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Urology/Peyronies Disease

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Question
I noticed a nodule inside my penis about 9 months ago. It was tender, I went to a urologist and he said it was Peyronies Disease and really didn't want to touch my penis. He said there was nothing that could be done....and seemed not to want to talk about it. My penis looks normal when flacid. Not that it means anything, but my penis when hard used to be about 8", and I know that as I got older it would shrink, but bending doesn't seem right. I am 62 now and it barely makes about 7" and can hurt ....if I can get it hard .....during intercourse.
In the meantime, it was becoming increasingly difficult to maintain an erection even with Viagra, so I went to another urologist and he gave me a prescription for Potaba which I have been taking about 20 days and have 2 more months to go. I take 24 capsules a day, ugh.
The problem is, my doctor is on vacation and my penis seems to be bending more and more. It had a slight curve in it, but now it bends drastically and where it bends is where the nodule is, but also where it bends, it has a significant indentation. I am wondering is this normal? Is the drug working? Should I expect my penis to bend more before it gets better?
I sort of understand that the internal nodule is causing the problem, but wonder if there is something I can do or what?
I have an appointment in 60 days, but I would like to know what to expect. I didn't think the drug would cause my penis to bend more....or is it the natural progression of the problem.
Please help, I can't seem to get any answers about this online.
Thanks

Answer
Larry:

Obviously having an indentation and a curvature is not normal.  In general, as long as the erections work and intercourse is possible, we often recommend leaving it alone.

Potaba has been pretty well shown to be worthless.  The best available oral agent seems to be trental but even that is questionable.  There is some enthusiasm for verapamil injections and a new injection agent called Xiaflex which to me seems a little too toxic for me to recommend.

On the positive side, there has been some success with penis extenders like Fastsize and Andropenis.  These are typically worn 6 hours a day with low tension and seem to help with the curvature a little but it takes months.

If erections are also poor, this might be an indication for a penile prosthesis, plaque excision and grafting.  An alternative would be a Nesbit type of surgery where the opposite side to the plaque is tightened to straighten the curvature but this does not fix the erection problem.

You should get a second urology opinion; possibly from a tertiary care university center where they can offer you more alternatives.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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