Peyronie's Disease

Peyronie’s Disease Frequently Asked Questions

 

How is Peyronie’s Disease Diagnosed?

An experienced doctor, specializing in Peyronie’s disease, will be able to diagnose Peyronie’s and the stage at which the disease is at, through an in person physical examination and a penis ultrasound test during which the plaques will be examined. Following a diagnosis of Peyronie’s, the doctor will recommend a treatment plan.

A very important aspect of the disease diagnosis, is to test the patient’s quality of erections given the high association between erectile dysfunction and Peyronie’s disease, which in turn affects the treatment protocol that will be recommended. Consequently, as part of the diagnostic consultation, your doctor will also perform a detailed evaluation of your erectile function.

We understand that a diagnosis of Peyronie’s can be very stressful for a man. One thing that should always be remembered is that irrespective of the stage and severity of the disease, there is always a treatment option as long as patients seek help from specialized doctors.

 

What Is The Progress Of Peyronie’s Disease?

 

Peyronies disease is a progressive disease and it has two distinct phases. From the onset and for about 12 months, Peyronie’s disease is in the so called acute phase, during which the size and morphology of the plaque continues to change. Because of these ongoing changes, the symptoms will also tend to change.

 

Unfortunately, for most patients the symptoms tend to become worse, however for a small minority they might improve and the plaque might even dissolve by itself – this happens to around 13% of patients. During the acute phase, a number of treatment options – referred to as conservative – are available and they mainly aim to alleviate some of the disease symptoms and to a certain degree prevent the disease progression.

After around 1 year from the onset of the disease, the plaque and the symptoms stabilize and all treatment options including surgery can be considered. Also after 1 year, the pain tends to go away for the majority of patients.

 

What Are the Treatment Options For Peyronie’s Disease?

 

There are various treatment options that have been tried for Peyronie’s disease – these fall under four broad categories (for more information, please refer to the dedicated webpages of each treatment option):

• Conservative treatment options such as oral medication, topical treatments and supplements – unfortunately to date none of these have proved to have a significant effect on reducing penile curvature or plaque size but some may help with pain management and potentially slowing the disease progress;
• Mechanical modelling – involves using a vacuum erection device and penile stretching and straightening exercises with the aim of reducing the curvature. Whereas on its own mechanical modelling is unlikely to be beneficial, it is essential to be performed after Xiapex injections or surgical correction of the penile curvature.
• Injection therapy with Xiapex – this is the latest treatment option available for Peyronie’s and the first non-surgical therapy that has proved effective in breaking up the Peyronie’s plaque. Since the introduction of Xiapex we have modified our treatment protocols and for most patients we recommend Xiapex as a first line of treatment (subject to certain contra-indications); and
• Surgical correction – before the introduction of Xiapex, surgery was the only effective treatment for penile curvature due to Peyronie’s and still remains the gold standard for most patients. There are various operating techniques but surgery should only be performed after the disease progress has stopped which usually occurs 12 months from onset (chronic phase).

Our Peyronie’s treatment protocol, in most cases, is a combination of these treatment options depending on a patient’s individual profile, the stage and the severity of the disease.

Although Peyronie’s is a dilapidating disease for patients, it is important to remember that nowadays it is treatable in the majority of cases and patients will be able to regain a healthy and functional sexual life.

 

Xiapex Injection for Peyronie’s Disease

 

Based on current scientific evidence, Xiapex is the only non-surgical treatment that has a significant impact on the peyronie’s plaque and on average leads to a 35% reduction in penile curvature – however, the results vary significantly from patient to patient with some patients experiencing even greater improvements.

 

How does Xiapex work?

The signs and symptoms of Peyronie’s disease are caused by a collagen plaque. Injection of Xiapex into a Peyronie’s plaque, which is comprised mostly of collagen, may result in enzymatic disruption of the plaque. Following this disruption of the plaque, penile curvature deformity and patient bother caused by Peyronie’s disease are reduced.

Our doctors have been trained exclusively to administer Xiapex injections and we have integrated this treatment option as a first line of treatment for Peyronie’s disease.

The results of our patients to date are very encouraging and in our opinion, this treatment option completely changes the landscape of peyronie’s disease management, allowing patients for the first time to start treating Peyronie’s disease from the onset of the disease.

 

What results can I expect?

