Frequently Asked Questions

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Peyronie's disease is a condition characterized by the development of fibrous scar tissue, or plaques, within the penis, leading to penile curvature, pain during erection, and potential difficulties with sexual function. The treatment for Peyronie's disease aims to address the symptoms and improve the quality of life of affected individuals. The choice of treatment depends on the severity of the condition, the presence of symptoms, and the impact on sexual function. Here are some of the treatment options for Peyronie's disease:

1. Observation: In mild cases where the curvature is not severe and does not cause significant pain or interfere with sexual function, the doctor may recommend a wait-and-see approach. The condition may stabilize or even improve on its own over time without any intervention.
2. Topical Medications: Verapamil, a calcium channel blocker, can be administered as a topical gel or cream directly on the affected area. Like oral medications, its efficacy is still a subject of debate.Medications: Certain medications may be prescribed to help manage the symptoms associated with Peyronie's disease. These may include:
   a. Pentoxifylline: This drug is believed to help reduce inflammation and decrease the formation of fibrous tissue.
   b. Potassium aminobenzoate: Although the exact mechanism is not well understood, this medication is sometimes used to manage symptoms.
   c. Collagenase clostridium histolyticum (Xiaflex): This is an injectable enzyme that can break down the collagen in the fibrous plaques, potentially reducing curvature. It is usually reserved for moderate to severe cases.
3. Mechanical therapy: Some devices, such as vacuum erection devices or penile traction devices, may be used to help straighten the penis and reduce curvature. These devices work by stretching the scar tissue over time. They may be used alone or in combination with other treatments.
4. Intralesional injections: Injections of medications, such as verapamil or interferon, directly into the plaques can sometimes be used to help soften the scar tissue and improve curvature.
5. Extracorporeal Shockwave Therapy (ESWT): ESWT involves the application of shockwaves to the affected penile tissue. It is thought to improve blood flow, reduce inflammation, and potentially break down the scar tissue. While ESWT shows promise, more research is needed to establish its effectiveness for Peyronie's disease.Surgery: Surgical intervention may be considered in cases where Peyronie's disease causes severe curvature, pain, or erectile dysfunction. There are different surgical procedures available, including:
   a. Penile plication: This procedure involves suturing the opposite side of the penis to straighten it and reduce curvature.
   b. Penile grafting: In cases of extensive scar tissue or severe deformity, a graft can be used to replace the damaged tissue and straighten the penis.
   c. Penile prosthesis implantation: If Peyronie's disease is associated with significant erectile dysfunction, a penile prosthesis can be surgically implanted to restore erectile function and straighten the penis.

It is essential for individuals with Peyronie's disease to consult with a  specialist experienced in treating the condition. Each treatment option has its own risks and benefits, and the choice of treatment will depend on the individual's unique circumstances and preferences. Additionally, early intervention and prompt medical attention can help prevent the progression of the disease and improve outcomes.

• Acute Phase (usually lasts 6-18 months):
  • Penile pain with or without an erection
  • Development or worsening of penile curvature
  • Presence of palpable nodules or plaques in the penis
  • Erectile dysfunction
  • Softening of the glans (tip) of the penis during an erection
• Chronic Phase:
  • Stabilization of penile curvature (no further progression)
  • Persistent or calcified plaques
  • Pain usually diminishes or resolves
  • Continued erectile dysfunction in some cases
  • Shortening or narrowing of the penis in some cases

Dr. Valenzuela at Peyronie's NYC  is board-certified and has completed extensive training and education in urology. He  has over 20 years of experience in diagnosing and treating urological conditions.

Peyronie's disease, also known as penile fibrosis or induratio penis plastica, is a condition that affects the penis, causing it to develop fibrous scar tissue, leading to curvature, pain, and sometimes difficulties with erections. The exact cause of Peyronie's disease is not fully understood, but it is believed to be a result of a combination of genetic, anatomical, and environmental factors. Some of the common conditions and causes associated with Peyronie's disease include:

1. Trauma or Injury: A significant number of Peyronie's cases are linked to penile trauma or injury. Repetitive microtrauma during sexual activity or an acute injury to the penis can lead to the formation of scar tissue in the tunica albuginea, the fibrous covering of the penile chambers.
2. Genetic Predisposition: There appears to be a genetic component to Peyronie's disease, as it sometimes runs in families. Specific genetic factors may increase the likelihood of developing abnormal scar tissue in response to penile injury or inflammation.
3. Connective Tissue Disorders: Some individuals with Peyronie's disease have an underlying connective tissue disorder, such as Dupuytren's contracture, which causes the thickening and contracture of tissues in the hand. These conditions may share common underlying factors.
4. Inflammation: Chronic inflammation in the penile tissue is thought to be a contributing factor to Peyronie's disease. Inflammation can be triggered by infection, autoimmune reactions, or other factors, leading to the formation of fibrous plaques.
5. Age: Peyronie's disease most commonly affects men between the ages of 40 and 60. As men age, the elasticity of penile tissues may decrease, making them more susceptible to injury and scar tissue formation.
6. Erectile Dysfunction (ED): Peyronie's disease can sometimes coexist with erectile dysfunction. The curvature caused by the fibrous plaque can interfere with blood flow within the penis, leading to difficulties in achieving or maintaining an erection.
7. Cavernosal Disorders: Conditions that affect the blood-filled chambers (corpora cavernosa) of the penis, such as priapism (prolonged and painful erections) or abnormal blood clotting, may increase the risk of Peyronie's disease.
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It's essential to note that while these conditions and causes have been associated with Peyronie's disease, the exact mechanism and interplay between these factors are still subject to ongoing research. If someone suspects they have Peyronie's disease or experiences symptoms such as penile curvature, pain, or difficulties with erections, they should seek medical advice from a urologist or healthcare professional who can provide an accurate diagnosis and appropriate treatment options. Early detection and intervention may help manage the condition more effectively.

