Peyronie’s Disease and Cancer Surgery

How Peyronie’s disease can start after cancer treatment

This blog entry will be different from the usual discussion of Peyronie’s disease. In this blog posting I will offer my comments about an email I discovered on another website that covers the subject of prostate cancer and Peyronie’s disease; it is predominantly a medically leaning website in which the moderator and visitors discuss their personal experiences with prostate cancer treatment.

Because there is a statistical relationship between men who undergo radical prostate surgery and Peyronie’s disease, I am interested in discussing this topic from a different perspective. There is a bit to say about these cases of secondary PD that occur after cancer surgery, often ignored in comparison to the more pressing problem of prostate cancer.

The man who wrote the following email wanted to tell others his experience while visiting an ED specialist after his radical prostate surgery. After this kind of surgery it is common for erectile dysfunction (ED) to develop due to the large amount of nerve damage that occurs. The writer mentions he developed Peyronie’s disease after his prostate operation, and makes several comments about PD that are typical of those I receive daily. This is why I bring this email and my comments to the Peyronie’s Disease Institute blog. Many people believe what this man expresses because of what they are told and read from other sources. I present my thinking to you to challenge your thoughts and beliefs. If you disagree, I would like to hear from you.

The email I am using was posted on this other website without comment because no one thought there was anything wrong or unusual about this man’s Peyronie’s disease treatment comments. It is important for my audience of PD men to read this email because of the popular ideas and attitudes that the writer reveals.

The email from the man (RR) who had the radical prostate surgery is written in black, and my comments inserted within his email are in red.

From RR:

A recent posting stimulated me to go to my ED specialist, a trip which I have been putting off. My history: RP
This means “radical prostatectomy,” or surgical prostate gland removal along with surrounding tissues – usually related to cancer. 9/20/99 at age 65, one nerve spared, PSA still undetectable, and some detectable Peyronie's, or at least a bending of the penis at about a 20% angle to the left (looking down on it) about one inch from the base.

I started early pursuing ED options and had tried Viagra, a VED and injections by seven weeks post RP. For those who have read the PDI website and blog you will immediately notice that this man within seven weeks after his cancer surgery did three things that are associated with causing Peyronie’s disease: 1. He used Viagra – this can excessively stretch and injure the tunica albuginea; the same is true of Cialis and Levitra. 2. He used a VED – this is the vacuum pump device that can overstretch and injure the internal tissue of the shaft. 3. He received injections into the shaft of the penis, probably to create an artificial and temporary enlargement, apparently because his doctor thought this is beneficial to his recovery. I never really had success with the VED, partly because I got enough initial take from the Viagra for a stuffable erection, This is an interesting point he makes here. After using Viagra he says it is necessary to “stuff” his penis into the vaginal opening for intercourse to take place. Forcing or stuffing a weak enlargement into the vaginal opening is a common way to start Peyronie’s disease or worsen your problem if you already have it. If a man is so soft that insertion is difficult, he runs the risk of abruptly bending his weak erection during insertion or possibly causing the shaft to bend, buckle or collapse during the thrusting of intercourse. This can easily injure the delicate tunica albuginea enough to start or worsen Peyronies. You never want to engage in sexual relations with less than a fully hard erection because a soft erection is an unstable situation that often leads to injury and PD. His doctor should have warned this man about his need to “stuff” his penis, but apparently did not. This fellow is writing as though this is just the way things are supposed to be when you use Viagra; you just have to push and “stuff” yourself in, like it is no big deal. This is a foolish and dangerous thing for a man who already Peyronie’s disease, but no one has warned him about this danger. but primarily because I had early success with injections. Notice he uses the plural form, “injections.” You will see in his next sentence he is referring to injections of the drugs Trimix and Papaverine Chloride into the shaft to create a temporary artificial enlargement. I have repeatedly warned about any kind of injection into the penile shaft that is known to start or worsen Peyronie’s disease because the needle damages the tunica albuginea. I have scores of conversations in which men who tell me their PD started after just one injection. It is certainly possible that this fellow’s PD started because of repeated injury caused by inserting a needle into the tunica albuginea and leaving irritating chemicals there. Trimix gave me too much discomfort for intercourse, so I was soon switched to Papaverine Chloride which is one of the three ingredients in Trimix. A 30 cc dose of this gives me a reliable erection for about an hour, and the pain-free reliability of this made me forsake the other options, even though I still take 100 mg. of Viagra two to three times a week to encourage nocturnal erections.

