Урологи призывают лечить болезнь Пейрони на ранней стадии, чтобы предотвратить необратимую деформацию

There are curves we admire — the sweep of a Bahamian shoreline, the bow of a well-built boat, even the bend of a perfectly placed cricket ball. Then there are curves that nobody ordered. Peyronie’s disease belongs firmly in the second category. It is one of those conditions whose name tells you absolutely nothing about what it does. It sounds almost elegant, perhaps something you might order from a French menu. The reality is considerably less sophisticated. Peyronie’s disease causes scar tissue to develop within the penis and, as that scar tightens, a previously straight erection can begin to bend. For some men, the change is slight. For others, the curve becomes significant enough to interfere with sex. There may also be pain, shortening, narrowing, a dent, or an hourglass shape. Sometimes, the first clue is simply a firm area beneath the skin. And before anyone starts quietly examining every angle and wondering whether they qualify, let us establish something important: a penis does not have to be ruler-straight to be normal. Men naturally come in different shapes. A lifelong gentle curve that causes no difficulty is not Peyronie’s disease. What interests me as a urologist is change — a bend that was not there before, a curve becoming more pronounced, new pain, new shortening, or a new lump. That is when the conversation changes. Peyronie’s disease has traditionally been discussed as though the scar itself were the main event. But there is a chapter before the scar settles. This is the acute phase, when the condition is still developing. The penis may hurt during erections, a plaque may begin to form, and importantly, its shape may still be changing. Think of wet cement rather than concrete. Once concrete has set, changing its shape becomes considerably harder. During the acute phase, however, the biological processes responsible for laying down that scar are still active. And that has become particularly interesting because researchers are now asking a rather different question. Instead of waiting for Peyronie’s disease to finish doing its damage, and then dealing with the consequences, could we interrupt the process while it is happening? That question takes us into some fascinating new research. But why does the scar develop in the first place? The short answer is that we do not completely know. The most accepted explanation begins with injury to the erect penis. Before imaginations run wild, we are not necessarily talking about some memorable bedroom catastrophe. The injury can be tiny. During intercourse, an erection is occasionally bent or buckled, producing microscopic damage that a man may never notice. For most men, the body repairs this and everybody gets on with their lives. In some men, however, the repair crew gets carried away. The normal healing process fails to switch off properly, and too much collagen and scar tissue are deposited. Researchers have identified several chemical signals involved in this process, particularly one called transforming growth factor beta (TGF-beta). You certainly do not need to remember its name — what matters is what it does: it helps encourage the cells responsible for fibrosis, or scarring. Why this happens to one man and not another is probably a mixture of bad luck, biology, and susceptibility. Peyronie’s disease is associated with increasing age, diabetes, erectile dysfunction, and several cardiovascular risk factors. Smoking has also been associated with the condition. There is an especially interesting relationship with Dupuytren’s contracture, where scar-like tissue develops in the palm and gradually pulls one or more fingers inward. In other words, some bodies simply seem rather enthusiastic about making scar tissue. This is about more than a bend It is easy to reduce Peyronie’s disease to geometry. How many degrees? Which direction? How long? How much shortening? The man attached to that penis may be asking very different questions. Will I still be able to have sex? Will my partner notice? Will it get worse? Is this permanent? Is something seriously wrong with me? That psychological burden should not be underestimated. Peyronie’s disease can affect confidence, relationships, and sexual well-being. Some men begin avoiding intimacy altogether. And because the subject is embarrassing, they may carry that worry alone. There is another reason silence matters. The early phase does not necessarily behave predictably. Pain often improves with time, but the curvature does not reliably disappear with it. Published reviews suggest spontaneous improvement of the deformity occurs in only a minority of men. So “it doesn’t hurt anymore” does not necessarily mean “it has gone away”. What if we treated the scar before it sets? This is where the story becomes particularly interesting. Professor David Ralph and Professor Selim Cellek published an article in Nature Reviews Urology, describing what they call a success story in taking scientific discoveries “from bench to bedside”. That phrase is worth understanding. The “bench” is the laboratory; the “bedside” is you and me. Their research began by trying to understand the cells responsible for the excessive scarring in Peyronie’s disease, and then testing medicines that might interfere with that process. Among the drugs that attracted attention were two familiar medicines being used for completely different purposes. One was a phosphodiesterase type 5 (PDE5) inhibitor- the family that includes tadalafil and sildenafil, medicines many readers will recognize as treatments for erectile dysfunction. The other was tamoxifen, a medicine better known for its role in breast cancer treatment. An unusual partnership, certainly. But medicine is full of drugs that begin one career and discover another. Laboratory research suggests that combining these medicines could act against the cells driving fibrosis. That eventually led researchers to ask the obvious question: could the same combination help men during the active stage of Peyronie’s disease? From the laboratory to real men A recent clinical study looked at 159 men with acute Peyronie’s disease. Of these, 133 received a combination of daily PDE5 inhibitor and tamoxifen for three months, while 26 received standard care. The results were intriguing— the men receiving combination treatment showed a significant improvement in penile curvature, while the standard-care group did not show a significant change. Pain improved in both groups, although the improvement was greater among men receiving the combination treatment. That is genuinely encouraging. But encouraging does not mean settled science. This was not a large randomized controlled trial, and the medicines were being used off-label for Peyronie’s disease. We still need larger, properly controlled studies before knowing exactly which men benefit, how long treatment should continue, and whether the improvements last. So please do not read this and begin constructing your own Peyronie’s cocktail. That is not the message. The important part of this research is bigger than the tablets themselves. It challenges the old idea that the early phase of Peyronie’s disease is simply something we watch until it settles. Perhaps that wet cement deserves our attention before it becomes concrete. Gentlemen, do not wait for embarrassment to make the decision. If you develop a new penile curve, pain during erections, shortening, narrowing, or a firm lump, there is no need for panic. There is, however, every reason for a conversation. See your doctor. If necessary, see a urologist. And do it while you can still describe how and when things began to change. Peyronie’s disease is not cancer. It is not contagious. It is not evidence of infidelity, masculinity lost, or some secret wrongdoing. It is an abnormal scarring process that medicine is beginning to understand much better. And perhaps that is the most important message from the latest research. For years, much of our attention has been directed towards what to do once Peyronie’s disease has settled. We are now beginning to ask whether the better opportunity may come earlier. Dr. Greggory Pinto is a board-certified Bahamian urologist and laparoscopic surgeon. He can be contacted at OakTree Medical Center #2 Fifth Terrace and Mount Royal Avenue, or telephone: (242) 322-1145(6)(7). Email: [email protected] or visit the website: www.urologycarebahamas.com.