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Peyronie's Disease: Symptoms, Diagnosis & Treatment
Dr. Kevin Ostrowski explains what Peyronie's Disease is, what causes it, symptoms, and when you should seek a doctor for a diagnosis.
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Learn more about Kevin Ostrowski, MD
Kevin Ostrowski, MD
The only fellowship trained men's health expert on the Eastside, Dr. Kevin Ostrowski is one of the busiest vasectomy reversalists and infertility doctors in the Northwest. He is the only physician offering the mini-incision vasectomy reversal. He is also one of the highest volume penile prosthetic surgeons in the Northwest.Learn more about Kevin Ostrowski, MD
Transcription:
Scott Webb: Welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And today, we are discussing Peyronie's disease, an often misunderstood and painful condition for men. And joining me today to discuss this disease is Dr. Kevin Ostrowski. He's a physician at EvergreenHealth Urology and Urogynecology Care. And doctor, thanks for your time today. What is Peyronie's disease?
Dr. Kevin Ostrowski: Peyronie's disease is a curvature of the penis. You see that when you get an erection most of the time. It is fairly common and, basically, whenever there is curvature or scar tissue that's created in the penis, that is Peyronie's disease. It is normally acquired and it means that their penis used to be straight and then now has some curvature to it.
Scott Webb: And doctor, what are the causes of Peyronie's disease and who can get it?
Dr. Kevin Ostrowski: So any guy can get Peyronie's disease. Peyronie's disease basically is when your body places scar tissue in the tissue in the penis. Basically, the way that your penis is three cylinders, and two of those cylinders is the erectile bodies and in one cylinder is the pee tube. Around two of those erectile body cylinders, there is this tendon that is similar to the tendons in your hand.
When your body has some trauma or something that happens there, whether you remember it or not, there is some scar tissue that can form, and that scar tissue isn't as stretchy or as elastic as your normal tissue. So, when your body places that scar tissue down there from that trauma, what ends up happening is that that area doesn't stretch and the area around it continues to stretch and it causes a deformation or a curvature of the penis or an hourglass narrowing and sometimes some pain.
Scott Webb: Okay. So you're saying that it's usually caused by some sort of injury, whether we remember doing it or not. So then is there any genetic or hereditary component to this?
Dr. Kevin Ostrowski: Genetics does play a part in Peyronie's disease, because we think of this really as a wound healing disorder. Not like a wound like you have a cut on your hand, but actually how your body forms scar tissue.
And so some people have an injury and really, they don't notice anything. Some people have an injury and create this really dense scar tissue or even calcified scar tissue and whether you do that or not is based upon your genetics. People who have Dupuytren's, which is the finger contractures in your hands, are more likely to have this as are patients who have Peyronie's disease in their family. Obviously, a lot of guys don't necessarily talk about that, but it is something that we see that can run in families.
Scott Webb: And besides curvature, what are some of the other symptoms of Peyronie's?
Dr. Kevin Ostrowski: The first thing that guys often notice is some curvature. They also can notice some pain with an erection. And that's just really from that scar tissue being formed in your body, dealing with that trauma or microtrauma that happened. Also other things are some guys can notice some kind of hourglass narrowing or hinging. And all of it depends upon where that scar tissue is created and how your body is dealing with the trauma and where the trauma happened.
Scott Webb: Yeah. And when should we see a doctor and how is Peyronie's diagnosed?
Dr. Kevin Ostrowski: Peyronie's disease really is diagnosed partially by discussion of your history and kind of what's happened and then doing a physical examination where we actually are trying to feel for that plaque or that scar tissue. Also sometimes we will do an ultrasound or even do an injection with a medication that can give you an erection with an ultrasound. It all depends upon your symptoms and kind of what things look like.
It also can be helpful to bring some pictures actually showing it. I know it sounds funny and weird and this is a personal topic, but having some pictures to show the curvature, the amount of curvature, which way it curves are all helpful in figuring out what's the best options for treatment and how much this is really impacting you.
Scott Webb: And doctor, what are the treatment options available to men for Peyronie's?
Dr. Kevin Ostrowski: There are FDA approved treatments and then non-FDA approved treatments when we look at Peyronie's disease, the American Urology Association has created some guidelines regarding treatments and best treatment options and things like that. We also think about Peyronie's disease in two phases. There's the active phase where things are still changing. And then the more chronic phase where things are stable. And so when we're in the active phase and things are still changing, we start talking about medications that look at and are for treating and trying to stop your body from creating really bad scar tissue.
And so there are some oral medications that help with how your body puts down the scar tissue. Those medications are things like pentoxifylline or Colchicine / And so those can help with the way your body puts down scar tissue. Those are not FDA approved, but we use them off-label and they've been studied to evaluate Peyronie's disease.
