WEBVTT - When the Penis Changes: The Basics of Peyronie’s Disease 0:00:00.600 --> 0:00:05.400 Let's talk about it. Let's talk about the man. Hero. 0:00:08.840 --> 0:00:09.960 Let's talk about it. 0:00:11.920 --> 0:00:13.880 Let's talk about the Man Hero. 0:00:17.000 --> 0:00:22.599 Welcome to the Man Yeah, welcome, Welcome back to the mailroom. 0:00:22.760 --> 0:00:25.759 It gets better here every day. We're not living like 0:00:25.800 --> 0:00:30.040 animals at all. We are living like civilized gentlemen. Jordan Runta, 0:00:30.240 --> 0:00:32.519 I don't I mean guns n' roses. We you know, 0:00:32.560 --> 0:00:35.040 we just you know, we could we could completely go 0:00:35.080 --> 0:00:36.919 off the rails on this crazy train if we get 0:00:36.920 --> 0:00:39.240 too much longer. I know it's not guns n' roses, 0:00:39.240 --> 0:00:41.160 but we're just gonna go with the hard rock theme 0:00:41.240 --> 0:00:44.880 for this this deal, because yeah, we're gonna be dealing 0:00:44.880 --> 0:00:47.840 with something that I deal with day in and day 0:00:47.880 --> 0:00:48.640 out in my office. 0:00:48.680 --> 0:00:49.960 In fact, probably one. 0:00:49.840 --> 0:00:53.920 Of the busiest aspects of my career, both research wise 0:00:54.080 --> 0:00:59.639 in the literature and publications and speaking professorializing with this 0:01:00.080 --> 0:01:02.200 condition that we're going to just come out and say, 0:01:02.240 --> 0:01:03.120 Pironi's Disease. 0:01:03.320 --> 0:01:04.280 Jordan, what's up? Man? 0:01:04.959 --> 0:01:05.560 Not much? 0:01:05.640 --> 0:01:07.760 I am really excited to do this episode because you 0:01:07.800 --> 0:01:11.040 are truly a rock star in the Peroni's Disease world. 0:01:11.120 --> 0:01:13.560 You are the Jimmy Page of Pronis. You were one 0:01:13.600 --> 0:01:16.399 of the leading researchers. Is because every time I was 0:01:16.480 --> 0:01:18.720 doing research on this episode in your name coming up, left, 0:01:18.760 --> 0:01:19.680 right and center. 0:01:19.959 --> 0:01:21.600 Just ramble on, man, just ramble on. 0:01:22.440 --> 0:01:24.840 Yeah, Yeah, I mean, I think we're going to get 0:01:24.840 --> 0:01:28.480 a little professor oil today. It's something that I'm super 0:01:28.600 --> 0:01:30.720 interested in the. 0:01:30.560 --> 0:01:31.039 History of it. 0:01:31.080 --> 0:01:33.720 We'll talk about a little bit and then you know, 0:01:33.760 --> 0:01:35.160 this is going to be another one of these series. 0:01:35.200 --> 0:01:36.600 We're gonna have a bunch of people. 0:01:36.360 --> 0:01:39.720 Some of my friends that I've known for years, that 0:01:40.000 --> 0:01:43.560 are also luminaries in the field of Perne's disease. Because 0:01:43.880 --> 0:01:47.840 this deserves a lot of oxygen. Not just because this 0:01:47.920 --> 0:01:49.840 is a big part of what I do at UCLA 0:01:49.960 --> 0:01:52.840 and both in the clinic and in the operating room 0:01:52.840 --> 0:01:54.960 as well as you know, in the laboratory essentially in 0:01:55.000 --> 0:01:58.720 our research, but also because it's it's a disease that 0:01:59.640 --> 0:02:03.840 has its roots in shame. It has its roots in 0:02:04.200 --> 0:02:07.840 the insecurities of men's health, and so I think these 0:02:07.880 --> 0:02:10.160 are the things we got unpacked we have to demystify. 0:02:10.240 --> 0:02:14.040 And also, you know, it's way more common than we think. 0:02:14.160 --> 0:02:17.720 And when I started practice, Perone's disease is you know, 0:02:17.919 --> 0:02:21.120 really is the one thing that there's no other specialist 0:02:21.639 --> 0:02:25.079 that can deal with this condition truly other than a urologist. 0:02:25.760 --> 0:02:27.880 All right, So you know we're just kind of rambling 0:02:28.040 --> 0:02:30.440 on we as it were. I mean, he gave me 0:02:30.440 --> 0:02:32.120 the Jimmy Page thing. It's no way I can live 0:02:32.200 --> 0:02:35.760 up to that. But I'll pull out my less policy 0:02:35.840 --> 0:02:38.720 what we can do. So, so what is Peoni's disease? 