Restore Comfort, Function & Confidence
Peyronie’s disease is a condition in which scar tissue develops within the penis and can cause curvature, narrowing, indentation, shortening, pain, or difficulty with sexual activity. Some men first notice a firm plaque beneath the skin, while others notice that the shape or rigidity of an erection has changed.
At East Coast Advanced Urology in Clifton, NJ, Dr. Karl Coutinho evaluates Peyronie’s disease as part of a comprehensive men’s health and reconstructive urology practice. Treatment is individualized according to the deformity, whether the condition is active or stable, erectile function, discomfort, and how much it interferes with sexual activity.
Peyronie’s disease develops when abnormal scar tissue, called a plaque, forms within the tissue surrounding the erectile chambers of the penis. Because the scarred area does not stretch normally during an erection, the penis may bend or develop another change in shape. During an active phase, the deformity may still be changing, and pain may occur; stable disease means the deformity is no longer changing.
Symptoms may include:
Evaluation includes when the changes started, whether the deformity is still changing, pain, erectile quality, previous treatment, and how the condition affects sexual activity. When treatment decisions depend on the exact deformity or erectile function, Dr. Coutinho may evaluate an erection in the office after medication is injected into the penis. Penile Doppler ultrasound can be added when information about penile blood flow would help guide treatment.
Not every patient needs a procedure. Treatment depends on whether the disease is active or stable, the amount and type of deformity, erectile function, pain, and individual goals.
Some men with mild deformity and satisfactory sexual function choose observation. Penile traction therapy may be considered in selected patients to help address curvature or loss of length, although improvement varies and regular use is required.
For appropriately selected men with stable disease, curvature greater than 30 degrees and less than 90 degrees, and adequate erectile function with or without medication, collagenase injections into the plaque may be considered to reduce curvature. Bruising, swelling, pain, and, rarely, a tear of the erectile tissue can occur.
Plication straightens the penis by placing sutures on the side opposite the curvature. It can be effective for selected men with adequate erectile rigidity. One tradeoff is the possibility of perceived or actual loss of penile length.
For selected patients with more complex deformity, severe curvature, narrowing, or an hourglass-type defect who still have adequate erectile function, the plaque may be incised and the defect covered with graft material. This is a more complex reconstruction and can carry a greater risk of postoperative erectile dysfunction than plication.
When Peyronie’s disease occurs together with erectile dysfunction that does not respond adequately to nonsurgical treatment, an inflatable penile prosthesis can address rigidity while also allowing the deformity to be corrected. Additional straightening maneuvers can be performed during implant surgery when needed.
Current guidance from the American Urological Association does not recommend oral vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or vitamin E combined with L-carnitine for Peyronie’s disease. Shockwave therapy should not be used to straighten the penis or reduce plaque size, although it may have a limited role for penile pain in selected patients.
Your Guide to Post-Peyronie’s Disease Care
Recovery depends on treatment. Injection therapy generally requires temporary restrictions after each session, while reconstructive surgery requires a longer healing period.
Dr. Coutinho will provide individualized instructions regarding activity and return to sexual activity.
The cost of Peyronie’s disease treatment in Clifton, NJ, and the greater New York metropolitan area depends on the care required. Office evaluation, penile Doppler ultrasound, injection therapy, and surgery may each have different insurance requirements and costs. The office can help review your benefits and explain any anticipated financial responsibility.
Dr. Karl Coutinho is a fellowship-trained reconstructive urologist with additional focused training in genitourinary prosthetics and reconstruction through Perito Urology. His practice includes penile Doppler evaluation, erectile dysfunction treatment, reconstructive surgery, and inflatable penile prosthesis placement, allowing both penile deformity and erectile function to be evaluated together.
This background allows treatment to be selected based not only on the degree of curvature, but also on erectile rigidity, penile anatomy, and the reconstructive considerations that may influence which approach is appropriate.
East Coast Advanced Urology
If you have developed penile curvature, narrowing, indentation, pain, loss of length, or difficulty with sexual activity, schedule a consultation with Dr. Karl Coutinho at East Coast Advanced Urology in Clifton, NJ. Dr. Coutinho welcomes patients from throughout the greater New York metropolitan area.
Contact the office to schedule your consultation.