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Penile Curvature Glos Care Pathway Overview

This pathway has been designed to clarify the management of penile curvature in Gloucestershire.

Please click the relevant flowchart box to be taken directly to textual information

Presentation

  • Present all of a man’s adult life.
  • Caused by asymmetrical (or uneven) chambers within the penis.
  • The condition does not progress but remains the same over time.
  • Patient’s usually present after reaching puberty as the curvature becomes more apparent with erections/sexual intercourse.

  • a thickened area or hard lump (plaque) in the shaft of the penis (it's rare to get more than one plaque) 
  • a curve in the penis when it’s erect (usually it curves upwards)
  • pain in the penis, usually during an erection (pain in the non-erect penis is rare) / and/or during sexual intercourse
  • the penis looking misshapen, like an hourglass
  • loss of length or girth of the penis 
  • may develop after trauma to the penis, such as bending or hitting

It usually occurs in 2 phases — the acute (or active) phase and the chronic (or stable) phase.

Acute Phase:

  • Can last up to 18 months
  • Is when the most changes to the penis occur
  • Plaques and curvature may develop
  • Pain often occurs with or without an erection

Chronic Phase:

  • Typically begins 12-18 months after symptoms first appear
  • Plaque and penile curvature are not likely to worsen but are also not likely to improve
  • Penile pain usually diminishes, but erectile dysfunction may develop or worsen
  • Acute phase may return if another injury occurs
Red Flags
  • Penile pain (particularly in the glans)
  • Penile discoloration (this occurs after blood flow is cut off); penis may become whitish, bluish, gray colored, or black
Admit direct via ED for surgical management.
Differential Diagnosis
  • Erectile Dysfunction
Initial Primary Care Assessment

  • A full genital examination
    • including measuring the penis dorsally from base to the tip of the glans
    • Plaque size and angulation should be measured while the penis is erect. Angulation can be measured by means of a photograph taken at home, a vacuum pump or by intra-cavernosal injection of a vasoactive agent.
    • Changes in girth are often self-reported by the patient.
  • The hands should be examined for evidence of Dupuytren's contracture.
Initial Primary Care Management

Peyronie’s Disease – Early Stages

Watchful wait/Conservative management for cases which are not severe?

Treatments to include;

  • Medications, vitamins and supplements

Provide advice on lifestyle changes that may help;

When to Refer

Resolution of pain and stability of the curvature for at least 3 months are well-accepted criteria of disease stabilisation and patients’ referral for surgical intervention when indicated - http://uroweb.org/wp-content/uploads/16-PenileCurvature_LR.pdf

Refer to Urologist if:

  • stable disease with no pain and no change in deformity for at least 3-12 months
  • sexual intercourse impeded by curvature
  • failure of conservative treatment
  • extensive plaque calcification
Secondary Care Management

Treatments may include:

  • Shockwave therapy
  • Corticosteroid injections into the fibrous band of tissue
  • Radiation therapy
  • Verapamil injection (a medicine used to treat high blood pressure)
  • Surgery (when other methods have failed or the patient is in the chronic stage of the disease)
    • Surgical complications may include;
      • reduction in penis length,
      • infections, and
      • loss of any erectile functions.
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