0:02:38.840 --> 0:02:44.120 The condition has been described really probably since about the 0:02:44.200 --> 0:02:49.400 thirteenth century since ay an Italian anatomus Philopius, who also 0:02:49.720 --> 0:02:53.600 those of us, and that no guynecology know of filopian tubes. Wo, 0:02:53.760 --> 0:02:56.160 So he knew a lot about the pelvis a both 0:02:56.240 --> 0:03:00.600 men and women pelvis, and he described this can called 0:03:00.639 --> 0:03:05.400 induracio plastica penis or basically in duration of the lining 0:03:05.480 --> 0:03:09.320 of the tunica virginia, the tough outer membrane of the 0:03:09.320 --> 0:03:12.000 penis that caused deformity. And so he did a lot 0:03:12.000 --> 0:03:15.840 of work in the anatomic dissecting labs, in the cadaver labs, 0:03:15.840 --> 0:03:18.160 and so he must have come across a bunch of 0:03:18.160 --> 0:03:21.800 these lumps in penises of cadavers that he was dissecting 0:03:21.800 --> 0:03:24.880 the pelvis on for other reasons, but it was not. 0:03:24.960 --> 0:03:26.880 Named Filopius's disease. 0:03:27.080 --> 0:03:30.520 It was named Peroni's disease for francoisi Go de le Peroni, 0:03:30.960 --> 0:03:35.680 who was the physician in mid eighteenth century France. He 0:03:35.720 --> 0:03:40.080 was a royal physician and one of the original papers 0:03:40.120 --> 0:03:43.120 that actually described a case report for perones goes back 0:03:43.160 --> 0:03:45.440 to about seventeen forty three or so. 0:03:45.520 --> 0:03:48.160 I'll make it up. I'm sure we can get Google. 0:03:48.600 --> 0:03:52.080 AI generated the answer to exactly when that paper came 0:03:52.240 --> 0:03:55.560 out first. But I said that pons, it's a disease 0:03:55.600 --> 0:03:59.360 that started in shame. And I mean that because the 0:03:59.400 --> 0:04:04.120 way that Roni, the physician described the paper, it was 0:04:04.400 --> 0:04:07.240 a guy that was out filandering in the streets of Paris, 0:04:07.280 --> 0:04:10.040 and he was about thirty two years old, and he 0:04:10.080 --> 0:04:12.760 had a few nights on the town away from his wife, 0:04:12.800 --> 0:04:16.200 and then he came back with this painful and curved direction. 0:04:17.080 --> 0:04:19.560 And that's what Pirone's disease is, quite simply, is just 0:04:19.600 --> 0:04:24.479 when the penis does not maintain its normal cylindrical shape 0:04:24.480 --> 0:04:26.000 that the guy has known all his life, and he 0:04:26.040 --> 0:04:30.520 develops either a painful lump or a plaque. 0:04:30.520 --> 0:04:32.080 We call it a curvature. 0:04:32.200 --> 0:04:35.960 Usually ensues p and l shortening almost always happens. In fact, 0:04:36.040 --> 0:04:38.479 one hundred percent of guys that have pironis will not 0:04:39.000 --> 0:04:41.880 be able to maintain or regain their normal length without 0:04:41.880 --> 0:04:44.520 some kind of intervention, and a lot of times it 0:04:44.560 --> 0:04:46.800 decreases blood flow, so it causes problems with directions. And 0:04:46.839 --> 0:04:50.480 so this guy had what was what Peroni thought was 0:04:50.520 --> 0:04:53.120 a veneerial disease. And that's what you get for stepping 0:04:53.160 --> 0:04:56.440 out on your on your wife is Pernes. And so 0:04:56.520 --> 0:04:58.560 imagine how many times in my career that I have 0:04:58.640 --> 0:05:01.800 a very nice, happily married man that goes on a 0:05:02.080 --> 0:05:05.320 business trip and he comes back and he has this curvature. 0:05:05.320 --> 0:05:07.720 How do you explain that one to your partner? And 0:05:08.160 --> 0:05:10.320 you know it has nothing to do with venereal diseases. 0:05:10.360 --> 0:05:13.840 There's no infectious ideology to Perrone's. But that's how the 0:05:13.880 --> 0:05:16.920 whole thing started in the seventeen forties. So we've known 0:05:16.920 --> 0:05:21.400 about this forever, we've described it. But you're going to say, well, then, okay, 0:05:21.480 --> 0:05:24.800 what causes paronius disease, doctor Mills, And I'll say, well, yes, Jordan, 0:05:24.839 --> 0:05:27.480 thanks for introducing me as this leader in the field. 