Incurvation of the penis
When during erection the penis deviates abnormally we speak of penile incurvation. It can be of great concern to men and their partners. Penile incurvations always refer to the shape of the erect penis. Nothing is measurable in flaccidity.
It is a common condition and in many cases a curvature should not be considered a disease or a problem. We only consider incurvation a problem or disease when it causes difficulties in sexual intercourse: either because of pain, difficulty in penetration or limiting certain positions, or when it affects urination.
It is very important if this problem is detected to see a specialist as in some cases, such as Peyronie's disease, it is advisable to act before 6 months to obtain better results in the incurvation and function of the penis.
What to do if you notice that your little one's penis has a very pronounced curve?
This type of curvature is present from birth and the parents or the patient become aware of the problem with the first erections. It is usually a long penis that curves downwards during erection.
Given that penises are large and that patients are young, if the curve is very noticeable, surgery is indicated. Surgery allows the curvature to be corrected, leaving a straight penis, but it must be performed by expert hands so as not to affect sensitivity (many nerves pass through the penis) and to ensure a full sex life.
This type of surgery should never be delayed and should be performed as soon as possible. Patients should be operated on before the onset of development and puberty. Emotional development is closely linked to sexual health and this type of alteration can greatly affect children at this time of development.
What is peyronie's disease?
Curvature of the penis acquired in adulthood. Sometimes the patient has previously suffered a trauma or blow to the penis and in other cases it happens suddenly. The penis usually deviates upwards and to one side.
Why does peyronie's disease occur?
The disease is caused by scarring and fibrosis in one area of the penis which creates a hard plaque. This scarring creates shortening of the penile tissues and deviation by stretching one corpus cavernosum more than the other. The penis is always curved to the side of the problem.
What should the patient do if he/she notices that the penis deviates upwards and to one side?
75% of patients have pain with erections during the first 6-9 months. It is very important that they come to our clinic quickly to apply the treatments in these first moments, as this is when the most benefits and best results are produced in the painful process and in the fibrotic disease itself.
After the first year the disease stabilises and the pain disappears, meaning that we should not expect it to progress and that medical treatments will not have as much benefit. Flares of the process are described.
What is the approach to peyronie's disease?
Sometimes the curve is minimal and does not hinder the sexual life of the patient and his partner, and sometimes a very pronounced curve is generated, resulting in shortening of the penis and impossibility or difficulty of penetration.
The treatment of penile curvature is very varied and we always try to be conservative in order to avoid surgery. This will depend on the stage of the disease and that is why it is so important to consult a professional as soon as possible. The angle of the curvature, the type of penis and the location of the lesion also have an influence.
What are the treatments for peyronie's disease?
- Congenital incurvation:
The only treatment that exists is surgical treatment: Corrective cavernoplasty returns the penis to a normal erect position. Given that they are penises with a good size, it is a surgery with very good results.
- Acquired incurvations-Peyronie's disease:
It depends on the type of curvature and the stage of the disease (before one year or after one year). Sometimes medical treatment can reduce the curvature to the point where it does not bother sexual intercourse and the patient can be spared surgery.
Similarly, within the therapeutic range we have multiple options, among them:
- Traction with approved medical devices: Penile traction has been proven to correct curvatures and angulations and to enhance the treatments we apply.
- Focal Shock Waves: For their anti-pain (improves nociceptive nerve terminals) and anti-fibrotic (induces fibroblast migration) effects.
- Medication: some drugs may help but their effect is disputed.
- Intraplaque treatment and Platelet Rich Plasma: This is the last contribution we have in this process due to its anti-fibrotic and reparative effect on scarring processes.
In our centre we combine all these treatments, observing the angle of the penis after treatment within 6 months with a new Kelami test (photographs to measure angles) and the degree of satisfaction of the patient, as well as the disappearance of pain.
What are the protocols in more complex cases?
When the problems are not satisfactorily resolved, surgical treatment is performed to correct the incurvation(cavernoplasty).
In the most severe cases, we remove the fibrous plaque and replace the area of the corpus cavernosum wall with a patch of biocompatible material.
When angulation is accompanied by erectile dysfunction or instability, coital dynamics are altered and the response to treatment has not been satisfactory, the only solution is penile prosthesis implantation.
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