INGECTION TREATMENTS FOR ED

Peyronie's disease: scar tissue formation

One of the concerns we have with dispensing injection therapy to our patients is that there is a risk of scar tissue formation.
Bob was concerned. He had been using injection therapy for two years, about once or twice a week on average. After six months, he developed a bend in the shaft of his penis.
'I didn't take too much notice of it. I thought it would correct itself. Then I found that it was getting weaker and weaker on the other side of the scar,' he said.
Bob had not been told to vary the site of the injection. He found a spot near the base of the penis where injecting the medicine was comfortable and it had worked well each time.
"The one big advantage,' he told me, 'is that I can piss around corners.'
Chris also developed scar tissue but after a much shorter period of time—just six weeks after using injection therapy. On examination, I felt a large thick nodule near the head of the penis. It was not painful, but I could see that it was going to cause problems.
Chris described to me how, when he got an erection, the head of the penis became bent 'facing up to meet me'. When he ejaculated, the semen would shoot straight up in
the air. This he could cope with. What he couldn't endure was the discomfort that this situation was causing to his partner.
'As soon as we get going', he said, 'she complains that it's too painful. We're having sex less and less now because it causes her more pain than pleasure.'
These two cases highlight the main problems associated with Peyronie's disease or scar tissue in the penis. The first problem is an unsightly bend in the penis, which can make urination in a straight line difficult. The second is the affect on the strength of the penis, usually the area past the bend. The third problem is discomfort for the partner as the penis rubs against the side of the vagina during intercourse.

What is Peyronie's disease?
This condition was first documented by the surgeon, Dr Peyronie. It involves the development of a fibrous scar-like nodule on the shaft of the penis. It occurs spontaneously and usually the cause is not known. Calling it a disease often leads to a misconception. When patients are informed of their condition, the name itself induces a degree of anxiety.
In my experience, in excess of 10 per cent of all men have a Peyronie's nodule or plaque with a resultant bend in the penis. Most men hardly notice the condition and will often not recall which side is bent. It is usually a painless condition, and rarely interferes with passing urine. Only if it is severe will it usually cause discomfort during intercourse. However, in later years it may contribute to difficulty in getting and maintaining an erection.
The causes of Peyronie's disease and how it affects the penis
In the majority of patients there is usually no history for the cause of their Peyronie's disease. Some men may have experienced trauma to the penile shaft, which can directly cause the condition. Some claim that certain intercourse positions promote the onset of the disease. (The position that has been particularly related to the cause of Peyronie's plaques is the man lying on his back and being straddled by his partner. It is thought that when the partner lowers herself onto his penis, a great deal of bending and trauma to the shaft may occur.) Another physical cause has been thought to be trauma during fellatio, where the teeth may be the main offenders.
I have developed my own theory arrived at through specific questioning of those patients who have this condition. After determining to which side the penis bends, I routinely inquire whether the patient is left handed or right handed. 1 have noticed that right-handed men have a bend to the left, and left-handed men have a bend to the right. My theory is that masturbation may be linked to this condition. Repeated rubbing of the index finger along the opposite side of the penis during masturbation may cause irritation in the tissue under the skin, which may develop into scar tissue.
As mentioned, the bend results from the formation of scar tissue (a fibrous plaque) in the shaft of the penis. You may notice that when a cut is healing itself, it pulls the skin around it more tightly. Similarly, when scar tissue in the shaft contracts, it pulls the tissue either side of it closer towards the scarred area. The penis will bend in response.
Another problem is kinking of the blood vessels in the affected area. This reduces the blood flow to the area past the scar. Think what happens when you pull a hose pipe around a corner: it kinks, and the water pressure past the kink is reduced.

How is Peyronie's disease treated?
There are three options for the treatment of Peyronie's disease:
1.         Leave it alone. The problem may disappear over time.
2.         Inject certain drugs into the scar tissue that reduce inflammation and scarring. This can be incredibly painful.
3.         An operation currently appears to be the most successful approach. Operative procedures may be one of the following: Cracking the scar tissue into smaller pieces, cutting the scar tissue out, or stitching the opposite side of the penis, thereby straightening it. The main problem with this operation is that the penis may end up a lot shorter than it was before, and the scar tissue may still come back.

My recommendation to people with this condition is that if it is not causing discomfort during intercourse and it is not painful, leave it alone and live with it. If it is causing discomfort during intercourse or if it is painful, then I recommend having an operative procedure. Either have the plaque 'cracked' or have it cut out. The scar tissue in some men is so severe that a balloon prosthesis must be inserted as the erectile tissue is destroyed.
Injection-induced scar tissue
As the use of injection therapy in the treatment of erectile dysfunction has increased over the years, so too has the incidence of scar tissue occurring in the penis. Some men have penis tissue that is highly sensitive to irritants. This irritant may be an injected medicine, or just a penetrating needle. Displacement of tissue due to the injection of a large volume of medicine may also cause this condition.
*42\4*