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Dr. L. Dean Knoll, Center for Urological Treatment and Research

A Nashville urologist is one of the nation’s foremost authorities on Peyronie’s disease, an affliction that causes the penis to curve and can lead to erectile dysfunction. Dr. L. Dean Knoll with the Center for Urological Treatment and Research, in collaboration with Indiana-based Cook Medical, has pioneered a successful surgical treatment for Peyronie’s and launched a physician-driven Web site to ensure that accurate information on the disease is available for patients and physicians.

“It’s estimated that, in the old days, one to two percent of the male population was affected by Peyronie’s. Now it’s probably anywhere from seven to nine percent, because of better recognition. We’re getting a much higher reporting of the true incidence of Peyronie’s disease,” Knoll said. He noted that awareness is up significantly among family practitioners and internists, who now recognize Peyronie’s, and because they know treatment options are available, refer patients to urologists.

Pronounced pah-ro-neez, the disease is named for a French surgeon, François de la Peyronie, who first described the malady in 1743. Peyronie’s disease is characterized by plaque or scar tissue that develops on the upper or lower side of the penis under the skin. Because the tissue has no flexibility, the penis curves in the direction of that tissue. In severe cases, painful erections and even ED result. About 85 percent of men who develop Peyronie’s are between the ages of 45 and 55, Knoll said.

“We’ve been studying Peyronie’s disease for a good 25 years, researching it because we don’t have very good medical therapy in Peyronie’s disease, meaning drug therapy or injection therapy that will stop the scar tissue from being laid down,” Knoll said. “We feel that it’s micro-trauma to the penis that leads to inflammation that eventually leads to the deposition of scar tissue.” Sexual intercourse can cause the micro-trauma, he added.

A decade ago, Knoll performed his first surgical procedure to correct the penile curvature, and improvements to the operation through the years have led to a 91 percent success rate. In the December 2007 edition of The Journal of Urology, published by the American Urological Association, Knoll reported the results of a study conducted on 162 patients with at least a 12-month history of Peyronie’s disease and a penile curvature of 60 degrees or more. Surgical correction of the curvature was achieved in 148 of those patients (91 percent).

Knoll’s procedure requires an incision of a centimeter or more into the scar tissue at the most indented part of the curvature. The cut releases the scar tissue, and thus relaxes the penile bending. “That will leave a defect that is exposing the smooth muscle of the penis, and if you don’t cover that up, the patient would bleed excessively because the penis is very well irrigated,” Knoll explained.

In the early days of the surgery, a synthetic material that didn’t stretch or become pliable was grafted, but not very successfully, over the incision site. Subsequently, tissue from the lining inside the gum or the scrotal area was used, but blood supply was still hindered and re-scarring was common. Enter Cook Medical, with a natural biomaterial dubbed Surgisis, which is derived from the small intestine, or the jejunum, of the pig.

Surgisis is “rendered acellular, and what you’re left with is a biomaterial with the protein matrix — residual proteins that no one will reject,” Knoll explained. “The protein matrix that’s left behind is what you then sew in to cover that defect. Then what happens in an eight-to-12-week period is this material gets completely absorbed by the host tissue. So when I go back to find the Surgisis, I can’t find it after three months. It’s fantastic.” The material also allows for the new growth of blood vessels, he added.

Knoll estimated that he performs this surgery 60 to 70 times annually.

Earlier this year, Knoll and other physician experts on Peyronie’s disease partnered with Cook Medical and its bioengineers who developed Surgisis to launch www.MensHealthPD.com, a comprehensive Web site for patients and physicians. “There’s not a whole lot of material out there on Peyronie’s disease that’s been as well done and as thoroughly laid out as this Web site has been,” Knoll said. “The nice thing about this is it’s designed for the layperson in one arm and also designed for the physician in another arm.”

The site features:

• Video answers to the most commonly asked questions about Peyronie’s disease. Knoll is featured in this segment.
• A searchable physician finder tied to the AUA to help patients find a urologist in their community.
• A question-and-answer forum where patients, partners and physicians discuss available treatments and exchange ideas on coping with the disease.
• Details of the signs, symptoms and progression of Peyronie’s disease.
• A list of questions to help patients prepare for the first physician visit.

Physicians also may access a summary of treatment options with links to the most current research and a secure, physicians-only Q&A forum.

“It’s a very up-to-date, interactive process that allows physicians who want to learn about it, as well as patients who want to learn about it, the opportunity to be in touch with people who work with this disease state very diligently,” Knoll said.



June 2008

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