A patient in his 60s was diagnosed with Peyronie disease and, after considering his options, decided to postpone treatment.
His pain resolved in the two years after the diagnosis, but when the disease began to make intercourse uncomfortable for his wife, he knew he was ready for treatment. The patient presented to Duke urologist Aaron Lentz, MD, with 45 degrees of upward, dorsal curvature of his penis.
There are typically four options for treating Peyronie disease:
- Plication, in which sutures are used to straighten the erection, shortening one side of the penis to make the other side symmetrical
- Grafting, in which scar tissue is removed and replaced with graft material
- Penile implant, which expands the penile tissue and stretches and straightens the penis, correcting both erectile dysfunction and Peyronie disease in one procedure
- Injections of collagenase clostridium histolyticum, an enzyme that breaks down two predominant types of collagen found in Peyronie plaque
Question: Which treatment did Lentz and the patient select and why?
Answer: Lentz and the patient selected injections of collagenase clostridium histolyticum. “Plication is the simplest procedure to perform, with a low risk of complications, but men with Peyronie disease often have lost penile length and plication can cause more loss of length,” Lentz explains. “Grafting is typically used only in cases of severe curvature, and the penile implant is a good option for men who also have underlying erectile dysfunction. This patient wanted to avoid surgery and did not have erectile dysfunction, so the injections were the optimal course of treatment for him.”
The treatment requires eight office visits over a period of four months, and between injections, patients perform gentle stretching and straightening activities to help reduce the curvature. The patient completed all eight injections and experienced a profound improvement—the most significant Lentz has ever seen. “We don’t yet know if the improvement will last forever,” Lentz notes, “but we have found that if a patient has a positive response initially, the long-term prognosis is good.”
Peyronie disease can occur in men of any age, and because many remain sexually active well into later life, more and more older men are experiencing the frustrations it causes, with or without other symptoms.
“With this disease, we first try to figure out whether it affects a patient’s sexual function, causes painful or difficult intercourse, or reduces the quality of erections,” says Lentz. “For this patient and many others, the curvature was getting in the way of an enjoyable sexual experience with his wife and was affecting his quality of life, which is just as important as any other symptom.”
For many men, the disease changes over time but never completely goes away. Lentz reports that new studies are showing that it may make sense to start treating men early in the course of Peyronie disease: “There are two phases of the disease—the acute or active phase, which lasts for about six to 18 months, and the chronic or stable phase. In the past, urologists waited for the second phase before starting treatment, but we’re now learning that intervening earlier may stop or reverse the disease before it worsens.”