Hello drsam2007,
Here are the answers to your three questions:
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1)What is Peyronie?s Disease?
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Peyronie?s Disease, pronounced "pay-rone-ees" (also known as fibrous
cavernositis) is a condition where benign (non-cancerous) plaque or
inelastic scar tissue builds up in the layers of erectile tissue
called tunica albuginea. Peyronie?s affects about 388 of 100,000 men.
The plaque/scar tissue starts as an inflammatory process, but over
time, can develop into a hardened scar. If the scar tissue or plaque
forms on the top side of the shaft, as it most commonly does, the
penis will bend upward. If the buildup occurs on the underside, the
penis will bend downward. The scar, in a way, acts like tape on an
balloon, preventing part of the penis to inflate.
If the plaque develops on the top *and* the bottom, it can cause an
indentation and a shortening of the penis. This certainly fits the
description of your problem, in spite of the fact that you can not
feel it, and is a reasonable explanation of your symptoms.
?Some patients may even develop a plaque that goes all the way around
the penis, causing a "waisting" or "bottleneck" deformity of the
penile shaft. The majority of patients complain of generalized
shrinkage or shortening of their penis.?
http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=50
It?s also possible that in your case, that you can?t palpate any scar
tissue because it is not at yet at the hardened stage, still being in
the inflammatory stage, but lesions can be seen with an ultrasound.
The inflammatory stage can last up to 18 months, after which hardening
of the plaque and scar tissue, penile curvature and erectile
dysfunction. Scar tissue buildup is a side effect of Caverject, and
use of Caverject is contraindicated in patients that already have
Peyronie?s or fibrosis. It is possible that you have Peyronie?s,
secondary to Caverject injections.
http://my.webmd.com/hw/impotence/ug1867.asp
http://www.rxcanadapharmacy.com/htmfiles/Caverject.asp
?In many cases, genital examination is conducted perfunctorily and, in
the absence of pain, a lump may be missed?
http://www.andrology.com/peyroniesdisease.htm
Causes:
·genetics: occasionally the disease has a tendency to run in certain
families (inherited or genetic predisposition), but this is not
common.
·injury: Peyronie's disease is more common after injury to the penis,
such as penile fracture or forceful bending of the erect penis. It
also occurs more frequently in men that give injections into the penis
for the treatment of erectile dysfunction (impotence).
·circulatory disorders: more men with Peyronie's disease seem to be
affected by high blood pressure and hardening of the arteries
(atherosclerosis), so these conditions might possibly be involved in
its development.
·diabetes: this is more common in men with Peyronie's disease. As a
result diabetes might also be involved in its development
http://www.netdoctor.co.uk/menshealth/facts/peyronies.htm
?Many researchers believe the plaque of Peyronie's disease develops
following trauma (hitting or bending) that causes localized bleeding
inside the penis. Two chambers known as the corpora cavernosa run the
length of the penis. The inner-surface membrane of the chambers is a
sheath of elastic fibers. A connecting tissue, called a septum, runs
along the center of each chamber and attaches at the top and bottom.
If the penis is abnormally bumped or bent, an area where the septum
attaches to the elastic fibers may stretch beyond a limit, injuring
the lining of the erectile chamber and, for example, rupturing small
blood vessels. As a result of aging, diminished elasticity near the
point of attachment of the septum might increase the chances of
injury.
The damaged area might heal slowly or abnormally for two reasons:
repeated trauma and a minimal amount of blood flow in the sheath-like
fibers. In cases that heal within about a year, the plaque does not
advance beyond an initial inflammatory phase. In cases that persist
for years, the plaque undergoes fibrosis, or formation of tough
fibrous tissue, and even calcification, or formation of calcium
deposits.?
http://kidney.niddk.nih.gov/kudiseases/pubs/peyronie/
You can see an illustration of the scar tissue buildup at the base of
the penis here. (The image has ?copyright? stamped over it, but enough
of the illustration shows for you to get an understanding of it)
http://medifocus.doereport.com/generateexhibit.php?ID=3873
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2)Treatment:
============================
According to the Andrology.com site, no treatment superior to the others.
http://www.andrology.com/peyroniesdisease.htm
?Because the course of Peyronie's disease is different in each patient
and because some patients experience improvement without treatment,
medical experts suggest waiting 1 to 2 years or longer before
attempting to correct it surgically. During that wait, patients often
are willing to undergo treatments whose effectiveness has not been
proven? You state you have already waited one year, so perhaps you
will improve without resorting to surgery.
Sometimes, Peyronies spontaneously clears itself up after a year or
two, and in about 13% of the cases the scar tissue disappears. About
40% of men experience no change after 1-2 years, and about 45% of
patients either maintain or see a worsening of their condition. For
these reasons, most doctors recommend waiting a year or two to see if
the condition cures on its own.
