For those who have received the diagnosis of Peyronie's Disease (Peyronie's Disease), or who have a state of a bent sexual organ from fibrous tissue accumulated under the skin, surgery may not always be the first choice. At present there are approaches to the treatment of Peyronie's without surgery, designed to break down the fibrous tissue at a particular point, restore the flexibility of the layer of membrane wrapping the sponge-like body (Tunica Albuginea), and adjust the distorted structure so that it comes back close to normal. This article explains the working principle of each procedure, the suitability according to the stage of the disease, and the considerations before deciding
What does Peyronie's disease arise from
Peyronie's disease arises from the abnormal creation of a fibrous scar (Fibrotic Plaque) at the area of the Tunica Albuginea layer, which is the sheath of membrane wrapping the sponge-like body, having the duty of holding the blood while erect. When fibrous tissue accumulates, the tissue in that area loses its flexibility, making one side of the sexual organ unable to expand normally. The result is that the sexual organ is bent, distorted, or narrowed and indented like an hourglass while erect, and in some cases it may lead to a state of weakened sexual capability (ED) from a state of a leaking vein (Venous Leak)
Why the treatment of Peyronie's must take time
The treatment of Peyronie's is not the putting right of the bending immediately, but is connected with the adaptation of the tissue, or Tissue Remodeling
The fibrous tissue that has already arisen is usually hard with reduced flexibility. The care therefore must rely on continuity, so that the body responds to the stimulation, restores the tissue, and adjusts the flexibility of the structure gradually
Generally, a plan of treatment of the kind without surgery may take about 2–3 months, or more than that, depending on the stage of the disease, the density of the fibrous tissue, and the response of each individual
The stages of the disease and the suitability for treatment of the kind without surgery
Assessing the stage of the disease is important in choosing the approach. Generally it is divided into the acute inflammatory stage (Acute Phase), which is usually within the first 12–18 months, in which the patient may have symptoms of pain while erect and the fibrous tissue is not yet fully hardened, and the chronic stage (Chronic Phase), in which the fibrous tissue begins to be stable, the symptoms of pain usually reduce, but the bending and the loss of structure remain
Treatment of the kind without surgery may be considered in both stages, but the goals and the response differ. The patient should receive an assessment from a physician in order to set the approach that suits the individual
The main procedures in the treatment of Peyronie's without surgery
1. High-Precision Focused Shockwave Therapy (f-ESWT)
This is the use of low-frequency sound waves at a specialised level of intensity, sending energy deep down to the position where there is an accumulation of fibrous tissue accurately. The mechanism of the working is striking to destroy the binding of the calcium in the fibrous scar, together with stimulating the creation of new blood vessels (Neoangiogenesis) in order to support the repair of the tissue. The shooting of focused shock waves may help manage the state of ED arising jointly from a state of a leaking vein at the same time
2. Intralesional Regenerative Injection (Activated Concentrated Growth Factors)
A procedure of injecting an extract from platelets of high concentration at a particular point, under the guidance of ultrasound (Ultrasound-guided), into the core of the fibrous tissue. The goal is to break down the surface tension of the fibrous tissue, stimulate the process of repairing the cells that have been injured, and support the creation of new blood vessels in order to return the flexibility to the Tunica Albuginea layer
3. Mechanical Tension Therapy (Vacuum Erection Device – VED)
The applying of mechanical pulling force (Mechanical Stretch) through medical vacuum equipment, in order to create an even tension in the tissue, helping stretch and break down the fibrous tissue and rearrange the collagen fibres anew. It is usually used alongside other procedures in order to adjust the bent structure continuously. The use of the VED should be under the recommendation of a physician, so that a suitable pulling force and rhythm is obtained
4. Transrectal QMR (Quantum Molecular Resonance)
A procedure of inserting equipment through the anus in order to send waves of energy to restore the working of the nervous system and of the deep structures of the blood vessels in the pelvic floor. It is a procedure without heat (Non-thermal), so it suits the stimulation of the repair of the cells in a delicate area
The diagnosis before beginning the plan of treatment
Before beginning any procedure, the assessment with Penile Color Doppler Ultrasonography has an important role in identifying the position, the depth, and the size of the fibrous tissue accurately, together with assessing whether there is a state of a leaking vein as well or not. The result of the examination leads to the design of a plan of treatment that is right for the character of the lesion in each individual
The approach to treatment at PYONG MEN
At PYONG MEN, the approach to the treatment of Peyronie's without surgery is designed as a plan in the form of steps of a ladder, depending on the severity of the lesion, the stage of the disease, and the goals of the patient, and it may consist of the injection of Activated Concentrated Growth Factors, Focused Shockwave, Transrectal QMR, and Mechanical Tension Therapy together in a suitable proportion
The plan of treatment is set only after the clinical assessment and the examination with ultrasound, not a choice according to the budget alone. The result of the treatment depends on the stage of the disease, the density of the fibrous tissue, and the response of each individual
In short summary
- Peyronie's disease arises from fibrous tissue accumulated at the Tunica Albuginea layer, making the sexual organ bent and possibly with accompanying ED
- Treatment without surgery consists of Focused Shockwave, injection to break down the fibrous tissue with Growth Factors, the VED, and Transrectal QMR
- The treatment must rely on continuity of 2–3 months, because the adjusting of the structure of the tissue does not arise immediately
- The choice of procedure depends on the stage of the disease and on the result of the ultrasound examination of the sexual organ (Penile Color Doppler Ultrasonography)
- The result depends on the stage of the disease, the density of the fibrous tissue, and the response specific to the individual
Frequently asked questions (FAQ)
1. Does the treatment of Peyronie's without surgery suit everyone or not? Not in every case. Treatment of the kind without surgery suits patients who have been assessed as having fibrous tissue and bending at a level at which these procedures may help adjust the structure. Patients who have very severe bending may need to consider other choices together with a surgeon
2. How long must the procedures be done before a change is seen? The general plan of treatment is continuous for 2–3 months, because the breaking down of the fibrous tissue and the adjusting of the structure of the tissue take time. The change that can be observed differs in each individual
3. Does Focused Shockwave hurt? The procedure uses sound waves of low energy. Most patients can receive the treatment without needing anaesthetic. The feeling is usually at a level that can be accepted
4. What is the injection of Growth Factors like? It is the injection of a biological substance extracted at high concentration into the position of the fibrous tissue, using ultrasound as a guide, so that it is accurate and the discomfort during the procedure is reduced
5. What will happen if it is not treated? In the acute inflammatory stage, some of the symptoms may change by themselves, but fibrous tissue that is already stable usually does not reduce by itself. Assessment from early on will help set the suitable approach
6. Can the VED be used at home by oneself? It should be used under the recommendation of a physician, in order to set the pulling force, the length of time, and the frequency that suit the character of the lesion of each individual