0:05:27.880 --> 0:05:29.640 And I will say, I have no idea. And that 0:05:29.720 --> 0:05:31.919 was one of the first things that I like to 0:05:32.000 --> 0:05:34.320 disavow of my patients that we know everything. 0:05:34.400 --> 0:05:36.240 We know what it is. We know what the scar 0:05:36.360 --> 0:05:36.880 tissue is. 0:05:36.920 --> 0:05:39.080 If I go in to the operating room because I 0:05:39.120 --> 0:05:41.720 have to remove this scar tissue, which is one of 0:05:41.760 --> 0:05:43.960 the surgeries I do, I can send it to my 0:05:43.960 --> 0:05:46.640 pathologists and they will tell me. It's a disorganized bundle 0:05:46.680 --> 0:05:50.479 of multiple types of collagen, primarily type one collagen and 0:05:50.560 --> 0:05:54.000 type three collagen. And there's probably seven plus types of 0:05:54.040 --> 0:05:56.919 collagen in our body, which is that connective tissue that 0:05:57.000 --> 0:05:59.520 makes our nose have shape. It keeps the balance in 0:05:59.560 --> 0:06:02.160 our skin, and so as we age and our skin 0:06:02.200 --> 0:06:05.960 becomes wrinkly and it becomes less firm than that's loss 0:06:05.960 --> 0:06:09.560 of collagen crosslinking or bridging in the penis, it's exactly 0:06:09.640 --> 0:06:14.080 the opposite. It's this giant ball of disorganized collagen. And 0:06:14.560 --> 0:06:17.280 we know that the normal lining of the penis, that 0:06:17.360 --> 0:06:21.599 tunic cal virginia is made up of two separate layers 0:06:21.600 --> 0:06:24.880 of college and we call longitudinal fibers which run straight 0:06:24.920 --> 0:06:28.000 down the cylinder as you imagine in the parallel fashion 0:06:28.040 --> 0:06:30.760 of the penis dangling from the body, and then the 0:06:30.800 --> 0:06:34.520 circular fibers which are what keep it in its cylindrical shape, 0:06:34.640 --> 0:06:37.800 and so the circular fibers go around the cylinder, and 0:06:37.839 --> 0:06:40.480 the two of those usually work in concert so that 0:06:40.560 --> 0:06:44.680 guys will get an erection that maintains its cylinder shape 0:06:44.680 --> 0:06:47.200 as it in gorges with blood and keeps it all 0:06:47.240 --> 0:06:50.240 trapped in and establishes the erection that most guys know 0:06:50.320 --> 0:06:52.919 and love, and pronis goes in and screws all of 0:06:52.920 --> 0:06:56.800 that up and you end up with this disorganized bundle 0:06:56.839 --> 0:07:00.560 of abnormal collagen. So the way I look at this 0:07:01.000 --> 0:07:03.520 is if I'm trying to explain to a guy, I said, 0:07:03.600 --> 0:07:06.680 look you before I lose all confidence as a provider 0:07:07.120 --> 0:07:09.720 that I don't know what's going on. We do know 0:07:09.760 --> 0:07:11.720 that there is a genetic basis for this, and that 0:07:11.760 --> 0:07:14.640 there are guys that are a little more susceptible to 0:07:14.920 --> 0:07:18.920 forming these plaques, which we call them. They're not plaques 0:07:18.960 --> 0:07:21.440 like you'd think cholesterol plaques and arteries, and they're not 0:07:21.480 --> 0:07:25.840 associated with coronary disease. But basically, using the loose definition 0:07:25.880 --> 0:07:28.400 of plaque, is a chunk of tissue that shouldn't be there, 0:07:28.960 --> 0:07:31.920 and that's all it is. It's essentially a chunk of 0:07:31.960 --> 0:07:36.000 this collagen that normally should be nice and elastic is 0:07:36.040 --> 0:07:41.120 now becoming fixed. Broni's is very associated with two other 0:07:41.440 --> 0:07:45.320 conditions of what we call connected tissue disorders, and they 0:07:45.360 --> 0:07:49.400 all have eponyms. So in the hand it's another French 0:07:49.400 --> 0:07:52.920 guy to putrins. And so if you ever notice, guys, 0:07:53.240 --> 0:07:56.920 usually as we age, or women too, can develop these 0:07:57.000 --> 0:07:59.960 contracted fingers where instead of being able to hold your 0:08:00.080 --> 0:08:03.520 palm all the way out, you get this contraction where 0:08:03.560 --> 0:08:06.520 the usually the pinky finger will come in so that 0:08:06.600 --> 0:08:09.080 you can't fully extend your hand or high five somebody. 