Hourglass Deformity in Peyronie's Disease - Pictures, Causes and Treatment Options

What Does An Hourglass Deformity Look Like in Peyronies Disease?

Peyronies disease involves the development of fibrotic scar tissue inside the penis, causing curved, painful erections and penile deformities. One characteristic deformity seen in some men with Peyronies disease is called an hourglass deformity. Here is what an hourglass deformity looks like, what causes it, and how it is treated.

Appearance of an Hourglass Deformity

An hourglass deformity refers to a specific pattern of scarring that constricts part of the penis. This causes the penis to look narrowed or pinched, resembling the shape of an hourglass. The constriction occurs along the shaft, usually about midway down the length of the penis.

Visually, the hourglass deformity looks like an indentation encircling the shaft, making that section of the penis abnormally slender compared to the wider areas above and below the constriction. It is most noticeable during an erection, when the scar tissue prevents full expansion of the encircled area.

In some cases, the hourglass constriction is so severe that it inhibits adequate blood flow into the tip of the penis during an erection. This can make the head of the penis look swollen and discolored.

The hourglass scar pattern gives the shaft an obvious wasp-waist appearance when viewed from the side during an erection. Palpation of the area may reveal dense, thickened scar tissue under the skin surface.

What Causes an Hourglass Deformity?

All penile deformities in Peyronies disease result from an accumulation of fibrous scar tissue called plaque. This scarring occurs inside the erectile chambers of the penis after injury, most often during vigorous sexual activity. The plaque buildup prevents normal expansion and causes curves, indentations, or hourglass constrictions.

Researchers believe hourglass deformities form due to the unique biomechanics of the penis during an erection:

• The mid-shaft area flexes significantly during vigorous intercourse.
• This repeated stress and stretching can damage the tunica albuginea layers surrounding the erectile chambers.
• Scar tissue then builds up in response to the trauma.
• The ring-like pattern of scarring constricts that section of the shaft.

In some cases, an hourglass deformity occurs in combination with other scar patterns that cause alternate bends or curves in other areas of the shaft. The hourglass is an indentation that develops on top of the underlying curvature.

Treatments for an Hourglass Deformity

Several treatment options exist for managing an hourglass deformity in Peyronies disease:

• Oral medications: Drugs like pentoxifylline, colchicine, and tamoxifen may help soften plaque and reduce pain in some cases.
• Injections: Collagenase and verapamil injections directly into the scar tissue can help break down plaque in some men.
• Vacuum therapy: Use of a vacuum erection device gently stretches the constricted area to regain length and girth.
• Stretching devices: Devices that traction or stretch the flaccid penis may reduce indentations from scar tissue.
• Shockwave therapy: Pulsed acoustic wave therapy aims to break down fibrous plaque and may reduce deformities.
• Surgery: For severe hourglass deformities, surgical plaque incision or grafting techniques can be used to correct the indentation.

The best approach depends on factors like the severity of the deformity, level of erectile dysfunction, and the mans preferences. Many men pursue a combined treatment plan for optimal results. Work closely with a urologist who specializes in Peyronies disease for an accurate diagnosis and effective treatment.

Nonsurgical Treatment Options for Peyronies Disease

Peyronies disease is characterized by the development of hard, fibrous scar tissue (plaque) inside the shaft of the penis. This can cause painful erections, penile deformities, erectile dysfunction, and psychological distress.

While surgery can correct anatomical defects from advanced Peyronies, most men seek less invasive options first. Here is an overview of the leading nonsurgical treatments for Peyronies disease.

Oral Medications

Certain oral medications aim to soften scar tissue, reduce inflammation, and minimize penile deformity in Peyronies disease. Common drug options include:

• Pentoxifylline: An anti-inflammatory that may inhibit collagen production and soften existing plaque.
• Tamoxifen: A selective estrogen receptor modulator that counters fibrosis and may reduce plaque size.
• Colchicine: Known to have antifibrotic properties that may soften or stabilize plaque deposits.

While some small studies show modest improvements, more research is needed to confirm the effectiveness and safety of these oral agents. They work best when combined with other nonsurgical approaches.

Collagenase Injections

Collagenase injections (such as Xiaflex) contain enzymes that break down collagen deposits. When injected directly into Peyronies plaque, collagenase aims to:

• Soften and weaken dense scar tissue
• Improve penile curvature
• Restore lost girth and length
• Relieve painful erections

A series of in-office injections followed by plaque modeling can reduce deformities by an average of 20-40%. Mild to moderate side effects include penile bruising, swelling, and pain.

