Penile curvature
Penile curvature – is a pathology of the reproductive system that leads to sexual problems in men. The condition is characterized by significant painful sensations and noticeable curvature of the penis during erection. Additionally, it can cause discomfort and affect erectile function.
Penile curvature is a condition that can significantly impact quality of life without causing physical pain. Sometimes, it may not even cause discomfort if not severe, but it can affect a man's psychological well-being
In many cases: the disease develops gradually following penile trauma, progresses, and eventually leads to complete inability to engage in sexual intercourse. For most men, this is a highly traumatic situation that can trigger depression and other psychological disorders. Such patients often develop psychological erectile dysfunction, meaning they are unable to have intimate relationships despite the absence of physiological barriers.
But this problem is entirely solvable!
The pathogenesis of the disease
The male sexual organ consists of spongy and cavernous (erectile) tissues surrounded by a dense layer of tissue known as the tunica albuginea. This layer acts like a sheath, allowing the organ to expand evenly during erection.
Due to various reasons, scar tissue patches, known as plaques, can form on the tunica albuginea. Over time, these plaques can harden and lose elasticity, causing the sheath to shorten and making the penis asymmetrical. As a result, the organ becomes curved, disrupting its normal functioning.
There are three main reasons for the development of such pathology.
Congenital penile curvature
Congenital anomaly does not involve abnormalities in the formation of the urethra — it is simply the result of disproportionate development of the tunica albuginea. According to various studies, the frequency of such curvature ranges from 1% to 10%.
Most often, adults seek help from a urologist because they begin to experience significant discomfort associated with their condition:
- dissatisfaction with their own appearance;
- embarrassment in front of the opposite sex;
- difficulties or inability to engage in sexual intercourse.
Diagnosing the anomaly is relatively straightforward. It typically involves gathering medical history and conducting a physical examination. Additionally, it is standard practice to ask the patient to take photographs of their erect penis at home from above, below, left, and right angles. This helps assess the degree of curvature.
Peyronie's disease (acquired penile curvature)
The disease primarily affects men in their mature years, typically between 30 and 60 years old. It is less frequently diagnosed in younger men. The most likely causes of this anomaly are micro-traumas experienced in the past, which have led to inflammation and subsequent fibrosis. There are several risk factors that increase the likelihood of developing scar tissue plaques:
- diabetes mellitus;
- unhealthy lifestyle habits (excessive alcohol consumption, smoking);
- arterial hypertension;
- erectile dysfunction;
- low testosterone levels;
- history of pelvic surgery.
Typically (though not always), over time, these hardened plaques lead to penile curvature and a high level of physical and psychological discomfort. In the early stages of the disease, some patients report painful sensations or painful erections. In another form of the disease, known as fibrotic, there is no pain, but the connective tissue proliferates, affecting healthy areas of the tunica albuginea.
Scarring of the tunica albuginea as a result of trauma
The third possible cause of penile curvature development — is trauma. This often occurs during sexual intercourse, particularly in positions where the woman is on top. The penis, not being a bone, cannot "break," but excessive friction can damage the tunica albuginea, leading to scarring of the affected areas and the formation of fibrotic plaques, similar to the previous cases discussed.
The diagnosis of acquired penile pathology
For precise diagnosis, it is essential to gather medical history, assess the tendency of the anomaly to progress, and conduct a physical examination during erection. In some cases, rather than progressing, the condition may stabilize spontaneously or even improve, although this is rare. These details influence the choice of treatment method, whether surgical or conservative. Additional tests may also be conducted:
- Ultrasound with Doppler Imaging: This can be adjunctive as it provides information on the location and size of scarred areas within the tunica albuginea.
These diagnostic steps are crucial for determining the appropriate course of action and ensuring effective management of acquired penile pathology, such as Peyronie's disease.
Treatment for penile curvature
In the early stages of Peyronie's disease, conservative treatments are often employed. Several methods can be used:
Oral Medications:
- Medications taken orally that can help reduce fibrotic plaques.
Injections:
- Medications can be injected directly into the penis to target and reduce the fibrous plaques causing the curvature.
Vacuum Therapy:
- Vacuum devices may be used as a form of therapy. These devices create a vacuum around the penis, which can help draw blood into the penis and potentially improve curvature or erectile function over time.
These conservative treatments aim to manage symptoms, reduce plaque formation, and potentially improve penile curvature and function without the need for more invasive procedures like surgery. Treatment choices should be guided by a healthcare provider specializing in urology or sexual medicine, based on the individual patient's condition and response to treatment.
Currently, there is insufficient conclusive evidence of the effectiveness of conservative therapies when Peyronie's disease has significantly progressed and causes substantial discomfort to the patient. The only definitive solution in such cases is microsurgical operation.
Surgical interventions
Previously, the most commonly used surgical intervention for Peyronie's disease was Nesbit plication. The essence of this procedure involves suturing the tunica albuginea on the side opposite to where the curvature is observed.
This minimally invasive intervention, while having few specific side effects, does have a significant drawback: it can result in shortening of the organ (sometimes up to 3 centimeters). |
For many patients, this is significant, so surgeons often seek alternatives.
The Nesbit procedure is performed when:
- The curvature is congenital, meaning there are no pathological plaques;
- The fibrous plaques are small in size;
- The degree of curvature is minor;
- The patient is informed about the potential shortening of the penis and is confident it will not diminish their quality of life.
A second, more progressive — option is tunical reconstruction (grafting). This procedure is more complex and involves completely removing scar tissue and replacing it with a graft of mucous membrane from the patient's cheek. This approach offers several advantages:
- The surgeon can ensure that there will be no shortening of the penis during treatment;
- There is no risk of rejection of the material since it is taken from the patient's own body.
Another option used for downward curvature of the penis – is the Shaeer's operation (Osama Shaeer). Special sutures are placed on the tunica albuginea, which slightly rotates the cavernous bodies relative to each other. This adjustment aligns with the principles of physics to correct this type of curvature.
5 Фев, 2024