0:08:09.120 --> 0:08:11.880 You end up with a little bit of a dysfunction 0:08:12.360 --> 0:08:13.320 of that ability. 0:08:13.360 --> 0:08:14.200 So it's difficult if. 0:08:14.080 --> 0:08:17.440 It's your right hand to shake hands, to do five 0:08:17.480 --> 0:08:20.960 fingered exercises, and that can be you know, a serious 0:08:21.520 --> 0:08:23.760 problem because it affects a hand, so it can actually 0:08:23.800 --> 0:08:26.200 affect work if you work with your hands. If you're 0:08:26.200 --> 0:08:29.040 a guitar player, just imagine that trying to fret with 0:08:29.240 --> 0:08:32.600 a with a pinky that doesn't fully expand. And it's 0:08:32.640 --> 0:08:35.840 the same connective tissue disorder. It's the same kind of lumpy, 0:08:35.880 --> 0:08:38.920 bumpy collagen that affects the penis. And then lastly, there's 0:08:38.920 --> 0:08:42.160 something called later host contractors. So German, dude, I guess 0:08:42.360 --> 0:08:45.960 maybe Austrian of the planter fascia of the foot or 0:08:46.040 --> 0:08:48.840 the bottom part of the foot. So it affects the 0:08:49.000 --> 0:08:51.880 arch and so it can be painful. And again it's 0:08:51.920 --> 0:08:55.360 just a lump in that connective tissue or that ligament 0:08:55.720 --> 0:08:59.079 that keeps the foot in a nice arch like fashion. 0:08:59.160 --> 0:09:03.360 It can contract that as well. So yeah, basically, penis, hand, foot, 0:09:03.600 --> 0:09:06.760 same deal. If I took out a piece of contractor 0:09:06.760 --> 0:09:08.160 in the hand or the foot and I send it 0:09:08.200 --> 0:09:09.839 to my pathologist, they would not be able to tell 0:09:09.880 --> 0:09:11.760 me if it came from the penis, the hand or 0:09:11.760 --> 0:09:12.120 the foot. 0:09:12.440 --> 0:09:15.040 Now, I guess, taking it back a little bit, how 0:09:15.080 --> 0:09:18.320 does a man first realize that something is wrong or 0:09:18.679 --> 0:09:20.760 it was a different for every case. Is it a 0:09:20.840 --> 0:09:24.240 visible curve? Is it painful eruption? Is it a lump? 0:09:24.360 --> 0:09:26.520 Is a loss of length? Is it difficulty having sex? 0:09:27.880 --> 0:09:31.880 Yes? Yes, the answer is yes. Yeah. 0:09:31.920 --> 0:09:34.520 So by way of I got all excited and jumped 0:09:34.559 --> 0:09:37.120 in to this whole thing because obviously this is what 0:09:37.200 --> 0:09:39.240 I do. But yeah, this is going to be a big, 0:09:39.640 --> 0:09:41.880 multi part episodes. We're going to unpack all of this 0:09:41.960 --> 0:09:43.720 I'm going to have some friends on as we were 0:09:43.760 --> 0:09:46.280 talking about, and so I think, yeah, what I'll tell 0:09:46.280 --> 0:09:49.360 you that in this intro phase is that it can 0:09:49.400 --> 0:09:51.360 happen all of those ways where a guy can literally 0:09:51.400 --> 0:09:53.480 wake up one morning with an erection that has bent, 0:09:54.200 --> 0:09:58.520 and often it starts in a painful way, and where 0:09:58.559 --> 0:10:01.440 they notice what directions, all of a sudden they develop 0:10:01.640 --> 0:10:04.360 pretty significant kind of either a throbby or a sharp 0:10:04.760 --> 0:10:08.360 stabbing pain because that a normal erectile tissue is limited. 0:10:08.400 --> 0:10:12.640 It can't expand past that scar tissue. So the most 0:10:12.720 --> 0:10:18.680 obvious manifestation is a curvature. The second most is length loss, 0:10:19.360 --> 0:10:24.040 and then it also can turn into length loss curvature 0:10:24.080 --> 0:10:26.720 problems and then not getting good blood flow past the plaque. 