The penis consists of three tubes: the hollow urethra that carries urine and semen, and two soft, spongy tubes called corpora cavernosa that fill with blood to harden the penis in an erection. All three are encased in a tough fibrous sheath called tunica albuginea, which, when the plaque is formed, makes the sheath less flexible. Depending on the location of the plaque (in 70 percent of cases, it forms on the upper part of the penis), it can cause the penis to bend up, down or to the side when it becomes rigid. Sometimes, the plaque forms around the penis, creating a narrow band like the neck of a bottle.
Heredity and certain connective tissue disorders such as Dupuytren's contractures increase the risk of developing Peyronie. Elevated blood sugar, smoking and pelvic trauma also increase the risk. The disease can develop gradually or appear suddenly. It occurs in two phases: acute and chronic. The acute phase, which often causes painful erections, lasts between 6 and 18 months, during which the plaque is formed and the deformity of the erect penis worsens. In the chronic phase, the pain ends, the plaque stops growing and the deformity stabilizes.
Mr. Cummings's doctor told him it was good that he went to treatment early, before the plaque calcified and was harder to treat. As he described it, the many verapamil injections made holes in the plate, "changing it from Cheddar to Switzerland" and making the penis more flexible. He also spent hours a day stretching his penis with a traction device called Andropenis, a penis extender approved by F.D.A.
This and other similar devices can help lengthen a Peyronie-shortened penis and encourage a more straight-forward remodeling as the plaque is replaced with healthy collagen.
"Xiaflex is not a miracle drug," said Dr. Mills. "The trial that led to F.D.A. the approval saw a 35 percent improvement in the curvature, although we are seeing a decrease of about 50 percent. I tell patients that you will never regain the penis you had, but you can get a functional penis & # 39; , which is what most men want. "Rarely, the problem is corrected only without treatment.
Severe cases that do not respond adequately to injections can be treated surgically, an option usually reserved for men with disabling deformities that hinder sexual activity. The surgery is not performed until the plaque and curvature have stabilized. Options include shortening the side of the penis opposite the curve or extending the curved side by filling in with a graft, a more challenging approach.
Some men with Peyronie's disease who also have erectile dysfunction can be equipped with an inflatable pump or with malleable silicone rods that smooth the penis and make it rigid enough for penetration.