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++++++++++++++++++++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: MEN'S HEALTH ❯ Treating ED Resulting from Peyronie's Disease Treating ED Resulting from Treating ED Resulting from Treating ED Treating ED Resulting from Treating ED Resulting from Treating ED Peyronie's Disease Resulting from Peyronie's Disease P E Y R O N I E ' S D I S E A S E I S t h e presence of a plaque or scar in the penis resulting in erectile deformity. It occurs in as many as 9 percent of middle-aged men. 1 Peyronie's disease occurs at a time in a man's life when erectile rigidity, while suitable for vaginal intromission, is less than it used to be, for example 7/10 rather than the normal 10/10 rigidity of a young man's erection. While 7/10 may be the average rigidity for some middle-aged men, this degree of rigidity is not always maintained throughout coitus. This subjects the penis to bending forces during thrusting, which can lead to delaminating injuries of the elastic tunica albuginea covering the erectile chambers. Healing of these injuries results in inelastic scar (plaque) which causes shortening of the erection as well as bending or hour glass deformities. The most common deformity is erec- tile curvature, which can be so severe that coitus is not possible. The goal of treatment is to straighten the penis and to have an erection which is sufficiently rigid so that further injury is not likely. In addition to assessing the degree of deformity, the ability of the man to attain and maintain an erection is also assessed. A trial of a PDE5 inhibitor (sildenafil, vardenafil or tadalafil) to see if the patient is a responder in terms of firmer, better-maintained erections is often done. If the patient is a responder, a tunica albuginea plication (TAP) procedure, which shortens the normal side of the penis opposite the point of maximum curvature is often recom- mended. The advantage of this procedure is that worsening of underlying erectile dysfunction (ED) is not likely. Ma ny men would like to have a straight penis as well as to regain lost penile length. Regaining some lost length is possible through procedures that straighten the penis by incising or removing penile plaque and placing a tissue graft. Unfortunately these grafting procedures can result in worsening of erectile function in 50 percent of cases. 2 In men with ED who do not respond to PDE5 inhibitors, inflatable penile prosthesis implantation is often advised. This operation, along with modeling or bending of the penis under anesthesia with the cylinders inflated, results in a straight penis with a 10/10 prosthetic erec- tion, which will prevent further injury. 3,4 In summary, Peyronie's disease is com- mon in middle-aged men, occurring in as many as 9 percent. It is linked to ED or erectile insufficiency, which causes penile injury. If coitus is difficult or impossible, surgical treatment should be considered. Goals in treatment should be to provide a straight penis with sufficient rigidity to prevent further injuries. Dr. Drogo K. Montague is a staff urologist at Cleveland Clinic, Glickman Urological & Kidney Institute. ■ References 1. Mulhall, J. P., Creech, S. D., Boorjian, S. A. et al.: Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol, 171: 2350, 2004 2. Flores, S., Choi, J., Alex, B. et al.: Erectile dysfunction after plaque incision and graft- ing: short-term assessment of incidence and predictors. J Sex Med, 8: 2031, 2011 3. Wilson, S. K., Cleves, M. A., Delk, J. R., 2nd: Long-term followup of treatment for Peyronie's disease: modeling the penis over an inflatable penile prosthesis. J Urol, 165: 825, 2001 4. Montag ue, D. K., A ngermeier, K. W., Lakin, M. M. et al.: AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie's disease: comparison of CX and Ultrex cylinders [see comments]. J Urol, 156: 1633, 1996 By Drogo K. Montague, MD 1 8 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ S E P T E M B E R /O C T O B E R 2 0 1 5