0:10:26.760 --> 0:10:28.760 It almost acts like a finger over a garden hose, 0:10:28.800 --> 0:10:32.200 where where if you have this extrinsic force pushing down 0:10:32.240 --> 0:10:35.800 on the blood vessels that normally supply the entire penis, 0:10:35.840 --> 0:10:38.520 then guys will develop what we call distal flacidity where 0:10:38.520 --> 0:10:41.439 they won't get an engorged tip of the penis where 0:10:41.440 --> 0:10:44.160 then they won't get an engorged portion of the penis 0:10:44.160 --> 0:10:45.200 that's past that plaque. 0:10:45.240 --> 0:10:46.120 And so so. 0:10:46.120 --> 0:10:49.559 Yeah, it can happen anyway, Most guys do not know 0:10:49.880 --> 0:10:53.439 what caused this, and so getting back to the genetics 0:10:53.480 --> 0:10:56.920 of this, I think that there are populations that have 0:10:57.000 --> 0:10:59.440 a slightly increased risk of this. We know that men 0:10:59.440 --> 0:11:03.920 that undergo pelvic surgeries or any kind of eurologic instrumentation 0:11:04.880 --> 0:11:07.800 where they're maybe getting surgery for kidney stones or surgery 0:11:07.800 --> 0:11:10.440 on their prostate, those guys tend to have a higher 0:11:10.520 --> 0:11:12.120 risk of developing pronies. 0:11:12.120 --> 0:11:14.240 And we don't know if this is fully causal. 0:11:14.679 --> 0:11:17.000 We also think if you are going to a urologist 0:11:17.120 --> 0:11:21.120 for some kind of eurologic surgery, then you also may say, hey, 0:11:21.160 --> 0:11:23.160 and by the way, I've got this change in my 0:11:23.200 --> 0:11:26.280 penis that I hadn't noticed before, and that becomes us 0:11:26.360 --> 0:11:29.600 what we call association bias or a selection to saying, 0:11:29.679 --> 0:11:31.760 you know, I'm already here for one penile issue or 0:11:31.800 --> 0:11:34.320 one eurologic issue. Do you mind taking a look at 0:11:34.320 --> 0:11:37.520 this lump or this bump I noticed and this card tissue? 0:11:38.120 --> 0:11:41.439 And you know that's the initial diagnosis is we actually 0:11:41.679 --> 0:11:43.600 most of the time, eighty percent of the time, don't 0:11:43.640 --> 0:11:46.600 know why they develop this card tissue, what goes rogue 0:11:46.600 --> 0:11:50.480 in their wound healing processes that allows for a hyper 0:11:50.920 --> 0:11:54.480 trophic wound heal. There are guys that get chloids cars 0:11:54.520 --> 0:11:57.240 you know, those are where you get Yeah, so if 0:11:57.320 --> 0:12:00.440 you see, sometimes it happens after say an ear piercing 0:12:00.520 --> 0:12:02.440 or something. They can happen anywhere on the body, or 0:12:02.480 --> 0:12:05.800 you have a pretty significant laceration or a cut somewhere, 0:12:05.800 --> 0:12:09.040 and instead of just a nice thin scar, they can 0:12:09.040 --> 0:12:12.520 get really lumpy, bumpy skin tissue. And a lot of 0:12:12.559 --> 0:12:16.800 times it happens in the ears and it is very 0:12:17.360 --> 0:12:19.800 You can see it and then say, gosh, what happened 0:12:19.800 --> 0:12:22.040 to that person's skin to that wound healing. That's another 0:12:22.120 --> 0:12:26.640 disorganized way that we heal wounds is to develop these keyloids, 0:12:26.679 --> 0:12:29.240 which are giant blobs of college and that's under the 0:12:29.240 --> 0:12:32.600 skin surface. And there's an association between keyloids and pyerhnies 0:12:32.640 --> 0:12:35.560 as well. But yeah, only about twenty percent of guys 0:12:35.600 --> 0:12:39.000 will tell me they had an inciting incident that led 0:12:39.040 --> 0:12:42.080 to it. And even those, even those, I have to 0:12:42.080 --> 0:12:44.640 be really careful with them to make them not feel 0:12:44.679 --> 0:12:47.319 like they did something wrong. I have to disavow guys 0:12:47.320 --> 0:12:49.880 that there is any component of shame or that I 0:12:49.920 --> 0:12:51.839 did something on my penis, I shouldn't. So a lot 0:12:51.880 --> 0:12:54.880 of younger guys come in thinking