And then for FDA approved treatments, we're talking about most of the time Xiaflex, which is a medication that basically helps break down that scar tissue. It's a really strong medication that gets injected directly into that plaque and it's kind of Pac-Man for that plaque. It breaks down that scar tissue to help the penis straighten and work and is a series of injections. If that isn't an option or if that doesn't work for you, then we start talking about surgery and surgery, we look at it as a last resort for most people to help deal with that curvature.
Scott Webb: I definitely appreciate the Pac-Man reference. I don't get a lot of Pac-Man references in these podcasts, so I appreciate that a lot. And is it a situation where if we suffer an injury, that there's any value in coming in immediately to potentially stave off Peyronie's disease?
Dr. Kevin Ostrowski: Yeah. I think it’s worthwhile to at least get evaluated and checked out. And to have someone monitoring the situation. Like most things, it's better to get evaluated early and potentially get put on some treatment or actively watched than it is to wait until things get worse. And it gets you in connection with a healthcare provider who helps treat these kinds of things.
Scott Webb: Doctor, as we get close to wrapping up here, what are the most common misunderstandings about Peyronie's?
Dr. Kevin Ostrowski: A lot of guys ask how common is this and we don't know for sure exactly how common it is. The way I describe it’s like there was no erectile dysfunction until Viagra came out and then as soon as there was an oral pill medication that worked to help fix the problem, then millions of guys had erectile dysfunction and similar is I think true with Peyronie's disease.
We think between 2 and 10% of the population have it. But I think that there's a large percentage of guys who aren't getting care and aren't getting treatment for it. It has significant impacts both obviously on your relationship with your partner, but also just there's psychological and personal impacts on it from just getting the diagnosis and seeing things change in an area that's really personal and really sensitive.
Scott Webb: Yeah. There's no doubt. We probably don't talk about it nearly enough, especially if we're suffering from it and good that we're doing that here today. And doctor, as we wrap up, anything else we can tell people about Peyronie's disease?
Dr. Kevin Ostrowski: I think that there are a lot of things that are not discussed and not talked about, but know that there are people who-- this is what we do all day, every day. And so coming in, seeking care, getting evaluated and then potentially getting treatment if you need it, are all reasons that we do what we do to help improve quality of life of guys.
Scott Webb: Yeah, no doubt. There is help available, people like yourself who are used to dealing with this who make awesome Pac-Man references and have the care and the sensitivity for people to feel like they can speak openly and freely and bring some pictures if they think that'll help.
So doctor, thanks so much for your time today. I look forward to talking to you again and you stay well.
Dr. Kevin Ostrowski: Awesome. Thank you. You too.
Scott Webb: And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to our website at EvergreenHealth.com for more information and to get connected with one of our providers. And please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.
Scott Webb: Welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And today, we are discussing Peyronie's disease, an often misunderstood and painful condition for men. And joining me today to discuss this disease is Dr. Kevin Ostrowski. He's a physician at EvergreenHealth Urology and Urogynecology Care. And doctor, thanks for your time today. What is Peyronie's disease?
Dr. Kevin Ostrowski: Peyronie's disease is a curvature of the penis. You see that when you get an erection most of the time. It is fairly common and, basically, whenever there is curvature or scar tissue that's created in the penis, that is Peyronie's disease. It is normally acquired and it means that their penis used to be straight and then now has some curvature to it.
Scott Webb: And doctor, what are the causes of Peyronie's disease and who can get it?
Dr. Kevin Ostrowski: So any guy can get Peyronie's disease. Peyronie's disease basically is when your body places scar tissue in the tissue in the penis. Basically, the way that your penis is three cylinders, and two of those cylinders is the erectile bodies and in one cylinder is the pee tube. Around two of those erectile body cylinders, there is this tendon that is similar to the tendons in your hand.
When your body has some trauma or something that happens there, whether you remember it or not, there is some scar tissue that can form, and that scar tissue isn't as stretchy or as elastic as your normal tissue. So, when your body places that scar tissue down there from that trauma, what ends up happening is that that area doesn't stretch and the area around it continues to stretch and it causes a deformation or a curvature of the penis or an hourglass narrowing and sometimes some pain.
Scott Webb: Okay. So you're saying that it's usually caused by some sort of injury, whether we remember doing it or not. So then is there any genetic or hereditary component to this?
Dr. Kevin Ostrowski: Genetics does play a part in Peyronie's disease, because we think of this really as a wound healing disorder. Not like a wound like you have a cut on your hand, but actually how your body forms scar tissue.
And so some people have an injury and really, they don't notice anything. Some people have an injury and create this really dense scar tissue or even calcified scar tissue and whether you do that or not is based upon your genetics. People who have Dupuytren's, which is the finger contractures in your hands, are more likely to have this as are patients who have Peyronie's disease in their family. Obviously, a lot of guys don't necessarily talk about that, but it is something that we see that can run in families.
