Medical Questions & Answers

Question: What is the cause of Peyronie’s disease, and can anything be done to correct it by means of drugs, surgery or laser treatment?
Peyronie’s disease was named after French surgeon Francois de la Peyronie (1678-1747) who was surgeon to Louis XIV, founded the Royal Academy of Surgeons in Paris, and who first described the condition. It is an uncommon problem that causes significant side-to-side (not vertical) curvature of the erect penis and a less firm than normal erection, as the normal tissue of the penis is replaced by fibrous tissue on one side only.
It may be caused by an injury to the penis, narrowing of the artery to one side of the penis (commonly with poorly controlled diabetes or high cholesterol), abnormal nerve supply to the penis or, most frequently, for no known cause. Its incidence increases with age.
There is usually a hard piece of tissue at the base of the penis on the affected side, and ultrasound scans can show the abnormal fibrous tissue in the penis. Unfortunately, treatment is not very effective. Surgery, steroid injections and even radiotherapy may be tried, but none of these procedures have a good track record.
The most radical, and most successful treatment, is surgical replacement of the contents of the penis with an inflatable bladder that can be pumped up when an erection is desired. Although complications can occur, 80% success is quoted in reputable centers.

Question: I have a very embarrassing problem. In the past month one of my testes has blown up to twice its normal size. It’s not painful, but I’m terribly worried and embarrassed. What could it be?
The most likely cause of your problem is a hydrocele. The testes are surrounded by a fine layer of tissue called the tunica vaginalis. Fluid may accumulate between the testes and the tunica to cause an apparent swelling of the testicle that is often painless. They may occur at almost any age, and may follow an injury or infection in the scrotum, or may occur for no apparent reason.
A needle can be used by a doctor to drain off the fluid, but it often reaccumulates after this and an operation is usually necessary to give a permanent cure. There are other cysts and growths that can occur in the scrotum, including cancer, which may not be painful. For this reason, any swelling of the testes, whether painful or not, must be checked by a doctor.
Pain in the testes, particularly in a teenager, is a medical emergency.

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