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Conditions: Peyronies Disease

Treating Peyronie’s Disease

Pills for PD

Researchers have studied a number of oral therapies for PD, including: carnitine, colchicine, potassium aminobenzoate, tamoxifen, and vitamin E, the first oral therapy used for PD was believed to be of value because of its antioxidant properties. The other oral agents were studied because they are thought to have properties that interfere with collagen synthesis and scar formation.

Unfortunately, most studies using oral PD therapies haven’t been well controlled. Since some PD cases improve on their own and few studies of oral medication have compared treated patients to an untreated “control group,” it’s not clear that the oral therapies for PD offer any benefit over no treatment at all in terms of penile curvature, pain, or the ability to have intercourse. The active phase of Peyronie’s disease takes 12 to 18 months. After this pain generally goes away but most patients are left with a penile nodule/plaque. The Peyronie’s plaque causes bending and shortening of the erection.

Intralesional injection therapy

Several agents have been studied as intralesional injection therapies, meaning that they’re injected directly into the PD plaques, or lesions. Some of the earliest drugs used in this way were steroids. Currently, intralesional steroid injection is discouraged in the treatment of PD because there are no clear benefits, it can cause penile tissue to atrophy, or waste away, and it can complicate subsequent surgery.

Verapamil, a calcium channel blocker usually used to treat high blood pressure, has been shown to stop collagen synthesis and increase collagenase activity, thereby promoting scar remodeling.

Likewise, interferon injections have been associated with PD improvement. In placebo-controlled studies, documented benefits have been established. Interferons work by increasing collagenase and reducing collagen formation.

Topical gel therapy

Verapamil was introduced as a topical gel in the mid 1990s. It was hoped that the drug, which had been somewhat successful as an intralesional injection, could produce the same results with less discomfort in this noninvasive form. Unfortunately, when applied topically, the drug fails to reach the tunica albuginea. This was confirmed when men scheduled to undergo penile prosthesis surgery had verapamil gel applied to the penile shaft the night before and morning of surgery. During surgery, small tissue samples from each man’s tunica albuginea were removed and examined for verapamil. No verapamil was detected in any of the sampled tissue.

Iontophoresis

The process of iontophoresis, also known as electromotive drug administration or EMDA, uses an electric current to administer a drug through intact skin. In the treatment of PD, this technique has been used to administer vera-dexamethasone—through a fluid-filled reservoir affixed to the penile skin overlying the plaque sites. Early investigation found the treatment effective in reducing pain, plaque size, and penile curvature. Furthermore, measurable levels of verapamil have been found in tunica albuginea samples taken from men undergoing surgery for penile straightening and plaque removal.

Electroshock wave therapy

Electroshock wave therapy has been tested as a means of breaking up PD plaques, promoting plaque resorption, improving blood flow to the penis, and straightening the penis. To date, no consistent improvements in penile curvature, plaque size, sexual function, or rigidity have been reported with this treatment.

Surgery

Men who have had PD for more than one year, are unable to have satisfactory sexual intercourse, and whose PD is painless and stable may be candidates for PD surgery (see “Is PD Surgery Right for You?” on page 10). Surgery is still the “gold standard” for correcting penile curvature associated with PD, and surgical technique has improved tremendously over the past several years.

No one type of surgery is right for all patients. If you can maintain a satisfactory erection (with or without medication), the curve in your penis is less than 60 degrees, and your penis has neither an hourglass nor a hinge deformity, your doctor may recommend tunica albuginea plication. When plication is performed, the tissue of the tunica albuginea on the opposite side of the plaque is plicated, or stitched, to counteract the bending effect.

If your penis has more severe curvature, or if there is severe narrowing in your penile shaft so that it cannot become erect without buckling, then a more complex surgery is required: plaque incision and grafting. This requires the plaque to be incised (cut into), straightened, and filled in with a graft, which is either composed of living tissue from another part of your body or harvested from human or animal tissue.

If post-surgical erections are unsatisfactory, treatment with Cialis, Levitra, or Viagra may be prescribed to enhance erectile response.

Prosthetic surgery (a penile implant) was once the mainstay of PD therapy. Today, that type of surgery is performed only on patients with PD and ED. Plaque excision (removal) is reserved for men with severe calcified PD.

All PD surgeries carry potential risks, including incomplete straightening, ED, and diminished penile sensation. Before undergoing any type of PD surgery, be sure to discuss all risks thoroughly with your doctor.

In most cases, surgical correction of PD successfully straightens the penis and makes it more rigid, but in the early phases of PD, other approaches are usually tried first. If you have signs and symptoms of PD, talk to your doctor about what treatment is best for you.

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