First observed in 1743 by a French surgeon, Peyronie's disease is a condition caused by hardening of normally elastic tissue in the penis. The result is curvature or a change in shape which may cause pain and interfere with sexual activities. Although less than 4 percent of men are affected, most are white and over 40. Risks are increased for smokers, close relatives of affected men, and those with a history of injury to the penis. European urologist Albert Leriche was inspired to free connective tissue the way hand surgeons do for those with contractures.
Background
Without treatment, 15 percent of Peyronie's disease cases improve spontaneously. Half of patients get worse, and the remainder stay the same. There is no single cure or treatment for Peyronie's disease. Vitamins E and C and the amino acid L-carnitine, along with medication have poor success rates. The only surgical treatment available prior to the Leriche technique straightened the penis of men with Peyronie's disease by shortening elastic tissue opposite the inflexible scar tissue. Most men are unhappy with the results because the procedure, known as Nesbit surgery, considerably shortens the length of the penis.
Before men are considered for the Leriche technique, they should have a history of at least three month's oral treatment that did not work. The disease must be severe enough to interfere with sexual function. Diabetics, or those who take blood thinning medications, may be ruled out. Men who have had Peyronie's disease for less than 18 months, a phase characterized by pain and inflammation, are not considered for the Leriche technique until scarring, or plaque, has stabilized. Plaque must be localized in an area small enough that it is likely to benefit from the procedure.
The Procedure
The Leriche technique is most often an outpatient procedure. The extent of plaque is located and measured under ultrasound. Anesthetic is used to numb the penis. Saline solution is injected to induce a penile erection. Plaque is then slashed with a needle or lance to break up the scarred connective tissue so the penis can straighten. Adjustments are made, with more saline solution and more lacerations, until the desired penile position is achieved. A pressure bandage is applied for three hours.
Aftercare and Outcomes
Following treatment, men must engage in early and daily sexual activity for one month to maintain good results. Approximately 30 percent of men who undergo the procedure are cured. Another 50 percent gain sexual function after one or more repeated attempts with the Leriche technique. Leriche is minimally invasive compared to Nesbit surgery and has had better outcomes. Also, for the 20 percent of men for whom Leriche does fail, the technique will not the option to have other treatments, such as surgery or penile implants.
Tags: Peyronie disease, interfere with, Leriche technique, Leriche technique, connective tissue