I now get nocturnal erections both with and without Viagra, and can get rather full erections without Viagra, but it takes a fair amount of stimulation, so that my wife and I have just continued with the Papaverine when we desire intercourse, Papaverine is an injection drug that is used each time this couple desires sexual union. So, rather than take Viagra because it is too much work because it requires “a fair amount of stimulation,” he chooses to inject himself each time with Papaverine. He does not say how often he does this, but this could be many injections monthly. Yet no one has presented the idea to this fellow that his shaft is not a pin cushion that could eventually develop Peyronie’s disease after this kind of repeated injury. This is how people get into trouble being far too casual about the use of drugs and intrusive therapies. rather than risk the undependability or hassle of the other options. Because he wants to avoid the risk of undependability and hassle of other options, he repeatedly stabs a needle into his tunica albuginea and now wonders why he has Peyronie’s disease. This kind of casual and repeated use of drugs in general is a common way for many people to create many problems for themselves – yet no where in this discussion does this fellow's doctor try to stop this kind of behavior.

The Peyronie's hadn't seemed to be getting worse, and didn't interfere with the enjoyment of sex, so until today I had been putting off the trip to my ED specialist because it involved a long trip. My specialist is Dr. Steven Auerbach who is listed as an ED specialist in the appendix to Eid's book and who also contributed the chapter on erectile dysfunction in A

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Auerbach's reply was that there did not seem to be enough scarring to take any action now. If it gets worse he will give me either Verapamil cream or Verapamil shots if the problem is more localized. He has about 15 men on Verapamil, and although there is not yet any real documented success he is pursuing this treatment. Please read that last sentence again. Both the doctor and this patient are not at all bothered that there are no reports of success using Verapamilthey will use it anyway. Neither the doctor nor the patient do not mind there are real dangers (increased or decreased blood pressure, lung and breathing complications, liver and kidney damage) posed by the use of topical Verapamil, because they think it might help his PD. Further, he does not mention that Verapamil is a calcium channel blocker that has been implicated as the cause of Peyronie’s disease in some men. He also continues to recommend taking Viagra frequently, if for no other reason than to stimulate blood flow. This is a favorite topic of mine – the idea that Viagra should be used “to stimulate blood flow.” First, no one can question the need for good blood flow and adequate circulation for health and healing. But, when should a person really consider taking action to increase blood flow? Answer: when there is actual evidence of reduced or inadequate blood flow to an area. This evidence would be slight coolness or a slight blue colored tint to the skin. We all know that if your skin is cold and blue, you need to increase circulation. If your penis is not cold or blue, but it is as warm as the rest of you and is the usual color, this is strong evidence that your circulation is fine. Second, the idea of increased circulation of blood should bring to mind either a faster blood flow into an area or more blood than is normally found in an area of the body. Let’s say that you are running for a while. You would expect more blood to be flowing into the lungs and legs, at least, and probably all the rest of you. This would be an example of increased blood flow. Do you know what an example of decreased blood flow is? (Remember, before you answer, that this means “a faster blood flow into an area or more blood than is normally found in an area of the body.”) Well, a good example of decreased blood flow in the body is what happens during an erection. What? Think about it. During an erection blood is trapped in the spaces of the corpora cavernosae and corpora spongiosum of the shaft. The primary veins of the shaft close, stopping drainage of blood that goes in and out, thus backing up or trapping blood to increase pressure against the walls of the tunica albuginea. This is what creates the characteristic hardness and enlargement of an erection. The shaft does get longer and thicker because more blood enters the shaft, but for the average man this might be only 2-3 tablespoons more blood than is normally present while flaccid. However, this slightly greater amount of blood is still trapped inside the shaft and does not flow freely like when you exercise. There is a very small amount of exchange or circulation of blood during this time; otherwise it would be dangerous to have an erection for more than a few minutes. But, overall, the actual movement and flow of blood is less at this time, compared to the non-erect state. You can prove this to yourself by close examination of your erection. Your entire organ is darker and more purple colored – when the normally red head or glans becomes tinted blue because of reduced circulation, it appears to be purple by mixing of the two colors. Also, the veins of the shaft become obvious (like varicose veins) in the same way they will if you wrap one hand around the other wrist and squeeze to stop the blood flow. So, if all this is true – and it is – then how does taking Viagra increase blood flow? Answer: it does not increase circulation in the penis. An erection can only happen if blood is trapped like air becomes trapped inside a balloon to make it more rigid. Go tell that to your MD the next time he wants to write a prescription for you to “increase circulation” down there. He/She is not thinking, but only repeating some nonsense he/she read somewhere.