Yes, at Peyronie's NYC  Dr. Valenzuela offers minimally invasive surgical options for the treatment of Peyronie's disease. These procedures often have shorter recovery times and less pain compared to traditional surgery:

1. Penile Plication:
   Penile plication is a surgical technique used to correct penile curvature caused by Peyronie's disease. During the procedure, the surgeon makes small incisions on the side opposite the plaque and then places sutures in the tunica albuginea to gather and shorten the tissue, effectively straightening the penis. This procedure is suitable for mild to moderate curvature and aims to preserve penile length as much as possible.
2. Penile Plaque Incision and Grafting:
   In cases where the plaque causing the curvature is located on the top (dorsal) side of the penis, the surgeon may perform an incision over the plaque. The incision allows access to the scar tissue, and the surgeon may either excise or release the plaque to reduce the curvature. Following this, a graft is often used to cover the incision and reinforce the tunica albuginea. The graft may be harvested from another part of the body, obtained from a tissue bank, or hemostatic Fibrin patches. 
3. Penile Plaque Excision and Grafting:
   Similar to the previous procedure, the surgeon removes the plaque causing the curvature. However, in this technique, the entire plaque is excised rather than being incised and released. After removal, the defect created is usually filled with a graft to restore the structural integrity of the tunica albuginea. The use of grafting aims to prevent excessive penile shortening and maintain as much length as possible.
4. Tunica Expansion:
   This surgical procedure involves making multiple incisions in the tunica albuginea on the side of the penis opposite the plaque. The incisions cause the tunica to expand, counteracting the curvature caused by the plaque. This technique can be effective for correcting mild to moderate curvature and is designed to preserve penile length.
5. Malleable or Inflatable Penile Prosthesis:
   Penile prosthesis are medical devices implanted into the penis to enable erections in cases of severe Peyronie's disease associated with erectile dysfunction. Malleable penile prosthesis are semi-rigid rods that are permanently firm but can be manually adjusted for sexual activity. Inflatable penile prostheses, on the other hand, consist of two or three interconnected components that can be inflated and deflated to simulate a natural erection. Penile prosthesis not only correct the curvature but also allow for an erect and functional penis.
6. Auxetic Cuts for Penile Length Preservation:
   The use of auxetic cuts is a relatively newer surgical technique for preserving penile length during curvature correction. The surgeon makes strategic cuts in the tunica albuginea to allow for expansion and elongation of the penis during erection. This approach aims to prevent further shortening caused by the plaque and maintain or improve penile length post-surgery.
7. Penile Length Restoration and Penile Lengthening:
   Penile length restoration procedures are considered when Peyronie's disease leads to significant penile shortening. These procedures aim to increase penile length while correcting curvature. Options for length restoration include penile grafting, as mentioned earlier.  
8. Penuma is a penile implant that was initially developed to increase penile length and girth, not specifically to treat Peyronie's disease. However, some physicians might suggest using a Penuma implant to address severe curvature issues associated with Peyronie's disease, especially if other treatments have not been successful.

Here's a brief overview of how it works:

The Penuma is a crescent-shaped piece of medical-grade silicone. In a surgical procedure, this implant is inserted into the penis between the skin and the corpora cavernosa (the tissues responsible for erections). The implant is designed to provide additional support and structure to the penis, which might help to reduce the curvature caused by Peyronie's disease.

There are potential benefits to using Penuma as a treatment for Peyronie's disease, but also several important considerations:

1. Benefits: The implant may help to straighten the penis and reduce the pain associated with Peyronie's disease. The Penuma implant might also increase penile length and girth, which can be beneficial for men who have experienced shrinkage as a result of Peyronie's disease.
2. Considerations: Penuma is a surgical treatment, so it comes with risks such as infection, changes in sensation, scarring, and dissatisfaction with the cosmetic results. There's also the possibility that the implant might not completely correct the curvature of the penis or could cause new complications.

Finally, it's worth noting that the use of the Penuma implant,  is not specifically FDA-approved for the treatment of Peyronie's disease. However, physicians may use approved devices and medications for off-label uses based on their medical judgment.

It's crucial to have a detailed discussion with a healthcare professional about the potential risks and benefits of using the Penuma implant for Peyronie's disease. This includes understanding alternative treatments available, such as oral and injected medications, traction devices, or other surgical procedures.