Chordee / Peyronnie’s Treatment

Peyronnie’s

Peyronnie’s is defined as a curvature of the penis that occurs sometime later in life after birth.

Curvature of the penis is not necessarily bad, in-fact it appears that some minor curvature is normal for the most part (although antidotal evidence appears to show that it occurs more in circumcised men).

Chordee

Chordee is defined as curvature of the penis that has been present since birth or that is found shortly thereafter before any injury can occur to the penis.

The term Peyronnie’s will be used for the remainder of this document although for the MOST part the terms Chordee and Peyronnie’ are essentially interchangeable.

 

Signs and Symptoms

The signs and symptoms of Peyronie’s disease may include: [1]

  • Hard lumps on one or more sides of the penis
  • Pain during sexual intercourse or during an erection
  • A curve in the penis when erect (but can occur when not erect)
  • Narrowing or shortening of the penis

Causes and Explanation

“Two long chambers inside the penis, called the corpora cavernosa, contain a spongy tissue that draws blood into the chambers. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries.” If there is any injury to the tissue that causes reduced blood flow to the penis then there can be a buildup of plaque. If the plaque is not removed thru natural processes or possibly broken up with ultrasonic waves, then it can cause a permanent blockage or disruption of blood flow.

The reduced or uneven blood flow and block of plaque are what actually cause the curvature.

Potential causes can be [2]:

  • Acute injury to the penis
  • Chronic, or repeated, injury to the penis
    • The injury could be secondary to another physical injury on the lower half of the body. For example if the individual plays a physical contact sport.
  • Autoimmune diseases – disorders in which the body’s immune system attacks the body’s own cells and organs

Chordee and Peyronie’s Treatment Option

Current Treatment Options

Currently, the mainstay of treatment is invasive surgery to reduce curvature by removing plaque and replacing the plaque region with a vein or other vascular tissue that is taken from someplace in the leg.

This generally requires anesthesia invasive surgery and around 6 weeks to recover.

Some health care professionals advocate Vitamin E therapy but the evidence support it uses or efficacy is limited.

Generally, due to the invasive nature of these surgeries, they are only done in the most severe cases where the patient is experiencing chronic pain or when it completely prevents them from engaging in sexual intercourse.

 

New Treatment Options

While the previous mainstay of treatment is enough to keep most men out of the OR, it does not actually help them often with their condition. Fortunately there are 2 new treatment methods that have started to show some amazing results.

 

Protein Recombinant Plasma (PRP) Therapy

PRP Therapy is a new form of therapy that has found a wide variety of application. The main idea is that the plasma in your blood has a lot of beneficial compounds that when isolated can stimulate tissue regeneration and regrowth.

  1. A small amount of blood is taken from the forearm.
  2. It is then put in a centrifuge to separate the plasma, hematocrit, and leukocytes.
  3. The plasma is removed and placed in a syringe.
  4. The penis is made erect
    1. Either through artificial means of an injection
      1. If an injection is used it is often done after the anesthetic.
    2. Or through some form of stimulus
  5. A strong local anesthetic is used to prevent the patient from feeling anything in the genital region.
  6. Next the plaque may be broken up with a large bore needle (but this may not be necessary depending on the severity of the curve or the practitioners preference.)
  7. The plasma is injected into the fibrous tissue or into the hole made when the plaque was broken up with the large bore needle.

Next the patient is discharged and will be instructed to engage in sexual activity as often as desired.

Or

The patient will be instructed to use a Vacuum Constriction Device (to force blood flow to the region).

A US based study done in 2017 shows an improvement in approximately 88% of participants with about 73% experiencing a significant improvement of the curvature they had previously.

 

Pentoxifylline and VCD

Other options include the use of:

  • Pentoxifylline (oral – or possibly the cream)
    • Future possible options may include Aminophylline or Theophylline. Both of which are vasodilators that increase blood flow.
  • Vacuum Constriction Device (VCD)

Pentoxifylline is a vasodilator that causes increased blood flow. The idea here is to use the VCD to force blood flow to the region and to use the pentoxifylline to encourage proper blood flow.

The idea here is that prolonged stretching will require the regrowth of blood vessels and therefore will result in some decreased curvature severity.

Pentox

 

A different US-based study (of 8 men) that looked into Pentoxifyllin and VCD treatment showed minor improvement in 5 participants. One participant experienced significant improvement in curvature. Two men did not experience any statistically significant improvement.

 

Peptides

An unproven theory is that artificial peptides may stimulate tissue growth and therefore improve peyroniees symptoms.

The possible candidate peptides include:

  • GHRP-2
  • GHRP-6
  • Hexarelin
  • Ipamorelin

[1] https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease

[2]: Same as 1.

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