17 Mar Peyronie’s Disease
The Penis Podcast Episode 6 | Follow on Spotify | Follow on Apple iTunes
DR JAYSON: Hi everybody, this is Dr Jayson, and with me is Dr Gav and together we are the dick doctors from CALIBRE Clinic and today we’re going to be talking about the bent penis. Dr Gav, do guys come in to see you with a bent penis?
DR GAV: Yes, thanks for having me, Dr Jayson, it’s a nice way to start the conversation. The short answer is yes, they do. Bent penises are an actual thing, there are certain conditions that we know of that can be responsible for guys having a penis that is misshapen or bent, especially on erection and we know it as Peyronie’s disease and they often find us because we obviously deal in cosmetic medicine, especially around the penis area, and they’re wondering if we can help them out at all. They also say that we deal with patients with erectile dysfunction and otherpenis realted issues, so often we’re a point of call for these guys with Peyronie’s disease and I believe you’ve encountered some other types of bent penises Dr Jayson?
DR JAYSON: So Peyronie’s is one group and the other is fractured penis. It sounds terrible and when it happens, it can be quite distressing. It usually happens during sex where the erect penis gets forcibly bent, and then on the outside where it’s getting bent, it can actually tear into the deep fibrous layer that is surrounding the erectile tissue, the corpus cavernosum. So when that tears and creates a split by not being intact when there’s an erection, it forces the penis away from the tear, so it creates this bend away from the injury, which is actually the opposite to Peyronie’s disease, where they’ve got a scar that forms that prevents that deep fibrous layer from stretching when there’s an erection, because it won’t stretch from the constriction in that area and so the penis bends towards the lesion. So interestingly, the thought is that Peyronie’s may be caused by small traumas to the penis that perhaps are occurring during sex, without it being a full rupture of that deep fibrous layer, so small traumas create a thickened scar and a bend towards it and the big trauma (the fracture) creates a split and bend away.
DR GAV: And so what’s your advice to these gentlemen who come to see you about these conditions?
DR JAYSON: Normally they’re not coming to see me at the time of the injury (of the fractured penis). Another thing to remember is there’s no bone in the penis, guys. It doesn’t matter what you call it or say, there’s no bone there, so when you’ve got a fractured penis, it is not a fracture of the penis bone. Yes, there are animals that have bones in their penis, but not humans. I don’t want guys out there getting the wrong impression, we want this to be strictly factual and getting good solid medical information out to them. So yeah, there’s no simple medical sort of treatment. Surgically it is possible to do what’s called a “de-gloving procedure” where an incision is made around the head of the penis, then the skin’s taken right back down to the base, and stitched up wherever they find the split in the deep fibrous layer therefore repairing it. So that’s possible, I think most guys once they hear the description of the surgery, sort of start thinking “is there another option..” and that’s where we come in. So PRP, also known as the P-shot, which we have discussed before, consist of ‘platelets’ which we know are full of growth factors (40-50 different kinds) are re-injected into the affected area. And it’s been used in orthopaedics, where it’s put into knees, shoulders and elbows, etc. on people with sports injuries. And there seems to be some evidence that there’s been some healing and improvement in cartilage. So there isn’t that same level of studies and publications talking about injecting platelets for fractured penis. But I’ve had a number of guys who have come in with this who’ve usually done multiple PRP shots into the penis, spreading it out over a number of months. All of them have noticed a gradual straightening and strengthening of their penis. They also said it feels a bit more stable as well. But what they report is that there’s a change in the angle and it looks straighter.
DR GAV: Okay! That’s quite amazing.
DR JAYSON: Yeah, but the great thing about PRP, with it being it’s your own platelets, is it’s very low in risk of complications. It’s just stimulating the body to heal itself, which certainly fits in much more with my idea of how we like medicine to work and heal. So it’s been surprising and quite successful. Again, this is something we’re going to have to write up and get a group of guys, that it’s not that common, it’s not as though I have somebody every week, but I’ve had a handful of guys it seems to have worked really well in. So I’m really happy to use PRP for a fractured penis.
DR GAV: And for Peyronie’s, which we’ve talked about, it’s the scar tissue or some kind of plaque formation in the deeper fascia of the penis, causing a bend towards that direction, for which we can use a similar technique of PRP injections into this area to stimulate formation of new tissue and try to release some of the tightening that that scar tissue is forming.
DR JAYSON: Yeah, so the guys have two complaints here, don’t they? They complain about the bend and also about shortening as well, and no guy likes shortening. I’ve had complaints about major, major shortening from Peyronie’s. But the bend can be so severe that the penis gets sort of non-functional. Sometimes it’s got a 90 degree bend in it, which could be a very severe bend. So you’ve been doing a bit of PRP into Peyronie’s, what kind of results are you getting?
DR GAV: Yeah! I think it’s still in the experimental phase for us. Certainly, as you said, it’s a simple procedure using their own blood, very low risk, so the great thing is that there are no complications and not much downtime really at all, it’s a walk in and out procedure. I think guys are coming back with some positive feedback, but it’s still in the experimental phase for us because we just don’t see Peyronie’s as often as I would see, or be doing other procedures, but certainly no complications, very low risk and positive feedback so far.
