What causes hourglassing/ dents?

[MacMathuna]

What causes hourglassing/ loss of girth.

I have both, but my hourglassing is only very apparent when I'm on the large end of flaccid.
When I'm erect or when my penis is flaccid and small it just shoes up as narrowing

I also have a ventral indentation which is pretty obvious when erect.

Anyway I just dont understand how plaques cause loss of girth, denying, and hourglassing.

[TonySa]

Yes, they are also caused by plaque...depends on the shape and position of plaque.  Maybe also on how diffuse or localized it is.

[melting]

What causes hourglassing/ loss of girth.

The smooth muscles fill with arterial(incoming) blood and then pressure the tunica to expand.  
When the tunica reaches it's maximum expansion(it's a "mesh") it also closes off the veins that allow the blood to flow out.

When a peyronies plaque sits anywhere in these structures it messes with the functions.  
When a plaque sits atop the tunica, the tunica can't expand right there cause the plaque is inflexible. This then creates a hinge effect bending the erect penis.  

With hourglass and intendations I think the plaques sit deeper. At least with me that was the case. I think it messes with the smooth muscles filling up with blood, failing to increase the pressure on the tunica to expand.  
When semi flaccid the pressure is lower than when hard so the pressure might overcome the plaques impact somewhat when erect.

Often doctors diagnose also "venous leakage"(veins are there to "leak"/move blood out/away) which I think is also due to the plaques sitting where normaly the veins are shut off by the tunica hardening, so blood is leaving easily creating a weak erection.

[jan.schaller1958]

What causes hourglassing/ loss of girth.

I have both, but my hourglassing is only very apparent when I'm on the large end of flaccid.
When I'm erect or when my penis is flaccid and small it just shoes up as narrowing

I also have a ventral indentation which is pretty obvious when erect.

Anyway I just dont understand how plaques cause loss of girth, denying, and hourglassing.

I started off with an hourglass deformity and indentation 5 years ago. I went to a Peyroines specialist, Dr Lue in SF hoping all I needed was Xiaflex. He did a full exam with ultrasound and said he couldn't use Xiaflex because my plaque was diversified. He said inside the capora cavernosa (sp?- I hate that word so I'll just use the German ,,Schwellkörper" instead),  the chambers that swell up with an erection, there are little struts like on a bridge. You need them so the penis keeps its shape when flaccid. (Without them, your penis would look like a deflated balloon when the blood flowed out.) My plaque formed around those strut-like things so Xiaflex would be too dangerous to inject. He offered me a alloderm grafting surgery at the time, but I declined it, thinking it wouldn't do anything. In hindsight, I probably should have gone for it. However, in 5 years the hourglass deformity disappeared on its own along with the indentation, and all I was left with was the shortening down to 13-14 CM erect (5-5.5 inches down from and an upward 30 degree curve at the tip. At my visit with Dr Lue this year, he said he now could use Xiaflex and that surgery was not recommended due to my age (61) because the risk of ED would be about 40%. So, this is a weird disease and can get better on its own, and change.  

[MacMathuna]

Melting... I'm confuzed when you say the plaque "deeper". Isnt the.plaque in the tunics, which surrounds the erectile tissue? How can it be deeper unless its inside the corpus cavernous rather than the TA?

Jan. Thats interesting that your hhourglassing resolved after such a long time. Do you think you did.anything to encourage resolution?
Was it a gradual or sudden resolution? Did it get worse sfter presentation brfore getting better?

Do you have your progression detailed in a post somewhere??

[bustedchubb]

You definitely give me some hope that one day my hourglassing can get better.  I took a major hit on the left distal side and across the top about 1/4" below the head.  Thank you for sharing that, jan!

[jan.schaller1958]

Melting... I'm confuzed when you say the plaque "deeper". Isnt the.plaque in the tunics, which surrounds the erectile tissue? How can it be deeper unless its inside the corpus cavernous rather than the TA?

Jan. Thats interesting that your hhourglassing resolved after such a long time. Do you think you did.anything to encourage resolution?
Was it a gradual or sudden resolution? Did it get worse sfter presentation brfore getting better?

Do you have your progression detailed in a post somewhere??