Verapamil Injections

The anti-fibrotic effects of verapamil may disrupt scar tissue formation and organization when injected into Peyronies plaque. Potential benefits include:

• Plaque size reduction
• Decreased penile curvature
• Improved erectile function
• Reduced pain with erections

Multiple in-office injections are done every 1-2 weeks. Mild side effects like bruising, pain, and dizziness may occur. More research is needed to confirm verapamils efficacy.

Vacuum Therapy

A vacuum erection device uses suction to pull blood into the penis, causing a simulated erection. When used in Peyronies disease, goals include:

• Stretching and elongating scarred tissues
• Preventing further shortening
• Reducing curvature
• Improving erectile rigidity

Daily use for 3-9 months may gradually provide small improvements in penile length, curvature, and deformities. It is noninvasive with minimal side effects.

Penile Traction/Stretching

Devices like the Penimaster or RestoreX mechanically traction the flaccid penis daily through the following mechanisms:

• Gentle, prolonged stretching of scarred plaques
• Recruitment of healthy tissues to expand the affected area
• Increased elasticity and reduced indentations
• Gradual straightening with reduced curvature

Small, incremental size gains are possible with consistent daily use for 3-6 months. Mild soreness may occur. More studies are underway.

Shockwave Therapy

Also known as acoustic wave therapy, this uses pulsating soundwaves to break down scar tissue in Peyronies disease. Goals include:

• Weakening and eventual dissolution of fibrous plaques
• Reduced penile deformity and curvature
• Improved erectile function
• Decreased penile pain

It appears safe and tolerable, but more research is needed to confirm efficacy. Multiple in-office procedures are done with potential bruising as the main side effect.

Nonsurgical options for Peyronies disease aim to stabilize or reduce penile curvature and deformity, improve sexual function, and decrease pain. Work with a urologist to determine whether nonsurgical approaches are appropriate before considering invasive surgery.

Surgical Treatment for Peyronie's Disease

For men with severe penile deformities or erectile dysfunction from advanced Peyronies disease, surgery may be recommended. Goals of surgery include:

• Straightening the penis and correcting deformities
• Restoring ability to penetrate during intercourse
• Removing painful scar tissue plaques
• Regaining penile length, girth and rigidity

Surgery for Peyronies disease comes with inherent risks of complications, so thorough counseling about surgical options and outcomes is essential.

Surgical Techniques

Several surgical techniques exist for correcting anatomical defects from Peyronies disease. The most common procedures include:

• Plication: Tucks healthy tissue on the opposite side of the curve to cancel out the deformity. No incisions or grafts needed.
• Grafting: Replaces scar tissue with healthy grafted tissues from another body area like the arm or leg.
• Plaque incision/excision: Surgically cuts or removes troublesome plaques that cause deformities.
• Penile prosthesis: Inserts inflatable penile implants to allow intercourse despite erectile dysfunction.
• Penile lengthening: Releases tethered penis from scrotum and repositions it on the abdominal wall for increased length.

The specific technique used depends on factors like deformity severity, erectile function, and surgeon preference. In some cases, a combined approach is warranted.

Considerations and Expectations

It is important to have realistic expectations about benefits and risks of Peyronies surgery. Things to know include:

• Not all curvature or deformities can be fully corrected.
• Penile shortening is possible due to grafting techniques.
• Erectile dysfunction may persist after surgery in some men.
• Risks include reduced sensation, pain, infection, and dissatisfaction with results.
• An experienced surgeon is vital for best surgical outcomes.

Thorough pre-operative education, careful surgical planning, and quality postoperative care can help maximize results and reduce risks. However, some curvature or minor deformity may remain even after expert surgery.

Recovery and Follow-Up

Recovery times vary based on the specific Peyronies surgery. Things to expect include:

• Hospital stay of 1-2 days for more extensive procedures.
• Wearing a specialized penile wrap and using pain medication as needed.
• Refraining from sexual intercourse for 4-8 weeks to allow proper healing.
• Gradually resuming sexual activity once cleared by the surgeon.
• Ongoing follow-up to monitor results, complications, and any recurrence.

Proper postoperative care is vital for reducing swelling, supporting healing, preventing complications like infection, and laying the foundation for optimal outcomes after Peyronies surgery.

While surgery is not appropriate for all men with Peyronies disease, it can successfully restore function and alleviate deformity in carefully selected patients. Experienced surgeons achieve the best results.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.