Scott Webb: And besides curvature, what are some of the other symptoms of Peyronie's?
Dr. Kevin Ostrowski: The first thing that guys often notice is some curvature. They also can notice some pain with an erection. And that's just really from that scar tissue being formed in your body, dealing with that trauma or microtrauma that happened. Also other things are some guys can notice some kind of hourglass narrowing or hinging. And all of it depends upon where that scar tissue is created and how your body is dealing with the trauma and where the trauma happened.
Scott Webb: Yeah. And when should we see a doctor and how is Peyronie's diagnosed?
Dr. Kevin Ostrowski: Peyronie's disease really is diagnosed partially by discussion of your history and kind of what's happened and then doing a physical examination where we actually are trying to feel for that plaque or that scar tissue. Also sometimes we will do an ultrasound or even do an injection with a medication that can give you an erection with an ultrasound. It all depends upon your symptoms and kind of what things look like.
It also can be helpful to bring some pictures actually showing it. I know it sounds funny and weird and this is a personal topic, but having some pictures to show the curvature, the amount of curvature, which way it curves are all helpful in figuring out what's the best options for treatment and how much this is really impacting you.
Scott Webb: And doctor, what are the treatment options available to men for Peyronie's?
Dr. Kevin Ostrowski: There are FDA approved treatments and then non-FDA approved treatments when we look at Peyronie's disease, the American Urology Association has created some guidelines regarding treatments and best treatment options and things like that. We also think about Peyronie's disease in two phases. There's the active phase where things are still changing. And then the more chronic phase where things are stable. And so when we're in the active phase and things are still changing, we start talking about medications that look at and are for treating and trying to stop your body from creating really bad scar tissue.
And so there are some oral medications that help with how your body puts down the scar tissue. Those medications are things like pentoxifylline or Colchicine / And so those can help with the way your body puts down scar tissue. Those are not FDA approved, but we use them off-label and they've been studied to evaluate Peyronie's disease.
And then for FDA approved treatments, we're talking about most of the time Xiaflex, which is a medication that basically helps break down that scar tissue. It's a really strong medication that gets injected directly into that plaque and it's kind of Pac-Man for that plaque. It breaks down that scar tissue to help the penis straighten and work and is a series of injections. If that isn't an option or if that doesn't work for you, then we start talking about surgery and surgery, we look at it as a last resort for most people to help deal with that curvature.
Scott Webb: I definitely appreciate the Pac-Man reference. I don't get a lot of Pac-Man references in these podcasts, so I appreciate that a lot. And is it a situation where if we suffer an injury, that there's any value in coming in immediately to potentially stave off Peyronie's disease?
Dr. Kevin Ostrowski: Yeah. I think it’s worthwhile to at least get evaluated and checked out. And to have someone monitoring the situation. Like most things, it's better to get evaluated early and potentially get put on some treatment or actively watched than it is to wait until things get worse. And it gets you in connection with a healthcare provider who helps treat these kinds of things.
Scott Webb: Doctor, as we get close to wrapping up here, what are the most common misunderstandings about Peyronie's?
Dr. Kevin Ostrowski: A lot of guys ask how common is this and we don't know for sure exactly how common it is. The way I describe it’s like there was no erectile dysfunction until Viagra came out and then as soon as there was an oral pill medication that worked to help fix the problem, then millions of guys had erectile dysfunction and similar is I think true with Peyronie's disease.
We think between 2 and 10% of the population have it. But I think that there's a large percentage of guys who aren't getting care and aren't getting treatment for it. It has significant impacts both obviously on your relationship with your partner, but also just there's psychological and personal impacts on it from just getting the diagnosis and seeing things change in an area that's really personal and really sensitive.
Scott Webb: Yeah. There's no doubt. We probably don't talk about it nearly enough, especially if we're suffering from it and good that we're doing that here today. And doctor, as we wrap up, anything else we can tell people about Peyronie's disease?
Dr. Kevin Ostrowski: I think that there are a lot of things that are not discussed and not talked about, but know that there are people who-- this is what we do all day, every day. And so coming in, seeking care, getting evaluated and then potentially getting treatment if you need it, are all reasons that we do what we do to help improve quality of life of guys.
Scott Webb: Yeah, no doubt. There is help available, people like yourself who are used to dealing with this who make awesome Pac-Man references and have the care and the sensitivity for people to feel like they can speak openly and freely and bring some pictures if they think that'll help.
So doctor, thanks so much for your time today. I look forward to talking to you again and you stay well.
Dr. Kevin Ostrowski: Awesome. Thank you. You too.
Scott Webb: And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to our website at EvergreenHealth.com for more information and to get connected with one of our providers. And please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.