Men with Peyronie's disease typically present to a physician in a number of ways, including painful erections, penile curvature or erectile dysfunction (ED).
The degree of these symptoms can vary significantly between patients and even among the same patient over time. It is not uncommon for patients to delay evaluation and treatment for up to one year. This can be due to a high degree of patient embarrassment and social stigma. It is also very common for males with Peyronie's disease to experience a loss of sexual self-confidence, attractiveness, and psychological distress.
Peyronie's disease can be classified into two phases: the acute (early, active) phase and the chronic (late, stable) phase. The acute phase can last up to 18 months, but is often much shorter. It is characterized by an evolving change in plaque consistency and penile deformity. The chronic phase immediately follows the acute phase and is characterized by resolution of pain and curvature stabilization.
It is estimated that approximately 12% of men who have Peyronie's disease will have improvement or complete correction of their penile curvature within the first 12 months of their condition. Thus, as the plaque in Peyronie's disease may shrink or disappear without treatment, medical experts suggest waiting a full year before attempting to correct it surgically. It is during the acute phase that patients often seek counseling and treatment, although no treatment has been proven to be of significant benefit during this period.
When evaluating a patient with Peyronie's disease it is important to examine the penis in its entirety. Feeling for the location, size, and consistency of the plaque (or plaques) is of utmost importance. If possible, examining the penis in the erect state is ideal because it affords the ability to measure the angle of curvature, location of maximal curvature, and presence of any indentation deformities (known as an hourglass deformity).
While some men may improve their curvature spontaneously, many men will progress over the first 12 months. Some men may have a persistent and complete inability to achieve penetration because of either the magnitude of the penile curvature or erectile dysfunction (ED). Treatment options largely depend on the severity of penile curvature and erectile dysfunction. All patients considered candidates for surgical correction should undergo penile vascular evaluation. Doing this allows the clinician to predict which patients may have worsening of their erectile function following penile reconstruction. In part, the operative intervention that is selected for the individual patient is based upon their preoperative erectile function.
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