His web site is not all that encouraging about the use of Verapamil, but he now seems encouraged. I do not understand this comment at all.

I questioned him on the use of the VED for exercise, The VED (vacuum erection device) is not exercise. It does not increase blood circulation; again, it merely traps more blood in the shaft by creating a negative force. This is why the penis turns very dark and purplish while it is in the VED, and the penis comes out cold – because blood is trapped there, not moving. This is also why in order to stay enlarged after removing himself from the VED, it is necessary to put a tight rubber ring around the base to keep the blood trapped inside. but he did not recommend it, but also did not recommend against it. He recommended taking Vitamin E and counseled against taking Vitamin C, especially in the mega dosages that some take. MDs do not study nutrition in medical school, did you know that? The vast majority of MDs think you do not need to take additional nutrients beyond what you get in your diet. I could go on and on about what MDs as a group do not know about nutrition, but this blog post is too long already. I have never heard of anyone who has taken vitamin E by itself – in the way that MDs recommend – and gotten any help with their Peyronie’s disease.

He also thought that my Peyronie's, or whatever we want to call it, may be entirely independent of the injections I am taking. It is common for a doctor to not admit to the possibility that a patient’s Peyronie’s disease was caused by the Papaverine injections he prescribed. That could result in a law suit. He believes most of the Peyronie, scarring or fibrosis comes from lack of use. In all my years of researching PD, I have never heard of this before; that PD is caused by lack of use. There is no way to support this idea that PD results from lack of sexual use – it just not make sense at all. He is strongly against sitting idly by for any period of time after an RP, believing that exercise and blood flow is very important for recovery. Of course good blood flow is important for recovery. But taking a bucket of Viagra is not going to make that happen. However, applying heat packs (rosy red skin and a larger shaft afterward) would be a good way to increase circulation. Wearing boxer shorts rather than tighty-whitey briefs would be a good way to help circulation. Also, a massage of that area to actually increase blood flow to the lower pelvis would be great. However, this man’s doctor apparently did not mention any of that. Your average MD would rather quickly write a drug prescription than take two minutes to talk about hot packs, underwear and massage. My bending is on the left side of the penis, which means that the scarring would be on that side, so being right handed I probably would be giving myself more injections on the other side. He probably gave himself more injections on the left side of the shaft. Just thought I would throw this information into the hopper of information to which we all have access. I believe what this post actually did was to create more confusion and bad information about what to do after RP surgery and what not to do if you have Peyronie’s disease. This is simply more drug promotion and little new thought about true health care.


Please forward your thoughts and comments about my opinions. I would be happy to hear from you, especially if you are interested in Peyronie’s disease natural treatment.


Curved Penis Facts and Humor

Since Peyronie’s disease is all about the effect of the Peyronie’s plaque that causes the classical curved penis, here is useful – and sometimes just fun – information about an important part of the male anatomy.

1. Pronged cigarette smoking can shorten the penis up to a centimeter, or slightly less than a half inch. Since erections are affected by normal blood circulation, and smoking leads to calcification of blood vessels, it is easy to see that erectile quality is not helped by smoking cigarettes.   If you are not concerned about how smoking is bad for your lungs and blood vessels, now you know it is also not good for your manhood. .

2. With knowledge and techniques developed through stem cell research, it is now possible to use the foreskins of circumcised infants to grow skin for burn victims.  A single foreskin can be used to create 23,000 square meters of new tissue.  This is an area large enough to cover every Major League infield in the U.S.

An enlarged prostate gland can lead to premature ejaculation, as well as erectile dysfunction (ED).  If you have a problem with either ED or premature ejaculation that has not responded to direct therapy, consider having your prostate gland examined.