In early cases, oral medications may provide some relief:
Oral vitamin E: It remains a popular treatment for early-stage disease
because of its mild side effects and low cost. While uncontrolled
studies as far back as 1948 demonstrated decreases in penile curvature
and plaque size, investigation continues concerning its effectiveness.
Potassium aminobenzoate (Potaba): Recent controlled studies have shown
that this B-complex substance popular in Central Europe yields some
benefits. But it is somewhat expensive, requiring 24 pills each day
for three to six months. It is also often associated with
gastrointestinal issues, making compliance low.
Tamoxifen: This non-steroidal, antiestrogen medication has been used
in the treatment of desmoid tumors, a condition with properties
similar to Peyronie's disease. Researchers claim that inflammation and
the production of scar tissue are inhibited. But early-stage disease
studies in England have found only marginal improvement with
tamoxifen. Like other research in this area, however, these studies
include few patients, and no controls, objective improvement measures
or long-term follow up.
Colchicine: Another anti-inflammatory agent that decreases collagen
development, colchicine has been shown to be slightly beneficial in a
few small, uncontrolled studies. Unfortunately, up to 50 percent of
patients develop gastrointestinal upset and must discontinue the drug
early in treatment.
http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=50
?Oral agents, particularly those with antioxidant properties, have
been tried with limited success. Such agents include vitamin E,
potassium aminobenzoate (Potaba), and colchicine. Experimental
intralesional treatments include corticosteroids, parathyroid hormone,
collagenase and verapamil (Calan). Various modes of energy transfer,
including ultrasound, radiation, laser therapy, short-wave diathermy
and lithotripsy, have also been used. However, all current published
reports of these treatments have been compromised by limited-sample
patient populations, lack of control populations, poorly characterized
outcome parameters, inadequate follow-up periods and inconclusive
results. It has been difficult, therefore, to determine which, if any,
of the nonsurgical treatments may be effective. Caution should be used
when recommending any of these experimental treatments.?
http://articles.findarticles.com/p/articles/mi_m3225/is_2_60/ai_55391946
Injections: Injecting penile lesions with selected medications, using
a small needle, is an often used therapy, particularly in the early
stages.
Verapamil: Early uncontrolled studies demonstrated that this substance
interferes with calcium, a factor shown by in vitro cattle connective
tissue cell studies to support collagen transport. As such,
intralesional verapamil reduced penile pain and curvature while
improving sexual function. Other studies have concluded that it is a
reasonable treatment in men with non-calcified plaques and penile
angles of less than 30 degrees.
Interferon: The use of these naturally-occurring antiviral,
antiproliferative and anti-tumorigenic glycoproteins to treat
Peyronie's disease was born out of experiments demonstrating the
antifibrotic effect on skin cells of two different disorders ?
keloids, overgrowth of collagenous scar tissue and scleroderma, a rare
autoimmune disease affecting the body's connective tissue. In addition
to inhibiting proliferation of fibroblast cells, interferons, such as
alpha-2b, also stimulate collagenase, which breaks down collagen and
scar tissue. Several uncontrolled studies have demonstrated
intralesional interferon's effectiveness in reducing penile pain,
curvature and plaque size while improving some sexual function. A
current multi-institutional, placebo-controlled trial will hopefully
answer many of the questions about intralesional therapy in the near
future.
Two often used corticosteroid injectables are Decadron (dexamethasone)
and Aristospan (triamcinolone hexacetonide), injected weekly for 6-8
weeks.
?Using the dexamethasone regimen in 31 patients, one study13 reported
an 81 percent benefit to a moderate or greater degree, with 42 percent
of patients achieving what they described as marked improvement. In a
study4 of 42 patients treated with triamcinolone, 33 percent of
patients had complete recovery or marked improvement in symptoms and
signs during the course of treatment.
Steroid injections are probably most effective during the initial
formation of Peyronie's plaque, and success is limited with mature
plaques. Patients are advised to abstain from sex during treatment to
minimize further potential trauma to the penis.?
http://articles.findarticles.com/p/articles/mi_m3225/is_2_60/ai_55391946/pg_2
?Peyronie's disease has been treated surgically with some success. The
two most common surgical procedures are removal or expansion of the
plaque followed by placement of a patch of skin or artificial
material, and removal or pinching of tissue from the side of the penis
opposite the plaque, which cancels out the bending effect. The first
method can involve partial loss of erectile function, especially
rigidity. The second method, known as the Nesbit procedure, causes a
shortening of the erect penis.?
firshttp://www.urologyhealth.org/adult/index.cfm?cat=11&topic=50t 12 months.
