enough
to prevent comfortable intercourse, then only conservative treatment is
necessary.
If there is a significant curvature, making intercourse uncomfortable,
but there is adequate erectile function, then surgery may be considered
to correct the curvature of the penis.
If there is significant erectile dysfunction but a curvature, which is
not significant enough to prevent intercourse, then the patient will be
treated like all patients with erectile dysfunction.
If there is significant erectile dysfunction as well as significant curvature,
the patient can consider an implantation of a penile prosthesis and straightening
at the same time.
The evaluation of penile curvature (Peyronie's disease) is a very sophisticated
one. Deciding on the appropriate treatment can involve difficult decisions.
Once a plan of treatment is determined, there is a significant amount
of expertise that is taken in performing the various surgeries involved
in correcting the curvature. It is truly advisable to see a specialist
when facing these decisions.
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