they had a masturbation 0:12:55.000 --> 0:12:56.040 injury that led to this. 0:12:56.800 --> 0:12:58.000 I've had, you know, in. 0:12:57.880 --> 0:13:02.320 California surfboard injuries, in Colorado snowboard injuries, where they're there, 0:13:02.400 --> 0:13:05.200 even with a flaccid penis, they may have taken a 0:13:05.240 --> 0:13:08.280 blow of some kind to the penal tissue and then 0:13:08.320 --> 0:13:11.360 they notice the curvature could be But most of the time, 0:13:11.720 --> 0:13:14.679 what we think is that because the most most guys 0:13:14.679 --> 0:13:17.720 that develop peronis, it's really between their forties and sixties 0:13:18.240 --> 0:13:21.360 that it happens because they're getting a little bit of 0:13:21.400 --> 0:13:25.520 these chronic, little flection injuries where the penole tissue may 0:13:25.520 --> 0:13:27.160 not be as in gorgeous it used to be. They're 0:13:27.160 --> 0:13:30.960 still getting erections, but that those little microtraumas lead up 0:13:31.160 --> 0:13:33.920 to at one point that genetic switch turning on to say, 0:13:33.960 --> 0:13:36.920 oh man, we got to put down this type one collagen, 0:13:36.960 --> 0:13:39.599 this type three collagen what I call the spackle of 0:13:39.640 --> 0:13:40.160 the penis. 0:13:40.160 --> 0:13:42.160 So if you put a hole in your wall, right, 0:13:42.200 --> 0:13:43.600 what do you do. You go to your. 0:13:43.520 --> 0:13:45.840 Hardware store and you get a tub of spackle and 0:13:45.880 --> 0:13:47.800 you throw it up to patch the wall. It's not 0:13:47.880 --> 0:13:51.080 quite like the wallboard that was installed, but it covers 0:13:51.120 --> 0:13:52.960 up the hole. And I think that's sort of what 0:13:53.040 --> 0:13:55.559 happens with our with our wound healing system, is that 0:13:55.559 --> 0:13:59.360 there's a slight, low grade inflammatory panic where when the 0:13:59.360 --> 0:14:01.480 penis sends, this is a micro trauma that could lead 0:14:01.520 --> 0:14:03.320 to a bigger injury, and all of a sudden, these 0:14:03.360 --> 0:14:06.000 guys that have a genetic predisposition are just throwing down 0:14:06.040 --> 0:14:09.480 spackle and it heals, but it doesn't heal to the 0:14:09.480 --> 0:14:13.160 point where a guy's going to have a completely normal penis. 0:14:13.160 --> 0:14:15.680 So yeah, penile injury, penile fracture. You know, we talked 0:14:15.679 --> 0:14:19.040 about the five p's of the Pinocalypse a few episodes ago, 0:14:19.080 --> 0:14:22.760 and two of those were penis fracture and pernis, and 0:14:22.880 --> 0:14:26.320 those are not very well associated at all. And even 0:14:26.360 --> 0:14:28.840 if a guy doesn't get his penis fracture healed, a 0:14:28.880 --> 0:14:31.040 lot of times they have problems with the rectile function, 0:14:31.720 --> 0:14:36.400 but they don't they don't necessarily develop pernis. So unclear, 0:14:36.600 --> 0:14:39.720 you know. Bottom line is that after this long, long 0:14:39.720 --> 0:14:42.480 consultation I'll have in my office with guys, they're going 0:14:42.560 --> 0:14:45.040 to leave feeling as if they don't really know what 0:14:45.160 --> 0:14:47.280 caused it. But the best and important thing I can 0:14:47.320 --> 0:14:49.480 do is disavow them of any shame factor that they 0:14:49.520 --> 0:14:52.000 didn't do anything to their their penises. I mean, their 0:14:52.160 --> 0:14:55.680 penises are pretty tough, durable organs, right, and they are 0:14:55.720 --> 0:14:59.080 the reason for our genetic procreation, so they're built that 0:14:59.160 --> 0:15:02.560 way to stand and a lot of different shenanigans, and 0:15:02.600 --> 0:15:06.400 so unfortunately sometimes that shananigan gets in the way. And 0:15:06.520 --> 0:15:09.520 here we are with a with a Perone's plaque developing. 