As the name suggests, congenital penile curvature is present from birth. Problems usually only become apparent during puberty. When men become sexually active and realize that something is wrong with their penis. Congenital penile curvature is estimated to affect around 1 to 4 percent of men.
Congenital penile curvature is caused by a defect during embryonic development.
If the following factors are present, the penis does not develop properly and asymmetry occurs:
- The length of the urethra (urethra) develops inadequately
- Scarring occurs in the connective tissue layers of the penis
Acquired penile curvature, medically known as induratio penis plastica, or IPP for short, is much more common: up to 10 percent of men are affected by acquired penile curvature in the course of their lives.
The exact cause of the development of IPP has not been conclusively clarified. Doctors assume that scar tissue (plaque) forms in genetically predisposed individuals with recurring stress and micro-injuries. The result is calcification as the disease progresses.
Patients often notice plaque in the form of small nodules that can be felt in a flaccid state.
The plaque deposits change the elasticity of the erectile tissue and thus lead to the classic symptoms such as
- Curvature of the penis axis
- Indentations on the penis shaft
- A loss of penis length and
- In advanced stages, also to erectile dysfunction
Erectile dysfunction is the inability to get an erection andmaintain itfor sexual intercourse @ Wasan /AdobeStockAcquired penile erectile dysfunction usually occurs in two phases.
At the beginning is the "acute" phase of the disease. This is when the plaque forms and the penis begins to change and curl, which can lead to indentation defects and even an hourglass phenomenon. Up to 80 percent of patients report that they also lose a significant amount of penis length as a result of IPP. In addition, around 40 percent of those affected also experience pain in the penis during the acute phase of the disease.
- The second phase of the disease is the "chronic" phase. Here, the disease stabilizes and the pain disappears, the curvature of the penis no longer changes and is stable. When the chronic phase sets in varies from person to person. In some patients, the chronic phase occurs as early as 3 months after the first signs of the disease. For others it takes 2 years.
The division into acute and chronic phases is important in order to be able to differentiate between the treatment options in the two phases of the disease.
Medical guidelines from various specialist associations recommend the correction of penile curvature from a degree of deformation of 30 degrees. However, the degree of curvature should not be the only decision criterion for treatment.
In some cases, patients with a pronounced curvature have no problems. In other cases , even a slight degree of deformity can lead to pain, far-reaching problems in their sex life and reduced self-esteem. Withdrawal from sexuality and problems in relationships are not uncommon.
Treatment should therefore be started as soon as the patient perceives the curvature as a problem. Even if it is not objectively that pronounced.
Patients with a congenital curvature normally go to the doctor when they are young.
Men over the age of 40 are more likely to have the acquired form. This is not to say that an acquired curvature cannot also occur at a younger age.
Congenital penile curvature requires surgery. However, different treatment options can now be used to treat acquired curvature, depending on the stage of the disease.
The treatment of IPP depends on the stage of the disease. In the acute inflammatory phase, the focus of treatment is primarily on pain relief. Treatment at this stage of the disease is conservative and involves medication and/or physical therapy.
In addition to oral medication, injections and iontophoresis treatments are used here. Extracorporeal shock wave therapy is also used to break up the plaque deposits using sound waves.
These approaches are pain-relieving. However, scientific studies have not been able to prove that the formation of plaque can be halted or that the curvature can be reduced.
In recent years, the most promising conservative treatment has been injection therapy with XIAPEX in conjunction with penile stretching devices or vacuum pumps.
The doctor injects a specific enzyme directly into the plaques in order to break them down. Unfortunately, the pharmaceutical company has stopped selling this drug in Europe.
Once the IPP has come to a standstill, the focus is on straightening the curvature. At the moment, the only option here is surgery.
The vacuum pump creates a vacuum in the cylinder around the penis and makes erectile function possible @ HENADZY /AdobeStock
Various surgical techniques are available for straightening an IPP, which can be divided into two categories:
- The classic surgical methods
There are the "classic" surgical methods, such as the Nesbit operation or the STAGE technique. These methods achievea straightening of the penile axis by shorteningthe healthy side of the penis. However, the shortening inevitably leads to a significant loss of length of the penis.
To prevent a loss of length, alternative approaches have emerged, also known as "graft surgery".
Doctors cut the plaque on the shortened side of the penis and sew in an artificial material (graft). This allows them to straighten the penis without losing length. The body usually breaks down the graft over time and replaces it with the body's own cells.
As this operation is more complex than a conventional Nesbit operation, the doctor needs to be a specialist. Which surgical technique is the right one always depends on the individual case.
In very advanced stages of IPP, erectile dysfunction often occurs. If this is the case, penile straightening alone can usually no longer correct the underlying problem.
In such cases, the doctor and patient should consider implanting an erectile tissue implant in the form of a penile prosthesis.
Although many men are affected by penile curvature, the condition is rare in everyday urological practice.
This is because many affected men do not know what to do or do not dare to seek professional help. However, it is important to recognize and treat penile curvature at an early stage.
Doctors can successfully treat induratio penis plastica in the acute phase. Conservative therapy is outpatient, so that the patient can return home after the injection.
The downtime for surgery is also limited. If surgery is performed on a curved penis, the man must expect to be sexually inactive for 6 weeks.
However, he can return to sport after 7 to 10 days. The time in hospital lasts no longer than 1 to 2 days.
Because doctors often misdiagnose congenital penile curvature as IPP, those affected should consult an andrologist or specialized urologist.