4. The average male orgasm lasts six seconds, while the average female orgasm lasts 23 seconds.

5. Scientists have identified the oldest male fossil animal yet discovered. It is an ocean-dwelling creature found in 425-million-year-old rocks in the UK. This creature is called is a hard-shelled sea creature called Colymbosathon ecplecticos; that is Greek for "amazing swimmer with large penis."

6. Even after circumcision the foreskin can be grown back. The movable skin of the penile shaft can be pulled up toward the glans (head) of the penis and kept in place with tape.  Using a series of plastic rings, caps, and weights, and after a few years the male can once again say, “Everything is covered.”

7. From a physiological standpoint, there are two types of penises. The first type is called a “grower” because it can easily expand and lengthen when erect to a size much greater than its flaccid dimensions.   The other is called a “shower” because it is very large when flaccid, but doesn't increase in size when erect.  It is estimated that 80% of men are growers, while 20% are showers.

8. German researchers say the average time for sexual intercourse is 2 minutes, 50 seconds.  Yet, women estimate that the average time for sexual intercourse is 5 minutes, 30 seconds, and men say it is in excess of 10 minutes.

The record holder for numbers of sexual partners is King Fatefehi of Tonga, an island in the South Pacific Ocean.  It is recorded that he had sexual relations with 37,800 women between the years 1770 and 1784—that's about seven women a night.

10. Spanish researches have determined that better-looking men may have faster and stronger sperm.  When women were shown photos of men who sperm was known to be in good, average, and unhealthy condition – and were told to select the men that they thought were most handsome.  The women consistently selected men who were in the good sperm category.

11. The act of ejaculation is not controlled in the brain, but it is a reflex that is started within the spinal cord.  It can therefore be said that it does not take any brains for a man to have sex.

12. The most common cause of penile rupture and injury is overly vigorous masturbation causing Peyronie’s disease.  For this reason it is wise to slow down, use a lot of lubrication, and enjoy a nice gentle ride.

Beta-Blockers and Peyronie’s Disease

What is a beta-blocker?

Anyone who has looked for a cause of Peyronie’s disease will eventually read about a drug called a beta-blocker.   I will not bore you with the technical aspects of the chemistry and physiology of beta-blockers, but only what might be important to you as someone who suffers with PD.

Beta-blockers are prescription drugs used to treat a wide variety of conditions, but most often heart-related disorders like abnormal and irregular heart rhythms, chest pain, and the immediate symptoms of a heart attack, as well as to lower the heart rate and reduce the force of heart contraction.  They are available in tablet, liquid and injection forms.  Beta-blockers can also be used to treat migraine headaches, social phobias, hypertension, muscle tremors related to anxiety and/or an overactive thyroid gland. Timolol is a particular beta-blocker that is prescribed as an eye drop, used in the glaucoma treatment since this beta-blocker reduces the pressure of fluid inside the eye. Beta blockers have been called "the musicians underground drug" because they can be used for performance anxiety.

Some of the more popular beta-blockers and their brand names are: acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren).

Inderal is perhaps the most commonly prescribed beta-blocker.  This beta-blocker affects the heart and circulation particularly well.  It is frequently used to treat hypertension (high blood pressure), heart rhythm disorders, tremors, angina (chest pain), and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the frequency and severity of migraine headaches.

If you have taken a medication for any of these problems you might have taken a beta-blocker and were not warned about it.  This might be worth checking out.

If you know you have taken a beta-blocker in the past and now have Peyronie’s disease, this might be a possible explanation for your PD and you might want to discuss this with the doctor who prescribed it for you.

If you are currently taking a beta-blocker you need to know that this category of medication should not be stopped suddenly, since this can bring about an attack of the original condition – sometimes more severe than the original problem – plus a rapid and dangerous rise of the blood pressure.  If beta-blocker use should be stopped or reduced, this should only be done under close medical supervision.  The best way to continue your Peyronie’s disease treatment is to keep your doctor informed and aware of what you are doing with Alternative Medicine.  You should try to get him or her to be a part of your natural Peyronie’s disease treatment.

Peyronie’s disease connection to beta-blockers

All beta-blocker drugs list Peyronie's disease as a possible side effect.  This association has been borne out in communication with men in my work with the Peyronie’s Disease Institute.