Several clinical studies have established the effectiveness of Xiapex in breaking up the Peyronie’s plaque and reducing penile curvature. Based on the latest studies, on average, the curvature reduction was around 35% – for example if your curvature was 90 degrees then a 30% reduction would mean that after the treatment the curvature would be less than 60 degrees.

However, these figures are average. Our practical experience suggests that individual results vary significantly. We have seen patients with 60 degrees that had complete curvature correction even after 1 injection, whereas others that after 3 injections saw little improvement.

 

How soon will I see results?

Following a Xiaflex injection, your doctor will instruct you to start mechanical modelling for a month which increases the effectiveness of the injection.

Assuming that you follow the post-injection instructions, within a few days from the injection and over the next month you will start noticing a gradual reduction in your curvature.   

 

Am I a good candidate for Xiapex?

During your consultation, your doctor will evaluate whether you are a good candidate for Xiapex treatment. The patients with the following characteristics might not be good candidates:

• Suffering from severe erectile dysfunction;
• Curvature is more than 60 degrees;
• Have a ventral (downward facing) curvature;
• Their plaque is calcified; and
• Still experience pain.

Since Xiapex is a novel therapy, the Xiapex treatment protocols and candidate criteria are still being studied and might change in the future. For example, when Xiapex was first evaluated as a treatment option for Peyronie’s it was only tested on patients in the chronic phase of the disease. However, practical experience suggests that patients in the acute phase might actually derive more benefit from the treatment as long as they are appropriate candidates.

 

How many injections do I need?

This is also an evolving research area and the short answer is that the number of injections will depend on the effectiveness and evaluation of the result, post-injection, from your doctor. As mentioned, results vary significantly from patient to patient but your doctor should be able to evaluate whether the treatment is likely to work for you after 2-3 injections.

Our protocol usually involves 3 injections with a one-month interval between each, although some patients might only need one injection and others more. Initial studies suggest that after 8 injections, there is unlikely to be any further improvement of the curvature.

So in summary, the number of injections will usually be between 3 and 8 for most patients.

 

What should I do in between injections?

After each injection and for one month (until the next injection) you would need to follow a regime called penis mechanical modelling, which will increase the efficacy of the injection. The regime we propose to our patients is the following:

• Vacuum pump therapy twice daily for 10 min each
• Gradually pump penis (making sure you don’t over pump once it’s erect)
• Leave erection on for 30 sec
• Deflate and start again (5times)

 

• Penile stretching exercises – each time you go to the toilet, gently and gradually stretch the penis until maximum (10 times). Alternatively, a penile stretching device can be used for 4-8 hours (the longer the better) a day some patients find this difficult.

 

• Penile modelling – each time you have an erection, gently try to straighten the penis.

Your doctor will show you exactly how to apply mechanical modelling and will instruct you how soon to start after the injection.

 

Who will perform the Xiapex Injection?

Xiapex injections can only be performed by uro-andrologists that have received training specifically for administering and managing Xiapex.

 

Do I need to be hospitalized?

No. The injections take place in a consulting room, in an outpatient basis and consist of four steps:

1. Preparation of the medication
2. Injection of local anaesthetic and a drug that induces an erection
3. Injection of Xiapex
4. Penile modelling from the doctor

 

The whole process is minimally invasive and together with the doctor’s consultation takes around 45 minutes.

 

Are the results permanent?

Xiapex dissolves the plaque and the results are permanent. In some very rare cases, some patients develop new Peyronie’s plaques, which would also need to be treated.

 

Is the the injection itself painful?

The injection is performed under local anaesthesia and hence for most patients it is not painful.

 

Will there be pain after the treatment?

Normal swelling and bruising will develop after the injection and some patients might find this painful.  Pain can be usually treated with standard oral pain killers.

 

How soon after treatment can I have sex again?

Do not have sex or have any other sexual activity for at least 2 weeks after each injection with Xiapex and after any pain and swelling has gone away.

 

What if the treatment doesn’t work?

Most patients should see a significant improvement after a course of Xiapex. However, for some the residual curvature might still impede intercourse or bother them. In such cases, surgical correction of the residual curvature would need to be considered.

 

What are the potential complications of the Xiapex treatment?