?After the scar has matured, the configuration of the tunica albuginea
is unlikely to be changed by nonsurgical treatments. However, many
patients with advanced disease who have not sought surgical correction
have been able to continue mutually satisfactory sexual intercourse
with a partner. Approximately one third of patients with end-stage
disease have a disabling curvature that requires surgical correction.?
http://articles.findarticles.com/p/articles/mi_m3225/is_2_60/ai_55391946
?Plication Procedures: attempt to straighten the penis by trying to
shorten the longer side to match the shorter side. Some authorities
are against this approach since the penile shortening that ensues is
unacceptable to most patients.?
http://www.andrology.com/peyroniesdisease.htm
Nesbitt Tuck
?The Nesbitt Tuck is a 10 to 20 minute outpatient procedure that puts
a stitch at the underside of the maximum point of the curve. It
requires about a week off work and discomfort with erections for four
to six weeks. Another surgical treatment consists of incision to the
plaque or scar tissue and patching with a vein. Since this is usually
on the top surface of the penis, the nerves and blood vessels
previously described must be elevated.?
http://www.malehealthcenter.com/peyron.html
Reconstruction Surgery: From the Glickman Urological
Institute:Reconstructive surgery for Peyronie?s disease provides a
successful outcome for the majority of men presenting with disabling
penile curvature. In men with stable disease and adequate erectile
rigidity and maintenance, options include modified corporoplasty or
plaque incision/excision with graft inlay. Several factors are
assessed in determining which of these procedures is optimal: 1)
erectile function, 2) penile length, 3) degree of curvature, 4)
location of curvature, 5) local erectile deformity, 6) medical
comorbidity, and 7) psychological factors.?
http://www.clevelandclinic.org/urology/patients/function/peyronies.htm
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3)Risk factors of treatment:
============================
As in any surgery, risk factors include dangers of general anesthesia,
bleeding and infection. (Risks and side effects of medications and
injections are mentioned above.)
http://peyronies.all-sexualhealth.com/www/14.htm
?Most types of surgery produce positive results. But because
complications can occur, and because many of the phenomena associated
with Peyronie's disease (for example, shortening of the penis) are not
corrected by surgery, most doctors prefer to perform surgery only on
the small number of men with curvature so severe that it prevents
sexual intercourse?
http://kidney.niddk.nih.gov/kudiseases/pubs/peyronie/
Side effects of Potaba include hypoglycemia (low blood sugar) and
stomach upset. Symptoms of low blood sugar are shakiness, fast
heartbeat, and dizziness. You may not take this drug concurrently
with sulfa antibiotics. It may also take several months for this
medication to work.
http://www.netdoctor.co.uk/medicines/showpreparation.asp?id=2107
http://www.drugstore.com/qxn00516005125_333181_sespider/potaba/potaba.htm
Verapamil seems to be a safe and effective penile injectable,
according to this abstract:
Verapamil injection of Peyronie's plaques appears to be a clinically
effective treatment option for pain and curvature and can contribute
to subjective improvement in sexual function and erectile capacity.
The low incidence of complications indicates that this therapy is also
clinically safe.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12131321&dopt=Abstract
?Verapamil injections: One study in a very small group of men has
shown that repeated injections of verapamil into the Peyronie's plaque
improved pain, deformity and lump size. Given that penile injection is
a potential cause of Peyronie's disease, more evidence from larger,
long-term studies must be gathered before this can be recommended as a
treatment?
http://peyronies.all-sexualhealth.com/www/12.htm
Remember the hot McDonald?s coffee lawsuit? Now we have the Starbucks Connection:
?From an on-line article in the Toronto Sun on a Toronto man who is
suing Starbucks because his penis was crushed by a faulty toilet seat
at a Starbucks coffee house: "Edward Skwarek, thirty-seven, and his
wife Sheri, thirty-five, are suing Starbucks Corp. for $2.2 million
after he was injured while on a romantic New York City holiday....
Skwarek's suit claims that as a result of Starbucks's carelessness,
Skwarek suffered a `crushed penis,' Peyronie's disease, retrograde
ejaculation with consequent substantial reduction in sperm count,
infertility, severe bruising to his penis, and sexual function
impairment. Skwarek seeks $1.45 million and his wife $750,000 because
she has been `deprived of his services.'" God.com
http://articles.findarticles.com/p/articles/mi_m1295/is_3_64/ai_60059928
It certainly seems that the Caverject injections may be responsible
for your current condition, and I was able to find no other condition
than Peyronie?s that could cause such symptoms. Discuss treatment
options with your doctor to arrive at the best choice for you, while
taking in your overall health considerations. I wish you luck!
If any part of my answer is unclear, please request an Answer
Clarifiction, before rating.
Regards,
crabcakes
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