The course of Peyronie's disease varies from patient to patient. It may stabilize and evolve no further, usually after subsidence of the inflammatory stage. Usually within 3 to 6 months, the disease will run its course. Certainly this would be an ideal time for initiation of more conservative measures such as Vitamin E or intralesional injection of Verapamil. Other methods described have included the use of Collagenase, steroids, and ultrasound therapy. In general, medical therapies tend to soften the plaque and reduce pain, but are less efficaceous with correction of angulation. Verapamil injections have been recently challenged as being no more effective than simple sterile saline injections, and the mechanism of action has been postulated to be a multitude of needle sticks breaking up the plaque.
Verapamil cream may be helpful, but no meaningful statistical data relating to correction of curvature has yet to be confirmed.
As surgical procedures are not indicated when there is a process in evolution, it would be wise to postpone such procedures until a period of stability has been achieved for 3 months, and regardless certainly no sooner than 6 months following onset. Clearly surgery is not absolutely necessary when the bend does not interfere with penetration.
When indicated, surgical option include:
A. Contralateral plication (shortening of the normal side). This approach has the advantage of lower incidence of erectile impairment. Candidates for plication include men whose stretched penile length is satisfactory, men with borderline erectile performance, older men, and smokers who have higher incidence of latent erectile impairment.
B. Removal or incising the offending plaque with graft insertion restores length to the affected side. This approach is best suited for potent men with severe penile shortening as a result of Peyronies often associated with a extreme curvature (i.e. greater than 60 degrees). Patients who undergo plaque release surgery must be counseled that at times because of insinuation of the plaque into normal tissue (spiculation), its entire removal may not be advisable. Following surgery, there may be a reduction or transient loss of normal sensation. This usually resolves in 6 months, as peripheral nerves have remarkable powers of regeneration. Cadaveric pericardial grafts in our practice have replaced venous patch grafts. Their compliance has been an invaluable asset to restore length. When compliant grafts are used to circumferentially replace fibrotic tissue, length gains up to 3" have been reported over 18 months using a vacuum erection device.
Patients who have simultaneous erectile impairment in Peyronie's disease are ideal candidates for simultaneous insertion of a penile prosthesis and lysis of the plaque. (Reference: Reed, H.M.; Simultaneous Inflatable Penile Prostheses Insertion and Corporoplasty for Septal Chordee Attributable to Peyronie's Disease. Annals of Plastic Surgery, 31:154-158, 1993)
Comprehensive surgical fee for the correction of Peyronie's which does not include adjunctive penile lengthening or prosthesis surgery is $6,200.00. If performed with insertion of Tutoplast graft for restoration of length and correction of curvature, $7,700. Consultation is $250.
Most insurance companies will fund for evaluation and treatment of Peyronie's disease. Please check with your carrier for an explanation of your benefits.