Most adverse reactions are local events of the penis and groin and the majority of these events are of mild or moderate severity, and most resolved within 14 days of the injection. Most frequently reported adverse drug reactions (>25%) during the Xiapex clinical studies were penile haematoma, penile swelling and penile pain. The most severe complications was one incident of a penile fracture (<1%).

 

Surgical Correction of Peyronie’s Disease

The ​objective of the surgical treatment of Peyronie’s disease is 4-fold:

• Restore a straight penis and minimize any residual curvature
• Retain, restore or increase penis length and girth
• Retain or restore good erectile function
• Minimize the potential for any minor complication such as hematoma, reduction in penis sensibility etc.

The first step to successful treatment, is to choose the operating technique that is best for the individual patient. At International Andrology we have a deep specialization in Peyronie’s surgical correction, we offer ALL the surgical options and as such we will guide our patients to the one that will ensure the best possible result.

This requires evaluating the severity and complexity of the curvature, identify where the Peyronie’s plaques are located, whether the disease has resulted in severe penile shortening and the bother of the patient for this and finally whether the erectile function of the patient is good or not. Taking all these into account, you and your doctor will choose the optimum surgical treatment.

 

In summary, there are 3 main surgical techniques for Peyronie’s:

• Plication (penile shortening) surgical techniques
• Grafting (penile lengthening) surgical techniques
• Penile prosthesis implant

Irrespective of the surgical technique employed, all the operations performed in our clinic are minimally invasive, day-care and to-date we have reported a much higher success rate compared to that reported in medical publications. In particular:

• Our surgeons have deep specialization in Peyronie’s surgical correction having performed in excess of 1500 Peyronie’s operations
• Our success rate across our network of centres to date (meaning no severe complications, no curvature recurrence and patient satisfaction) is over 95% which is significantly higher than the experience reported in medical publications
• All the surgical techniques we offer are minimally invasive and day-care meaning that our patients can go home and function normally (excluding heavy physical activity) the very same day of their operation
• Based on the shared experience of our doctors, we have developed state of the art post-surgical follow up protocols that assist in achieving a speedy and complication-free recovery
• Our surgeons and patient co-ordinators are on call 24/7 and will continuously follow-up with our patients after their surgery so as to ensure their well-being

 

Which is the best surgical technique?

In general, we do not believe there are best techniques, but rather best surgeons. All the techniques we employ have been significantly improved by our surgeons and our success rates are very high and consistent irrespective of the technique.

All surgical techniques have advantages and disadvantages depending on an individual patient’s profile and the most important thing is that the appropriate technique is chosen, for the appropriate patient.

 

I am good candidate for surgical treatment?

Surgery was and remains the gold standard for the majority of Peyronie’s patients. However, as we explain in “Our Treatment Protocol” section we would suggest that less invasive treatments are considered first, before proceeding with surgery. Assuming that surgery is the indicated treatment option then there are no contra-indications except being healthy enough for general anaesthesia – this will be assessed by your doctor pre-operatively.

 

How long does the operation take?

All our Peyronie’s surgeries are day care and take between 1 and 2 hours of operating time. This means that the whole process (from admission to discharge from the clinic) is around 6 hours, after which you can return to your accommodation.

 

Do I need general anaesthesia?

Yes – the operation is performed under general anaesthesia. However, this need not worry you. Modern day care surgery requires light anaesthesia and since our operations are minimally invasive, it is very unlikely that there will be any issues.

Practically, you are put to sleep just before the operation starts and wake up just after the surgeon finishes – so in total you will be under anaesthesia for around 2 hours.

 

How long do I need to stay in the hospital for?

After the operation you would need to stay in the hospital for 3-4 hours. During this time, you will be attended by our nurse, eat something, get checked by your surgeon and then you will be ready to go home. You will be able to walk and function normally, usually with very little pain or discomfort.

 

I am travelling from abroad – how long do I need to stay for follow up after my surgery?

The next day after your operation you will have a follow up in office consultation with your surgeon to check that everything is fine. After that, most patients can travel although we recommend that you stay for a further 1-2 days so that you have further follow ups over the next few days with your surgeon but in most cases, this is not necessary.

 

What do I need to do to prepare for the operation?

Practically nothing – although following a healthy lifestyle (in terms of diet, exercise, smoking and alcohol consumption) the preceding month is advised since this will assist with the recovery. Moreover, you will be given detailed fasting instructions that you would need to follow 6 hours before the surgery. However, if you have fallen ill or there are any other recent health concerns make sure you inform your surgeon as soon as possible so as to evaluate whether the surgery would need to be post-poned to a later date. If there are any other things you would need to do pre-operatively then the doctor will inform you during your consultation.