Channel Blockers and Peyronie’s Disease

Peyronie’s disease and Verapamil

Calcium channel blockers, or calcium antagonists, are a class of medications as well as natural substances (D-glucaric acid) that disrupt calcium ion conduction along what are known as the calcium channels of the body.

While some doctors use calcium channel blockers to treat Peyronie’s disease, there are researchers who have evidence that these very same calcium channel blockers can actually cause Peyronie’s disease.  This shows how strange and up-side-down is the world of Peyronie’s disease treatment.

The most widespread prescription use of calcium channel blockers is to reduce elevated blood pressure in patients with essential hypertension, particularly elderly patients.  Calcium channel blockers are notably effective to reduce large blood vessel stiffness, a common cause of elevated systolic blood pressure in geriatric patients.  They are also used to control and reduce rapid heart rate, prevent spasms of brain blood vessels and reduce chest pain due to angina pectoris.

Calcium channel blockers, or calcium antagonists, also treat a variety of conditions, such as Peyronie’s disease, high blood pressure, subarachnoid hemorrhage, migraines and Raynaud's disease.

All tissue of the body requires oxygen, and the heart muscles in particular need oxygen to pump blood.  The faster and harder the heart pumps blood, the more oxygen it needs. Heart pain occurs when the amount of oxygen available to the heart muscle walls is inadequate for the work load of the heart.  Calcium channel blockers dilate the large arteries that supply blood to the heart muscles, and thereby reduce the pressure within those arteries. This action reduces the stress on the heart muscles and reduces the need for oxygen at the same time, thus reducing angina pain. In similar mechanism, calcium channel blockers reduced elevated blood pressure, and slow the rate at which the heart beats in a condition known as tachycardia.

Peyronie’s treatment with verapamil

One type of calcium channel blocker known as a phenylalkylamine calcium channel blockers, is called Verapamil.  It is used in the treatment of Peyronie’s disease because it is thought to be effective in disrupting the calcium ions found within the Peyronie’s plaque, thus slowing or reversing the development of the offending plaque material that is the cause of the notorious Peyronie’s curved penis.

Peyronie's disease is a complex health condition without a known cause that affects nearly 4-6 percent of the worldwide male population.  It is best characterized by the development of internal fibrous plaque material below the surface of the penile shaft that results in curvature of the penis, as well as pain.  Peyronie’s disease typically on average at age 54, yet men of all ages (from 16 to 80) can and do  develop it for reasons that are not consist or clear.

Some medical doctors prescribe a topical gel of the calcium channel blocker, Verapamil to be applied once or twice daily over the area of the Peyronie’s plaque.  Since it is thought that calcium channel blockers change the way that calcium is bound within the plaque, that it might slow or reverse the development of Peyronie’s disease.  While this form of treatment has not proven especially effective, and has fallen out of general favor, other medical doctors attempt a more direct route of administration by injecting Verapamil directly into the plaque material of the penis.  This can be a rather painful treatment, and is often given in series of 12 to 20 injections over time.  Verapamil injections have not proven to be especially effective, either, yet remain on the list of medical therapies because it offers some avenue of treatment for both patient and doctor who do not have much medical treatment available for this troublesome and persistent problem.

Danger of Verapamil injections into the Peyronie’s plaque

In addition to the problem of inconclusive results and lack of support within the medical community for the use of Verapamil drug injections as a Peyronie’s disease treatment, there is also the vexing problem of trauma to the delicate tunica albuginea by repeated piercing of these multiple injections.

While there is still debate if calcium channel blockers actually cause Peyronie’s disease in healthy men, as well as if it can be used to treat Peyronie’s disease in those men who have it, the use of verapamil appears to be reducing if only because of discouraging clinical outcomes.

The Peyronie’s Disease Institute has maintained since 2002 that it makes sense to attempt to restore and support the natural healing ability of the body to correct Peyronie’s disease as occurs in about 50 percent of men who develop this condition. Read how you can use many Peyronie’s disease natural treatment options to help your body heal and repair without risk or danger of unnecessary drugs or surgery.

Possible Peyronie’s Cause: Catheter and Cystoscope Trauma

Unrelated cancer surgery possible cause of Peyronie’s disease

Debate and confusion persist about a Peyronie’s cause, no matter how much time passes.

