Urologist, Andrologist

Curvature of penis (Peyronie’s disease)

What is Peyronie’s disease ?

Peyronie’s disease is the fibrous scar tissue of the penis which forms as a result of prior trauma to the outer layer of erectile body tissue. This leads to the bend or curvature of the penis. Short Frenulum (Tight Frenulum, Frenulum Breve)

What are the symptoms of Peyronie disease ?

The common symptoms includes curvature of the penis on erection (upward/downward or lateral direction), difficulty getting or maintaining erection (erectile dysfunction), pain while erection, feeling of lump in the penis, shortening of penis etc. Erectile dysfunction – causes, diagnosis and treatment

What is the cause of Peyronie disease ?

The exact etiology of this condition is not known. It is the repeated prior trauma by sexual acts, accident, athletic activities etc. to the penis which leads to formation of fibrous scar after healing. This leads to bending or curvature of penis.

How this condition is diagnosed ?

Peyronie’s disease is typically diagnosed with examining the scar tissue on palpation. The degree of curvature or bending is assessed on erection. Patient can self report with pics taken at home with penis in erect state or it can be assessed at hospital setting with intracavernous injection.

What is the treatment of peyronie disease ?

There are various oral and intralesional therapies available for this conditions though the therapeutic value of each is limited. Various oral agents include tamoxifen, pentoxyphylline, Vitamin E etc. Intralesional agents are injected into the scar tissue and helps loosening the scar and its size. Various intralesional agents which are commonly used are Collagenase injection (not available in India), verapamil injection, triamcinolone etc. Despite these therapies, there are large number of patients which need surgical treatment, whic include simple plication (placing suture to the opposite side of bending), partial or complete incision or excision of scar tissue followed by grafting. Penile implant is often required in patients undergoing excision of scar tissue with grafting.

Whom to meet if suffering from peyronie disease ?

You should meet your andrologist for management of peyronie disease.

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Urologist, Andrologist

Erectile dysfunction – causes, diagnosis and treatment

What is erectile dysfunction?

Erectile dysfunction or otherwise called impotence, is the inability of achieving or maintaining hard enough erection of penis, that is required for sexual act. Persons with erectile dysfunction have either looseness of erection or have complete lack of erection. Read how it is different from premature ejaculation Premature ejaculation- causes, diagnosis and treatment

What are the causes of erectile dysfunction?

There are numerous causes of erectile dysfunction. It can be broadly divided into – Organic and non-organic causes. Organic causes are those where there is some underlying cause which leads to erectile dysfunction and non organic causes include those where no underlying cause is found.

Organic causes – Uncontrolled long term diabetes or hypertension, heart diseases, low testosterone levels, obesity, hypothyroidism, certain blood pressure medications, hyperlipidemia, prostate enlargement, chronic kidney disease, peyronie’s disease etc.

Non-organic causes- These includes stress, anxiety, relationship problems, depression etc.

Erectile dysfunction can be caused by any one of above factors or these factors can be present together in some patients. ED patients usually also suffer from premature ejaculation.

How to diagnose erectile dysfunction?

History and examination is most important parameter in diagnosis of ED. It include detailed questionnaire pertaining to erection After history, if required doctor may order few investigations in search of underlying causes leading to erectile dysfunction. Blood tests to check for diabetes, kidney disease, hypothyroidism, hypogonadism (Testosterone and Testosterone deficiency syndrome), PSA (PSA testing) etc are done. Doctor may do oral phosphodiesterase test after giving either sildenafil or tadalafil orally and checking the erection achieved. Sometimes your doctor may order penile doppler ultrasound after applying injection in penis to check penile vessels and hardness of penis.

What are the treatment options for ED?

There are various treatment options for ED. The underlying cause need to be addressed along with the ED treatment.

Psychological counselling- Psychological counselling is done in patients with anxiety, stress or depression or patients having relationship tension.

Oral therapy – There are multiple drugs in market which are used for ED such as Sildenafil, tadalafil, avenafil etc which are usually prescribed by andrologist for ED treatment.

Intra penile injections- Sometimes doctor may prescribe you with intra-penile injection (also called Intracavernous injection). These injection therapy is more beneficial in patients which are primarily having psychogenic erectile dysfunction with failed response to oral therapy.

Vacuum erection device – These devices help in achieving erection with the help of pump action. These can be particularly useful for elderly people or patients in whom other therapies are contraindicated.

Penile prosthesis (Penile implant) – Penile implant placement is the last resort for patients with erectile dysfunction who do not respond to oral or intra cavernous injections. There are variety of penile prosthesis in market (malleable, 2 piece, 3 piece implant). These implants are placed if patient has failed other therapies mentioned above. After implant surgery, the ED patient usually have high satisfaction rate.

Which doctor to meet for treatment of ED?

You should meet your nearby andrologist for treatment of erectile dysfunction.