Induratio Penis Plastica
The Induratio Penis Plastica (IPP) is a disease of unknown aetiology that implies the occurrence of fibro-sclerotic areas into the albuginea layer enveloping corpora cavernosa. This degenerative disease commonly advances slowly having a starting phase, inflammation phase, characterised by pain at lesion point and during intercourse. At this time is still possible to get some regression of scars by appropriate therapy. After some months the lesion becomes a hard scar well distinguishable from soft surrounding tissues by penis palpation. At this stage bending of penis that inevitably follows the onset of scar becomes almost permanent and impossible to straighten in erection. Fibrosis can be more or less pronounced with possible calcium deposition and scar ossification. Not all lesions follow this path quite slowly evolving: some stop at initial stage with limited extension and hardness, others increase in dimensions and fibrosis with deviation and retraction of erected penis with possible associated torsion of penis cylinder; others more can regress or remain stable with minimal residual change Anyway it’s important to refer to Andrologist as soon as possible because best results can be achieved in the first months of disease. Therapies based on drugs or supplements have small impact on disease evolution but commonly are prescribed with the aim of cooperating with more invasive treatments. Between mild invasive treatments, we can enroll physiotherapy ones, widely described into focused chapter, mainly those with stretching and remodeling under VP erection. Physiotherapy can be associated advantageously with needle infiltration of drugs like Corticosteroids or Verapamil and following Stretching session and handle remodeling by straightening of penis held erected by constrictor rings. The role of physiotherapy, questioned by some Author in review study, has been recently reappraised and advised in association with Clostridium Histolyticum collagenase infiltration.
This enzyme, of bacterial origin is able to “dissolve” scar tissue and then to free penis from plaque grip. The use of this drug besides is allowed only to authorized structures where expert doctors operate under ultrasound control to avoid injection into structures as urethra or blood vessel. Also a correct injection could imply the risk of albuginea layer perforation with hematoma and surgery repair. Nowadays the substance is really expensive so his wide-scale usage is limited . Besides its strongly recommended, in association with drug infiltration, penis remodeling physiotherapy on held erected by ring constrictor after VP with manipulations aimed to stretching and re-straightening a bent penis. These manoeuvres must be done with caution to not break corpora with following bleeding more or less evident and possible erectile dysfunction. As an alternative to infiltration, some drugs can be delivered through flat electrodes applied onto the penis releasing low intensity current to carry on polarized molecules of drug deep into tissues ( Electromotive drug administration or EMDA). Also EMDA is more effective if made in early stages of disease.
Surgery is the only chance when other procedures have failed and deviation angle remain high and not compatible with intercourse. It has the goal of complete straightening, goal reachable by two different ways:
1) Resection of plaque with tissue patch repair;
2) Straightening through contralateral shortening of albuginea layer.
Surgery of plaque requires surgeons particularly skilled in this field because relapsing scar and possible erectile troubles can easily happen despite a correct technique. Straightening procedure is much more easy, pretty complications free and quickly healing.
Therapy of praecox ejaculation
Praecox ejaculation ( PE) is a trouble of normal ejaculatory latency implying an early orgasm after few seconds or minutes after penetration. In extreme cases the orgasm can happen only because of strong arousal without penetration or penis manipulation. In most cases ejaculatory latency time ( IELT) is one/two minutes. PE is a condition that generates frustration of men and dissatisfaction of partner, giving rise to great discomfort of couple requiring Andrologist consultation and psycho-sexologist counseling. Sometimes after prostate/vesicular inflammation can take place a transient PE that slowly disappears with healing or rather can undergo alternating phases of regression or relapse. Onto PE play a crucial role some psycho stimuli especially those related to stress or performance anxiety: particularly the second is promoted from the more or less sensed fear of experiencing detumescence also partial during intercourse. In those situations an early orgasm, putting end to coitus, rescue man from so unpleasant condition of feeling his penis become more or less flaccid during sex. Other psycho factors can depends on penis size and shape dissatisfaction with inadequacy feelings or on other psycho-sexual disturbances as about gender identity and role, mommy issues or more generally discomfort with women as about discharging sperm into vagina and so on. In the vast majority of cases is present some hypersensitivity of glans and prepuce mucosa able to trigger an immediate ejaculatory reflex as soon as touched. This hypersensitivity can be present since childood or can follow circumcision that exposes glans till then covered by skin and therefore less sensitive to external rubbing. Therapies for PE intend to counteract those two main causes of problem, i.e. psycho-emotional and hypersensitivity conditions. Onto psycho-emotional sphere are effective drugs like inhibitors of serotonin reuptake that produce a general sedation and consequent relative inhibition of ejaculatory reflex. More recently have been proposed and employed with some success Tramadol a central opioid drug that besides can promote addiction especially if taken longtime. To avoid those side effects or adverse reactions by prolonged consumption those drugs can be taken on-demand i.e. only before a sexual intercourse. The second way to afford this condition is to desensitize glans and prepuce mucous membranes with physiotherapy as described before. Moreover are available on the market many medicinals as cream or spray able to desensitize partially penis distal areas, but those products acting as neuroleptic , have the disadvantage of intercourse to be planned, that not always is possible or pleasing.
So, according to our opinion, the best way to treat PE consists in desensitizing progressively the penis mucosal areas adding, whenever it should be not sufficient, a neuroleptic drug customizing dosing to individual feedback.
In our experience the majority of patients respond in a satisfactory way to physiotherapy alone. But the association with neuroleptic drugs can resolve also the hardest cases.