 

What is the cost of the surgical treatment?

Surgical treatment costs will depend on the type of operation, the medical material used and the specific circumstances of each patient. Following your consultation and if you are a candidate for a surgical treatment an all inclusive cost will be quoted (covering medical material, hospital fees, anaesthetist fees and surgeon’s fee and all the follow up consultations).  

 

How experienced are your surgeons?

Our surgeons are focusing exclusively on male uro-genital surgery and have also published extensively on the diagnosis and treatment of Peyronie’s disease. In fact, we are an international referral centre and patients travel from all over the world to get operated at our centre.

Equally important is the fact that as an international network of andrology practices, we have developed very strict and state of the art surgical protocols and have monthly sessions during which our surgeons share their experiences and discuss difficult cases hence constantly improving the surgical techniques employed.

This means that the surgeons of our group have a combined experience of over 1500 Peyronie’s disease surgical corrections, which is one of the highest in the world.

 

What are your success rates?

We define our surgical success rate in three ways:

• No major complications;
• No significant curvature recurrence; and
• Demonstrable patient satisfaction.

Based on these three criteria our success rate is more than 95% in Peyronie’s surgical correction, which is significant higher than that reported in medical literature. We believe that a very important element that results to such high success rates, beyond the surgical skills of our doctors, is the correct patient selection in terms of surgical technique and also the very extensive post-surgical follow up of our patients – our experience suggest that this is of paramount importance for a successful surgical outcome.

 

Do you have any patient testimonials?

 

Yes. We have extensive patient testimonials (published anonymously here) and we can also put you in contact with individual patients, via phone or email if you would like to know more about their surgical experience in our clinic.

 

What do I need to do after the surgery?

The day after your operation, you need to attend a consultation with your surgeon, during which he will give you detailed post-operative instructions, change your medical dressing and answer any questions that you might have.

After that and until your next in person consultation (usually a month later) your surgeon and our patient co-ordination team will be in close contact with you asking for regular updates and also addressing any concerns you might have.

Two weeks after your surgery (unless instructed otherwise) you would need to start with the post-operative rehabilitation, which involves penile stretching and/or exercises with a Vacuum Erection device (for more information see here) – detailed instructions will be provided to you post-operatively.

 

How long do I need to take off work in order to have the surgery?

Most patients can return to work 2-5 days after their operation assuming it is an office based work. If your work involves heavy physical activity, then you might need a bit longer off work.

 

How long after the surgery can I resume with sexual activities?

Usually sexual activities can be resumed after 4-6 weeks unless your surgeon advices otherwise.

 

Will I experience pain after the operation?

Some muted pain and discomfort should be expected but this can be countered with over the counter oral painkillers. Same patients, especially younger ones might feel pain during erections for the first few days.

 

What are the potential complications?

All our operations are minimally invasive and most complications can be treated conservatively.

Most patients will experience some swelling of the penis, which will subside over the first few days from the operation. Rare complications (most of them associated with any type of surgery) might include bleeding, infection (you will be prescribed anti-biotics straight after the surgery so as to prevent this), localised tissue damage (blood vessels, nerves, penis glans, urethra), temporary/ permanent glans numbness, recurrence or residual curvature, penile shortening, post-operative erectile dysfunction and in some cases penile bulging. These risks are minimised by choosing the right operating technique based on the individual circumstances of the patient and during your pre-operative consultation, you will be informed extensively about the risks of the operation and your surgeon will answer any questions that you might have.

 

What is the cost of Peyronie’s Disease Treatment?

Unfortunately, most insurance companies do not cover sexual dysfunction or male fertility consultations and most of our patients are self-paying. If your insurance company covers the cost of treatment or diagnostic tests, then we would be glad to assist you with the refund claim or claim directly from your insurance company on your behalf.

Surgical Treatment Costs

Surgical treatment costs will depend on the type of operation, the medical material used and the specific circumstances of each patient. Following your consultation and if you are a candidate for a surgical treatment, an all inclusive cost will be quoted (covering medical material, hospital fees, anaesthetist fees and surgeon’s fee and all the follow up consultations).