We who deal with Peyronies on a daily basis know that not much research effort is given to this problem we share.  Medical research into the cause of Peyronie’s disease is often directed toward a genetic quirk or biochemical flaw within the cellular structure – that can be treated with drugs.  In spite of a hundred years of failure looking for a pharmacologically treatable Peyronie’s disease cause, one obvious area has not received much interest: trauma.

No one denies that trauma is at least a common secondary cause of Peyronie’s disease, if not the primary cause.  Yet, there is nothing in the medical literature that addresses the great amount of totally preventable trauma delivered while under medical care.  It is my opinion that doctors can be a Peyronie’s cause during the sometimes brutal and hidden trauma of male catheterization and cystoscopic examination that occurs before, during or after many types of surgery, like bladder or penis surgery.

Since 2002 when I started the Peyronie’s Disease Institute I have communicated with a host of surgical nurses.  They advise me that during surgery, while a man is under general anesthesia and is catheterized or given a urethral scope examination for any reason the process is often rushed and aggressive since the patient is not awake or aware.

To understand the potential problem, consider that the male urinary opening at the tip of the penis is a slit that averages 0.15 to 0.20 inches (4-5 mm) in length, compared to a 9 mm catheter or cystoscope that is put into that slit.  .

The potential for abuse that can lead to Peyronie’s disease exists because the size of the cystoscope used for men ranges from between the thickness of a pencil up to approximately 9mm.  In addition, many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.  That is a lot of material that goes up that little passage way.  Sometimes twists and narrowed areas of the male urethra are encountered that prevent passage, when the catheter or cystoscope will be forced deeper by a surgeon who encounters difficulty.  This, I have been told, is a common problem that is not much talked about.

Nurses get into big trouble, and jeopardize job security, for revealing what they see and hear in the operating room.

It is my speculation that unnecessary injury related to forceful and rushed catheterization or cystoscope insertion is the reason many men develop PD that they cannot otherwise explain.  This opinion is based on the number of men I speak to who tell me they cannot account for their PD based on penile trauma.  Of these men who recall no direct penile trauma, when I ask about any kind of surgery that took place within a year or so before developing PD, at least 95% tell me they were either catheterized or received a cystoscopic examination for one reason or another.

For this reason I speculate these men were traumatized during their catheterization or cystoscopic procedure sufficiently to injure their tunica albuginea enough to cause Peyronie’s disease.

One example within Peyronie’s disease research to support this theory of an association between surgical catheterization and cystoscopic examination and PD, comes from the Urology Service of the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, in June of 2010 published an article in Urology Times titled, “Peyronie’s Disease Following Radical Prostatectomy:  Incidence and Predictors.”

This search for a cause of Peyronie's disease must consider that for men in their 50s, both prostate cancer and Peyronie's disease are fairly common.  The purpose of this project was to determine if there was an actual link between those men who had a radical prostatectomy (RP) operation for prostate cancer and Peyronie’s disease.

They reviewed their sexual medicine database from 2002 to 2008.  They isolated men who received a RP as the only form of treatment for a well-defined and localized prostate cancer, looking for those who developed Peyronies within three years after their RP surgery and compared this group to those men who did not develop Peyronies.  They studied 1,011 such men, of whom 15.9% PD – a number higher than the general population.   They found that the average time for a man to develop PD after his RP was 14 months, give or take a month.   The average curvature was determined to be 31 degrees, +/- 17 degrees.   They further found that younger men (average of 59 years) who had a RP operation were more likely to develop PD afterward, than older men (average of 60 years), and that white race men (18%) were more likely to develop PD than non-white rave men (7%).    Also, they discovered that erectile function after RP surgery did not predict the later development of PD.

Because men who experienced sexual dysfunction after RP were found to develop Peyronie’s disease more frequently than the general population, the study suggested that this group should be routinely evaluated for PD.

This study, written by R. Tal, M. Heck and others, speculates that the Peyronie’s cause for these men might be somehow related to their prostate cancer.

Because it is common for the medical community to primarily delve deeply and intently into the biochemical and hereditary factors for a cause of Peyronie's disease,  without consideration of more simple and obvious reasons, they do not much evaluate for trauma.   Surgical trauma is a possible Peyronie’s disease cause for those with a history of prior radical prostatectomy (because of the cystoscopic and catheterization procedures they receive), but apparently is not investigated since this would cause a medicolegal problem for the medical community and little reason to use medication.