Curvature Of The Penis: Therapy

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Curvature Of The Penis: Therapy
Curvature Of The Penis: Therapy
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Curvature of the penis: diagnosis & therapy

The diagnosis of a curvature of the penis is usually made after a detailed anamnesis and a tactile finding. The doctor first finds out about the beginning and type of symptoms, possible traumatic events in the genital area and accompanying erectile dysfunction. Since the causes of penile curvature (acquired or congenital) have not been clearly clarified, all therapeutic measures can only be carried out symptomatically. This is followed by an examination of the penis. The doctor assesses whether a curvature can also be seen in a non-erect state.

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  • Non-operative therapy options
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An artificially induced erection can be used to examine the degree of penile curvature and its severity. Then he / she feels the penis shaft and examines it for noticeable hardening (plaques). An ultrasound examination can provide information about the size and shape of the scarred or nodular changes (plaques) on the penis. Other imaging procedures such as MRT or CT are only used if a penile curvature cannot be clearly diagnosed.

Note For the diagnosis, it can be helpful if the patient takes photos of his erect penis from all angles.

Non-operative therapy options

There are currently no guideline recommendations for the treatment of penile curvature. However, the European Association of Urology (EAU) has published therapy recommendations based on various studies on acquired penile curvature. Since the causes of penile curvature have not been clearly clarified, all therapeutic measures can only be carried out symptomatically.

Während der akuten Phase wird ausschließlich medikamentös therapiert (konservative Behandlung), da sich der Verkrümmungsgrad des Penis noch verändern kann. Durch diese Maßnahmen können bestimmte Symptome wie z.B. Schmerzen gelindert werden. Auch kann verhindert werden, dass sich die Plaques vergrößern. Derzeit steht jedoch noch keine konservative Behandlungsmöglichkeit zur Verfügung, die zu einer vollständigen Auflösung der Plaques bzw. Penisverkrümmung führt.

Hinweis Die European Association of Urology (EAU) weist in ihren Empfehlungen darauf hin, dass die Studienergebnisse zur konservativen Behandlung der IPP (erworbenen Penisverkrümmung) oft widersprüchlich sind und deshalb nur schwer Empfehlungen für die tägliche Praxis abgeleitet werden können.

In principle, there are various non-surgical treatment options available.

Oral drug therapy

The following drugs and food supplements are used to treat penile curvature. These include:

  • Vitamin E: has antioxidant effects and can be effective in the acute phase. In the clinical studies carried out so far, however, there was no clear benefit of this therapy.
  • Potassium paraaminobenzoate (Potaba): has an anti-inflammatory and antifibrotic (counteracting increased formation of connective tissue) and can thus prevent the curvature from progressing - but it cannot improve the curvature of the penis. Side effects such as nausea and stomach cramps are common side effects.
  • Phosphodiesterase: has an anti-fibrotic effect. In the clinical studies available to date in patients with acquired penile curvature (IPP), plaque regression and an improvement in erectile functions have been shown after taking these drugs.
  • Pentoxifylline: has an anti-inflammatory and blood circulation-promoting effect. This is to prevent the plaques from progressing. Recent studies have shown an improvement in penile curvature. This also improved the size of the plaques.

Injection therapy

Injection therapy is available as an alternative to drug therapy. A specific active ingredient is injected directly into the plaques. This loosens the plaque and reduces the curvature of the penis. The substances used include cortisone, verapamil, interferon alpha. Injection therapy is not possible if there is calcification in the plaques.

Note The long-term use of injection therapies is very uncomfortable for the patient as it can be associated with pain, swelling and skin bleeding.

The US FDA and the European Medicines Agency have approved the use of the microbial collagenase from Clostridium histolyticum (Xiapex®) for the treatment of a curvature of at least 30 degrees in the penis. It breaks down collagen - the main component of scar tissue. According to the manufacturer, the enzyme is injected directly into the hard scarring strands of the penis to break up the plaques. After multiple injections, a manual erection of the penis by the doctor is possible. The results of the study are promising. However, a complete straightening of the crooked penis is not always possible.