0:15:37.800 --> 0:15:41.400 Now this is a really beginner question, but good. 0:15:42.960 --> 0:15:47.000 You talk about developing Perone's disease the manifestation of it. 0:15:47.040 --> 0:15:49.560 Is it truly you wake up one day and there 0:15:49.600 --> 0:15:51.720 is a curve or is it something gradual that occurs 0:15:51.760 --> 0:15:52.880 over days, weeks, months. 0:15:53.320 --> 0:15:55.400 Yeah, again, I'm gonna say yes, yea. 0:15:57.600 --> 0:16:00.200 So it's a reasonable time to talk about something that 0:16:00.240 --> 0:16:02.880 I don't want to talk about anymore. But because we 0:16:03.000 --> 0:16:07.080 argue about this in the academy, we have traditionally classified 0:16:07.080 --> 0:16:11.280 peronis into an acute phase and a chronic phase. Where 0:16:11.840 --> 0:16:17.200 guy notices a disturbance in his normal penis anatomy, and 0:16:17.720 --> 0:16:22.120 that's day one, and then day I don't know, one 0:16:22.160 --> 0:16:25.600 hundred and eighty. He notices that things haven't really changed 0:16:25.680 --> 0:16:29.040 much since day one, And say he wakes up one 0:16:29.080 --> 0:16:31.800 morning and his penis has bent forty five degrees to 0:16:31.840 --> 0:16:33.960 the right or to the left, or up or down, 0:16:34.000 --> 0:16:38.040 because parone's curvature can really go in any direction of 0:16:38.080 --> 0:16:40.200 the cardinal orders. In fact, some guys go up into 0:16:40.200 --> 0:16:41.720 the left, up and to the right, down to the left, 0:16:41.720 --> 0:16:44.280 down to the right, straight down, straight up. But either way, 0:16:44.320 --> 0:16:47.200 if a guy wakes up with that curvature, that change 0:16:47.200 --> 0:16:50.520 in the penal anatomy, he may never change again. In 0:16:50.600 --> 0:16:52.800 other words, you wake up a forty five degree bend 0:16:53.280 --> 0:16:56.040 and six months later it's exactly the same. Some guys 0:16:56.040 --> 0:16:58.400 don't have any pain with this at all. Some guys 0:16:58.400 --> 0:17:00.960 have pain that last two years. Some guys have pain 0:17:01.000 --> 0:17:04.439 that doesn't go away, that can continue throughout the course 0:17:04.440 --> 0:17:08.760 of this condition. And then some guys will have a 0:17:08.920 --> 0:17:13.000 very gradual onset of pain and curvature where they say, gosh, 0:17:13.000 --> 0:17:14.800 you know, well, cop and I noticed it was about 0:17:14.840 --> 0:17:18.080 twenty degrees bent to the right. And a lot of 0:17:18.119 --> 0:17:22.520 guys Jordan have underlying curvature anyway. I mean, there's some 0:17:22.760 --> 0:17:27.399 normal anatomy that allows you know, a variance of about 0:17:27.440 --> 0:17:30.080 twenty degrees, where guys will have a bend, and that 0:17:30.119 --> 0:17:32.120 gradual bend may never get in the way of intercourse, 0:17:32.160 --> 0:17:35.080 and that's just normal for them, and so it's really 0:17:35.119 --> 0:17:37.679 what's abnormal for them. And in fact, some men are 0:17:37.720 --> 0:17:41.359 even born with a significant angulation where where it can 0:17:41.520 --> 0:17:45.159 their penis can be born bent ninety degrees. That's not payerne's. 0:17:45.240 --> 0:17:49.160 That's called either cord where a guy's penis bends downwards, 0:17:49.320 --> 0:17:54.040 and that's an anatomic variant where a guy's penis the 0:17:54.320 --> 0:17:56.440 chambers of the penis don't all grow at the same time, 0:17:56.480 --> 0:17:58.520 and one of them or two of them are mismatched. 0:17:59.160 --> 0:18:01.959 And so whenever guy gets an direction, or even a 0:18:02.000 --> 0:18:05.679 young boy gets an erection, he may have a physiologic curvature. 0:18:06.000 --> 0:18:08.280 And again sometimes they're not bothered, and sometimes we have 0:18:08.280 --> 0:18:09.760 to fix them surgically if they get in the way 0:18:09.760 --> 0:18:12.680 of intercourse. But it is good to distinguish all things 0:18:12.680 --> 0:18:15.119 that are curved are not pynees. And so when we 0:18:15.119 --> 0:18:17.960 talk about paronis from a definition, it is an acquired 0:18:18.560 --> 0:18:21.280 disorder of the shape of the penis, and it can 0:18:21.320 --> 0:18:24.000 happen at age seventeen, it can happen at age eighty seven. 