Peyronie’s Disease Causes Pain, Psychological Trauma

Q. My husband, who is 53, has Peyronie’s disease and we think it was caused by Fosamax. It has gotten much worse and the penis curvature is so severe that intercourse is impossible. My husband’s urologist first gave him some POTABA and told him to take vitamin E. He now feels that surgery is the only option.

My husband would prefer not to have surgery. We have heard that Propoleum injection has been effective. Do you know anything about it? What nonsurgical treatment has been the most effective for your patients?

A. I doubt that taking Fosomax (used to treat and prevent osteoporosis) caused your husband’s Peyronie’s disease, because there is nothing in the medical literature linking this drug to that disease.

Although it is always wise to keep track of changes in health related to starting a new drug, two unrelated events may occur simultaneously.

Peyronie’s disease can be very painful as well as psychologically traumatic. It is a disorder in which an inflammatory fibrosis forms in the covering (tunic) around the spongy erectile tissue of the penis.

This fibrous plaque, similar to scar tissue, is contracted relative to surrounding tissue, causing a curvature of the erect penis that may make sexual intercourse difficult, painful or impossible. If the fibrosis extends into the erectile tissue, it can actually prevent erection, leading to a form of acquired erectile dysfunction.

Often there is also a narrowing of the shaft, causing an hourglass or hinge effect. Shortening of the erect penis length is also seen.

The cause of Peyronie’s disease is unknown, but it’s thought to begin as a local inflammation caused by trauma, such as a minor injury to the penis during sex. Many also believe genetics play a part.

Some investigators see an association between Peyronie’s disease and hypertension and high cholesterol, among other conditions.

No absolutely effective treatment exists for all cases. There are a number of nonsurgical therapies available, but all of them appear only partially successful. For many, the disorder can even go away by itself over a period of weeks or months.

Vitamin E and potassium para-aminobenzoate (POTABA) have long been suggested as treatment for Peyronie’s disease, alone or in combination with other treatment. But these drugs have been effective only in some patients.

Injection of drugs, especially verapamil, a calcium channel blocker, directly into the plaque has been shown to be effective, again, in some cases. Steroid injections or ultrasound may relieve symptoms for some men.

Incidentally, I could not find anything in the medical literature on “propoleum” as a treatment for Peyronie’s disease. For reliable, evidence-based information on medical conditions, it’s always best to consult authoritative resources like the Urology Care Foundation.

In more severe cases, such as your husband’s, surgery may be recommended. Here again, no one procedure is likely to solve the problem in all men with this condition. A number of factors, such as the severity of the curvature and narrowing and the ability to achieve erection play a part in the selection of surgical method.

Surgical procedures for this condition consist of either incision of the tunic or excision (cutting away) of the fibrous material. Penile prosthetic implants that help straighten the curvature may also be recommended.

I understand your husband’s reluctance to undergo surgery. There are risks with any surgery, and this surgery carries the additional risk of more scar tissue formation and may even cause impotence.

I can only recommend that your husband meet again with his urologist and get further information, such as the expected risks and benefits of all treatment options available to him. With that information, he can balance the potential benefits against the potential risks when deciding what to do.