Peyronie's disease

Peyronie's disease can also have psychological effects. While most men will continue to be able to have sexual relations, they are likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit depression or withdrawal from their sexual partners.[7]

On Penile ultrasonography, the typical is hyperechoic focal thickening of the tunica albuginea. Due to associated calcifications, the imaging of patients with Peyronie's disease shows acoustic shadowing, as illustrated in figures below. Less common findings, attributed to earlier stages of the disease (still mild fibrosis), are hypoechoic lesions with focal thickening of the paracavernous tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile isoechoic lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea.. In the Doppler study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability. Ultrasound is useful for the identification of lesions and to determine their relationship with the neurovascular bundle. Individuals with Peyronie's disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage at the site of the plaque. Although plaques are more common on the dorsum of the penis, they can also be seen on the ventral face, lateral face, or septum.[10]

• 
  Transverse ultrasound of the penis, in a ventral view, in the middle portion of the penis. Note the echoic image with posterior acoustic shadowing, corresponding to calcification (arrow), in the left corpus cavernosum.[10]
• 
  Projectional radiography ("X-ray"), penetrating the soft parts of the penis, showing radiopaque images that correspond to calcifications in the corpora cavernosa (arrows).

Many oral treatments have been studied but results so far have been mixed.[11] Some consider the use of nonsurgical approaches to be "controversial".[12]

Vitamin E supplementation has been studied for decades, and some success has been reported in older trials but those successes have not been reliably repeated in larger, newer studies.[13]

The use of Interferon-alpha-2b in the early stages of the disease has been studied but as of 2007 its efficacy was questionable.[14]

Collagenase clostridium histolyticum (Auxilium) is reported to help by breaking down the excess collagen in the penis that causes Peyronie's disease.[15][16]

There is moderate evidence that penile traction therapy is a well-tolerated, minimally invasive treatment but there is uncertainty about the optimal duration of stretching per day and per course of treatment, and the treatment course is difficult.[17]

Surgery, such as the "Nesbit operation" (which is named after Reed M. Nesbit (1898–1979), an American urologist at University of Michigan),[8] is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniques. A penile prosthesis may be appropriate in advanced cases.[18]