DR JAYSON: I guess the main problem is that guys don’t know that this is available as a treatment and there are still only limited publications overseas of it as one, but they do seem to be supportive. So that’s a start.
DR GAV: One of thing that I don’t unfortunately offer here in Sydney, which is something you offer, is the low intensity shock wave therapy in combination with PRP, that could be helpful as well for Peyronie’s.
DR JAYSON: Yeah so again, it’s had limited published studies, which have suggested the PRP shot by itself was said to have some benefit, same with the low intensity shock treatment. The obvious thing then came to “let’s use both and see if we can get better straightening”. We’re still awaiting more results with this. And of course, it’s not an instant thing, unfortunately. You aren’t done with just one session of PRP and shock treatment. And just to remind everyone, when we say shock therapy, it’s not electric shocks, it’s a more physical therapy, similar to a device that physically thumps into the penis, which is why I always call it ‘the thumper’. So with that hopefully we’ll see some really useful benefits. Something that’s has been available recently, is a stretching device. Now stretching devices have been around for forever, which have also been suggested as treatments for Peyronie’s, there’s publications on them! But they’re all relatively limited in benefit. There’s a newer one called Restore X, and maybe we can have some details put at the end of this. So it’s a stretching device that grabs the penis head that’s got these rods that come down to a ring around the base of the penis, which stretch the penis out, and you can position anywhere along it a hinge, and the idea with this is, you hinge the penis over this smooth fulcrum that’s in the middle and you bend it away from the tightening. So you’re stretching that out, which seems sensible to me. You can see how that is much more likely to create stretch into that fibrous plaque and straighten it. After that, the logical thing would be to combine it with the PRP shot into that plaque. We don’t obviously have any financial link to Restore X at all, I send every guy that asked me about it, to their websites, and this again isn’t an instant thing. It’s going to take time and real dedication, in fact, they go through it very carefully on their website. It takes hours of treatment almost every day, over a period of months to get that benefit, but I think it’s really worthwhile and something guys should definitely be looking at.
DR GAV: Of course, coming back to what you mentioned before for the fractured penis about the fractured penis with the 90 degree bend, is there is surgery available that you can consult with your urologist and talk about the surgical options for Peyronie’s?
DR JAYSON: Unfortunately, the most common surgical option is to tighten the fibrous layer on the opposite side of the scar and shorten the long side down. The most common complaint with Peyronie’s surgery is that while it’s straightened the penis, it’s made it shorter and guys are never happy with that. There is surgery to excise the plaque and to place a graft in, but it’s a much more complicated surgery with a higher rate of complications. I don’t myself know any urologist who does that surgery. So yeah, most guys aren’t rushing in to have it. Dr Gav, do you find the guys come to you and ask about CALIBRE and using fillers to disguise the bend in their penis?
DR GAV: Absolutely. They kind of draw the conclusion themselves, which is quite clever, that if you can put dermal filler in the shaft of the penis to create extra girth, well you can then create a straighter shape of the penis. So yes, they come to me and ask if I can do this for them. And I guess there’s a couple of things that need to be taken into account, 1) how severe the bend is, which is normally most noticeable on erection. 2) If we’re going to try and straighten the penis from just a cosmetic point of view with dermal filler, will we have to place the dermal filler on the side of the bends or where the concavity is, and really that’s for when it’s erect to look straighter on that side, that the bend is in. But inevitably, when the penis is flaccid and not in the erect state, if we put a lot more dental filler on that side to fill in that gap, then you’re going to have, I guess a bulge or a large amount of filler when it’s flaccid making it look slightly unnatural.
DR JAYSON: Five, six years ago when I had the first guy come in, it wasn’t a huge bend, he just wanted it to look straighter when erect and I thought this was a great idea, that I would just put a little bit more filler on the concaved side. He came back and said it’s great! We did the treatment while the penis was erect, (we used an erection injection). He then came back and told me a couple of weeks later that it resembled something that of a turtle shell sort of on the side of his penis. There was a definite bulge on that side. Also that he didn’t mind it that much, but I certainly noticed it, I will only do very limited sort of asymmetric injections for a concavity.. But you just can’t chase a big bend, can you?
DR GAV: No, and I guess the other question we get is, with Peyronie’s, just from a penis enhancement point of view can guys still get an increased size in their girth and are they suitable for this? The answer is yes, you are still suitable and can have it done.
DR JAYSON: Yeah, so at least there’s a bunch of treatments that are available for the bent penis. With Peyronie’s, I’d be getting guys to look up Restore X, if you then want to maximise the benefit from your Restore X, get a P-shot injected in after. If you’ve had a fractured penis then, again, have the PRP.
DR GAV: Excellent. All right, well, it’s been enlightening, again, talking with you doctor Jayson,
DR JAYSON: And talking to you, Dr Gav.
DR GAV: We’re the dick doctors with the penis show here today, and don’t forget guys, confidence changes everything.
DR JAYSON: Great, look forward to talking to you again soon.