Frequently asked questions about penile sclerosis

The incidence of penile sclerosis, also known as fibrous cavernositis of the penis and Peyronie’s disease, is about 3.2% in the population, and the incidence increases with age. It is a fibrotic lesion that occurs in the white membrane of the penile corpus cavernosum, resulting in vitreous degeneration of normal elastic connective tissue or replaced by fibrous scarring, so that a single or multiple plaques are formed on the dorsal or both sides of the penis, and because of the lack of elasticity of the fibrous plaques, the side of the plaques cannot expand accordingly with the filling of the penile corpus cavernosum with blood when the penis is erect, resulting in curvature, and accompanied by painful, palpable penile nodules, etc. Clinical manifestations, and in severe cases, bending with erectile dysfunction even when the penis is weak. What are the causes of sclerodactyly? It is believed that the cause of penile sclerosis may be related to repeated mechanical compression of the white membrane and microvascular injury as well as hereditary constitution, but the details are not well understood. Systemic diseases such as atherosclerosis may lead to the development of penile sclerosis or accompanying penile sclerosis. About one-third of patients with sclerosis have painless curvature of the penis, while other clinical manifestations may include discomfort in the penile area, pain during urination, and increased pain during erection. In severe cases, the penis may not be fully erect due to excessive bending, which may affect sexual life and even impotence. Single or multiple nodules can be palpated on the dorsal side of the penis or near the coronal sulcus, which are hard, have an irregular surface and cannot be pushed. The diagnosis of this disease can be confirmed based on the time and manner of onset (sudden or gradual), the course of the disease, the history of penile surgery, the history of urethral instrumentation or injury and the appearance of harder, non-ulcerated nodules on the penis, localized skin color unchanged and curved, and painful manifestations. The pain caused by penile sclerosis is usually tolerable and the curvature of the penis caused by it becomes the main target of clinical treatment. It is well known that a straight penis in men is one of the basic conditions for a satisfying sex life, because if the penis shape is curved, it will inevitably lead to embarrassment, shyness, and even doubts about one’s sexual ability, losing the confidence that a man should have. In fact, the curved penis will bend more severely during sexual intercourse erection, the penis also appears short, and may be accompanied by pain during erection, affecting the smooth completion of sexual intercourse; even if barely complete sexual intercourse, it will also leave a shadow on the psychological, fear of sexual intercourse and erection sequelae, and over time, may even develop into erectile dysfunction (commonly known as impotence). The current treatment for penile sclerosis mainly includes non-surgical and surgical treatments. Initial treatment is usually conservative and includes systemic, local or injury site treatment. The main treatments are internal medications such as Vit E, para-aminobenzoic acid, colchicine, and herbal medicine; local injections such as corticosteroids, interferon, isobotulin, and colchicine; iontophoresis; and x-ray radiation therapy. However, non-surgical treatment has not yet brought convincing results and is only applicable to patients with shorter duration and milder conditions, while those with longer duration and more severe conditions should be treated surgically. The traditional surgical methods include penile curvature correction and penile prosthesis implantation. The indications for the former are severe curvature, stenosis or depression for more than one year, sexual dysfunction due to deformed penis, severe shortening or causing discomfort to sexual partners, but the surgery is not effective and the lesion is prone to recurrence after surgery; the latter is for people with penile sclerosis and erectile dysfunction who are ineffective to medication, but the surgery is more expensive and the treatment effect is not certain. Electric grinding is a newly developed surgical method with better efficacy. It uses a high-speed rotating dental drill to grind the plaque in order to remove it, restore the elasticity of the cavernous body and reshape the straight penis. The procedure is performed by separating the vascular nerves around the plaque and marking the plaque, then grinding the plaque under the condition of saline continuously cooling the drill, and stop grinding when the grinding cutter hits the elastic resistance at the bottom of the plaque, for those who are more curved, we routinely perform a modified Nesbit procedure to straighten the penis at the same time to make the procedure more effective. Compared with the traditional plaque removal, the electric grinding has the advantages of precise plaque removal, less trauma, faster recovery, simpler operation, and lower incidence of serious complications such as impotence; due to the relatively small trauma, the patient’s hospital stay is shortened and the cost is not increased by the use of the new technology; we have performed electric grinding for dozens of patients with penile sclerosis since we started this technology in June 2002. The majority of the patients considered that they had obtained better treatment results, were satisfied with the shape of the penis, had significantly improved penile curvature and erectile pain, and could have a satisfactory sexual life. It should be noted that, similar to other surgical treatments, electric polishing should be performed after the patient’s condition has stabilized (more than 1 year of disease duration), otherwise there is inevitably a high recurrence rate, and very few patients also have some surgical complications, such as wound infection, glans numbness, impotence, etc.