Note This medication may only be used by appropriately trained doctors, as penile fractures or hematomas can occur as a side effect. There is currently also no reimbursement of costs for the drug from the social security agencies.

Shock wave therapy

Extracorporeal shock wave therapy (ESWT) is a good alternative to drug therapy in the early phase of acquired penile curvature - especially for pain reduction. It is assumed that the ESWT leads to a direct destruction of calcified structures and an improved blood flow with subsequent resorption of the calcification.

Note Even though ESWT can provide rapid pain relief, randomized studies have shown no effect on the symptoms of plaque size and curvature.

Penis extensor & vacuum pump

The penis is stretched for a few hours a day with a penis extensor or a vacuum pump. A curvature can thereby be reduced. However, it is often difficult to use because the penis extensor or vacuum pump has to be used for many hours every day for six months.

Note Penis extensors or vacuum pumps may be of little use.

Operative therapy options

Curvature of the penis is only treated surgically when all non-surgical therapy options fail. There are various surgical techniques available to correct a curvature of the penis. Which method is used depends on the degree of curvature and the symptoms. It is also decisive whether the patient really wants an operation, because different patients are impaired very differently with the same penile deviation.

Note Surgical interventions in the sense of correcting the curvature are only indicated after three - or better after six months, in the stable phase of the disease. In addition, a pain-free interval of six months should have elapsed, so that at the time of the operation the disease had already existed for about six - better twelve months.

Surgical treatment of a curvature of the penis consists either of straightening the penis or of implanting penile implants.

Gathering or plication technique (penis curvature up to 60 degrees)

By gathering the erectile tissue, the penis can be straightened on the healthy side opposite the plaque. The plaque itself remains unaffected. Disadvantage: The penis can be shortened by a few millimeters to two centimeters. Therefore, this surgical technique should only be used with sufficient penis length and slight curvature up to a maximum of 60 degrees.

Plaque surgery (penis curvature more than 60 degrees)

In these cases the so-called grafting technique is carried out. The plaque is removed or incised, the penis is stretched and the defect is covered with alloplastic material. The penis length is retained in the majority of cases. Risk: There may be a deterioration in erectile function.

Penile implants

In patients who develop severe erectile dysfunction up to impotence in addition to a curvature of the penis, penile straightening can be carried out by inserting hydraulic erectile tissue implants. However, penile implants should be the last option and should only be used if all other treatment options have not been successful. Cavernous body implants are implants that cannot be seen or felt from the outside. During the operation, with the implant limb filled, the penis is bent straight through strong pressure ("penile cracking / modeling")

This technique is final and irreversible. The actual erectile tissue is destroyed by the implants. The implant is connected to a pump in the scrotum and can thus bring about an erection. Cavernous body implants are therefore only recommended:

  • for penile curvatures with accompanying erectile dysfunction,
  • if an erectile dysfunction cannot be treated with medication.

Note A penile implant is not a replacement for the penis! Only the erection mechanism is replaced, so that the stiffness of the limb is possible again.

Whom can I ask?

For the diagnosis and treatment of penile curvature, you can contact the following doctors:

  • Specialist in general medicine
  • Specialist in urology and andrology

Clinical psychologists and psychotherapists also support the therapy.

Sexual problems are still a taboo subject. Therefore, there is often a great inhibition threshold to see a doctor. However, he / she is familiar with the clinical picture and will treat your concerns confidentially.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). The costs of some over-the-counter OTC preparations must be borne by the patients themselves.

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic.

For more information, see Costs and Deductibles.

Please contact your social security agency for information on the respective provisions.

You can also find out more about reimbursement on the website of the social insurance agency.

When hospitalization is required

If there is severe dehydration due to diarrhea, hospitalization may be necessary. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

For more information, see What does a hospital stay cost?

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