Thanks guys for your questions about that hourglass deformity. I can't explain why it occurred (Dr Lue could easily), but yes. It just resolved on its own with no treatment. I have no idea why. I did take Pentox religiously the first year, because that's all Kaiser had, and they gave me viagra, but I never needed it since I never had ED, and I never liked the side effects of viagra (stuffy nose, flushing) anyway.  I never thought Pentox did a thing, so I just tossed them after the first year. But it might have helped a little, I really don't know. But after the first 6 months of Peyroines, my penis with that awful hourglass deformity looked like a truck had run over it. But, then it just sort of went away on its own after a few years.  It was weird. So, I'm not doing so bad now and am getting Xiaflex injections and going to use traction in June to get rid of the upward curve at the tip (around 30-35% maybe?). I only wish I could get the length back. But the plaque causes contracture, so I guess I'm stuck with a smaller penis. Girth is the same. But, If I can be straight as an arrow again, like before, I can live with what they tell me is an ,,average" length. I was used to a lot more length, but I'm keeping my fingers crossed that that Xiaflex straightens me out.  

[jan.schaller1958]

Melting... I'm confuzed when you say the plaque "deeper". Isnt the.plaque in the tunics, which surrounds the erectile tissue? How can it be deeper unless its inside the corpus cavernous rather than the TA?

Jan. Thats interesting that your hhourglassing resolved after such a long time. Do you think you did.anything to encourage resolution?
Was it a gradual or sudden resolution? Did it get worse sfter presentation brfore getting better?

Do you have your progression detailed in a post somewhere??

MacMathuna: my Peyroines slowing came on. I just woke up one morning with the usual ,,morning wood" and I noticed my penis was bending to the right. It hadn't done that before. I actually thought I had just slept on it or something. When it didn't go away in a week, I went in and the doc diagnosed Peyroines. Then it slowly got worse over the next 6 months with that hourglass deformity. That was the worst of all, since like I said, it looked like I had been run over by a truck. I really never thought it would ever get any better and it really did a number on my self esteem. But, when I started doing something about it this last year, and went back to Dr Lue, I suddenly noticed it actually looked better and that hourglass deformity was gone, as well as the indentations. So now I don't need surgery and can take the Xiaflex injections and use traction. So yeah. It can get better on its own. It's a really weird disease. It's totally benign, but it can really do a number on you mentally, but keep a positive attitude. I think they say 10-15% of Peyroines cases resolve on their own anyway. So, keep the faith. As they say in German ,,die Hoffnung stirbt zuletzt"- Hope is the last to die.  

[melting]

Melting... I'm confuzed when you say the plaque "deeper". Isnt the.plaque in the tunics, which surrounds the erectile tissue? How can it be deeper unless its inside the corpus cavernous rather than the TA?

It can sit right in the tunica or ontop. Then you will probably see a bend.  
If it's towards the septum or inside towards the erectile tissue I think hourglass deformities happen.
If you look at  a diagram of the penis you will see the tunica isn't just outside but goes around the 2 chambers.
Depending where the plaque is the effect can be different.

[TonySa]

Jan, the traction can help w length restoration as well as remodeling the plaque.

Melting, this theory of hourglassing being caused by "deeper" plaque...just curious where you've read this or heard it?  Or, is it just your thinking based on your experience and overall understanding of Peyronie's.  I've just never heard it explained, so I'm curious.

[melting]

My own penis, hourglass effect, and understanding the erection process. Looking at diagrams helps. I tried to insert one with some drawings here but I wouldn't let me..

like this: https://www.researchgate.net/figure/Schematic-penis-anatomy_fig1_316592651

Depending on where the plaque sits in the tissue the effect will be different on the erection process and then the penis form.

Plaque on the outside tunica, the inner erectile tissue might fill normally creating enough pressure to harden the tunica but at the plaque area it will hinge/leverage/bend.

If the plaque sits inside in the corporal tissue not enough pressure is created by the inflowing arterial blood into the smoothmuscle to harden the tunica. Where that happens the tunica stays soft/intended.

That's just 2 basic ones. Several plaques can create some of the twisted forms I guess.

[jan.schaller1958]

Jan, the traction can help w length restoration as well as remodeling the plaque.

Melting, this theory of hourglassing being caused by "deeper" plaque...just curious where you've read this or heard it?  Or, is it just your thinking based on your experience and overall understanding of Peyronie's.  I've just never heard it explained, so I'm curious.

Thanks,Tony, for the encouragement. I think the Xiaflex softens up the plaque to make remodeling possible.  It makes sense that stretching with traction would cause some increase in length, once if the plaque is softened,  since it causes the contracture. The loss of length was the worst part of Peyroines for me (I suppose ED ranks up there for those men who experience it).