Penis Problems - Treatment

Peyronie's Disease

Although a variety of treatments are available, there isn’t a cure for Peyronie’s disease. If the lump doesn’t cause a problem with erections or prevent normal intercourse, nothing further is necessary. Spontaneous regression and disappearance of Peyronie's disease and all of the symptoms occasionally occurs in 10% of patients (10%).

Although rarely successful, vitamin E and Potaba are frequently used to treat Peyronie’s disease. Potaba is a prescription medication that is in the vitamin B family. Potaba allegedly decreases scar tissue by increasing tissue oxygenation. Potaba is available in 500mg capsules or tablets or 2 gm Envules. The recommended dose is 12 grams of Potaba in divided doses of 2 grams each with water and taken with food. Side effects may include gastrointestinal upset, fever and rash. Vitamin E is an over-the-counter antioxidant that theoretically decreases scar tissue via its anti-inflammatory properties. Vitamin E 400 I.U. should be taken once daily with food. Taken as directed, Vitamin E is safe. Trental (Pentoxifylline) is a prescription medication that improves vascular flow to peripheral tissue. Trental may improve penile curvature caused by Peyronie’s disease. Trental is dosed 400mg three times daily. You should check with your physician or pharmacist before taking Trental if you have a history of impaired renal function or if you have other medical conditions or are taking prescription medication. A medication called Verapamil can be injected into a Peyronie’s plaque to soften the plaque. Verapamil allegedly decreases collagen formation. Collagen forms scar tissue. Verapamil may decrease penile curvature and penile pain caused by Peyronie’s disease. Other treatments that have been recommended or tried in the past include steroid injections into the plaque and ultrasonic and lithotripsy procedures to soften the plaque. None of these treatments have been particularly effective. Taking an anti-inflammatory drug such as ibuprofen may decrease penile pain caused by Peyronie’s disease.

More invasive surgical treatments depend on the extent of the disease and the amount of symptoms. As a rule, surgical intervention should be postponed until the plaque has stabilized and conservative measures have been tried. It generally takes 12 to 18 months for the plaque to mature. Additional studies such as duplex penile Doppler studies should be considered prior to proceeding with surgical correction of Peyronie’s disease. Duplex penile Doppler studies can determine whether there is sufficient blood flow to generate a normal erection and whether the plaque is calcified.

If the penile curvature is so severe that intercourse is impossible, surgical treatment is a reasonable option. A Nesbit procedure is a minimally invasive surgical option. A Nesbit procedure is performed as an outpatient procedure in the hospital. The foreskin is mobilized and then an artificial erection is performed to identify the point of maximum curvature. Sutures are placed on the side of the penis opposite the plaque. During an erection, the sutures offset the curvature caused by the plaque. Penile shortening is the main side effect of a Nesbitt procedure. For more severe penile curvature (greater than 90 degree of curvature) the plaque is usually incised (cut) or removed to straighten the penis, and artificial or autologous graft material is sewn over the defect. Recurrent curvature or erectile dysfunction are possible complications of plaque incision or removal with grafting. If a patient is already suffering erectile dysfunction, a penile prosthesis is often placed at the same time of plaque incision or removal.

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Penile Cancer

Once penile cancer is confirmed, surgical excision is usually performed. The extent of the surgery depends upon the severity of the disease. Lesions that are detected early and that are confined to the skin surface may be treated by laser surgery or less invasive surgery. Radiation therapy and chemotherapy is occasionally used to treat penile cancer.

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