0:18:24.960 --> 0:18:28.720 But you alluded to something, which is this idea that 0:18:29.680 --> 0:18:32.399 we like to categorize in medicine and so acute and 0:18:32.480 --> 0:18:36.399 chronic phase for decades to centuries kind of made sense. 0:18:36.520 --> 0:18:40.800 And I've been really working a long time to disavow 0:18:41.160 --> 0:18:45.439 our patients and our professional societies from trying to do this, 0:18:45.520 --> 0:18:48.560 because sadly in this day and age, now that we 0:18:48.640 --> 0:18:52.480 have treatments for parone's disease, this becomes an issue with 0:18:52.560 --> 0:18:55.600 sometimes getting coverage and care for it, and some insurance 0:18:55.640 --> 0:18:58.960 companies will not allow us to treat guys in the 0:18:59.000 --> 0:19:02.520 acute phase because it seems like we just need to 0:19:02.560 --> 0:19:05.400 wait and see if it gets better. And the other myth, 0:19:05.640 --> 0:19:09.040 because we love taking things down on the show, is 0:19:09.400 --> 0:19:12.120 that paronis will get better on its own. And there 0:19:12.160 --> 0:19:15.800 was one study in the nineteen seventies or so that 0:19:15.960 --> 0:19:18.400 looked at what we call the natural history of Pironi's 0:19:18.400 --> 0:19:20.960 meaning when you say something as a natural history means 0:19:20.960 --> 0:19:24.160 you observe it from the beginning until the guy dies, 0:19:24.200 --> 0:19:27.439 basically without intervening, because for years we didn't really have 0:19:27.600 --> 0:19:31.480 a viable intervention for Pirona's disease. And in that study, 0:19:31.560 --> 0:19:34.560 and I still get physicians that quote this to me, 0:19:34.880 --> 0:19:37.359 or patients that requote what their doctor told them. Is 0:19:37.400 --> 0:19:40.199 that a third of these get better, a third of 0:19:40.240 --> 0:19:42.359 these stay the same, and a third of these get worse. 0:19:42.400 --> 0:19:43.960 And so if you look at the if you wanted 0:19:44.000 --> 0:19:47.520 to dichotomize into acute and chronic phase, then you would say, hey, 0:19:47.520 --> 0:19:48.399 look a guy comes in. 0:19:48.440 --> 0:19:49.160 I woke up with an. 0:19:49.119 --> 0:19:52.480 Erection this morning, and it's bent that maybe my afternoon 0:19:52.480 --> 0:19:54.880 clinic today waiting for me. Most likely because of how 0:19:54.920 --> 0:19:57.320 often I see this condition. I'll probably have six or 0:19:57.359 --> 0:19:59.440 eight new guys in my clinic today with this condition. 0:20:00.119 --> 0:20:03.199 And if they've seen other doctors before they see me, 0:20:03.280 --> 0:20:05.159 they may have told him they say, look, man, this 0:20:05.280 --> 0:20:05.919 just happened to you. 0:20:06.320 --> 0:20:06.879 It's okay. 0:20:07.000 --> 0:20:09.119 You know, probably got about a thirty percent chance, so 0:20:09.200 --> 0:20:10.520 go away in its own, so let's just keep an 0:20:10.520 --> 0:20:11.000 eye on it. 0:20:11.800 --> 0:20:13.560 That would be based on a. 0:20:13.520 --> 0:20:16.400 Really crappy one paper that I'd love to just toss 0:20:16.400 --> 0:20:20.280 out of literature, and a third of them stay the same, 0:20:20.400 --> 0:20:22.919 I think is also probably not true. In fact, I 0:20:22.960 --> 0:20:25.680 see a lot of guys that will develop the original phase, 0:20:26.160 --> 0:20:28.320 what we used to call a cute phase, where it 0:20:28.320 --> 0:20:30.320 doesn't get any different. It just they wake up their 0:20:30.320 --> 0:20:33.600 penises bent ninety degrees. No trauma, they just kind of 0:20:33.640 --> 0:20:36.840 happened to them. That doesn't get any better, It doesn't 0:20:36.880 --> 0:20:37.520 get any worse. 0:20:37.760 --> 0:20:38.520 It is what it is. 0:20:39.200 --> 0:20:41.280 And so imagine me trying to tell a guy, hey, look, bro, 0:20:41.800 --> 0:20:43.200