Course of the disease
There is a misunderstanding that has to be cleared up in this area as well: It is unclear to many urologists as well as many patients what the actual ‘active’ status of Peyronie’s disease is, while there may justifiably be hope for a spontaneous healing (approximately 20%).
The sad truth and difficulty with medication-based therapy is that you as the patient are not aware of the active status of your disease of Peyronie’s disease at all. The ‘active’ status is the inflammatory response that lapses before the plaque arises. According to our experience, as soon as a plaque has occurred the chance for spontaneous healing is therefore zero percent.
This plaque, which is nothing other than a simple scar, will change over time, however, as every scar does. Like any scar, the plaque will lose water, constrict and form mounds of fibre (which you can feel as bumps). This will not all occur at the same time but rather in different spots at different times.
This means that this plaque and the visual changes and symptoms caused by it will change over time. This is not because the disease is still ‘active’ but rather because the scar is going through its normal ageing process.
The growth of a plaque will not cease. The plaque will not continue to grow because the disease is still present but rather for purely mechanical reasons. Significant shear forces occur during every erection and all sexual intercourse in the transitional zone between solid plaque tissue and elastic erectile tissue. The results in small tears on the edge of the plaque or directly within it again and again, which then heal again as scars. The plaque therefore increases bit by bit over time like adding bricks to a wall. Depending on how things pass, these ageing processes can even cause the direction of the curvature of the penis to change.
As Peyronie’s disease is not a malicious disease that is terminal, it must be viewed purely from the perspective of medical science but does not necessarily require treatment.
If the patient decides not to be treated, that is his right. For the complete and conscientious provision of medical information, however, we will explain the consequences in detail to precisely these patients.
It would be a great fallacy to believe that the exhibited characteristics and symptoms of Peyronie’s disease will always remain the same as they were at the point in time when the patient decided against therapy. It would be an even bigger fallacy to believe that the prospects for successful therapy would be just as positive even if the patient waits longer before beginning therapy. Here are the facts on this:
1. Peyronie’s disease plaque continues to grow throughout the patient’s life through mechanical strain. Curvature and/or constriction and/or shortening will increase, it will become more difficult to get an erection, a venous leak will arise and at some point this will result in impotence.
2. Normally many years pass before such a dramatic development of the symptoms results, but unfortunately not always. Depending on the location and size of the original plaque, impotence can also result within a few months or even a few weeks. Unfortunately no physician is capable of foreseeing this.
3. The larger the plaque grows, the more and more structures it will influence and thereby the more difficult it will be to remove. This will increase the risk and costs of an operation.
4. The larger the plaque is, the more restrictions it will cause to the normal function of the penis. If the plaque exists for too long then it will no longer be possible to restore the function and length of the penis even through professional therapy.
The sad truth is that some patients who believe from insufficient or erroneous information that they could still wait before beginning therapy of their Peyronie’s disease are thereby squandering their chance for successful therapy.
The results of not treating Peyronie’s disease are normally significant and must not be left unstated, even if the statement seems drastic.
Approximately 90% of all sexual contact in Europe occurs within a relationship. This means that sexual intercourse plays an important role in a relationship. If the function of the penis is mostly or completely disrupted for months or years, this will normally place a significant strain even on relationships that started out well and have lasted for years. Then there is also the drastic impairment to the patient’s self-confidence after a time.
We do not wish to pressure any patient into therapy, however it is our duty as physicians to point out that lack of treatment or treatment that is provided too late can lead to a grave defect of the primary sex organ (in this case the male penis) and normally to significant long-lasting consequences that the affected patient cannot begin to imagine in advance for the most part.