Treatment for Peyronies disease

At this time the standard FDA and AMA explanation is that there is no accepted or known drug that can be used for treatment of Peyronie’s disease.  The only standard medical procedure that is approved for Peyronies treatment is surgery, yet many doctors are reluctant to recommend surgery because of the problems that can develop as a result of surgery to this area of the body.   In addition there are only a handful of drugs (Verapamil, cholchicine, POTABA,  sildenafil, pentoxifylline) that are not FDA approved that are used “off label” by doctors because there has been some limited positive response to their use for Peyronies in the past, but not enough good results to have these drugs receive full approval.

Drugs

Some medical doctors believe these drugs can be used as a Peyronie’s disease treatment even though with extended use they have not shown to enough efficacy  to definitely prove they actually work.  Many times doctors will have a favorite drug they will use because they believe it might cause less harm than others if a drug reaction occurred, or the drug might be one that they used for other health problems and so they use it to treat Peyronie’s disease solely because they are familiar with it. Commonly prescribed drugs include colchicine, tamoxifen, pentoxifylline and the erection producing drugs known as PDE5 inhibitors (Viagra, Cialis, and Levitra).

Bear in mind that the drug your doctor might prescribe for you is not an actual Peyronies drug, because there is no Peyronies drug.  Any drug used is simply a best guess your doctor is making for something that might help you, although each carries the risk of side effects.

None of the drugs prescribed for Peyronie’s disease treatment have proven to be effective enough to become an FDA approved standard of care.   Of all the different medication used there is little evidence that using any of them is better than watchful waiting, or doing nothing .

Injections

Research doctors have tested injecting drugs directly into the Peyronie’s scar tissue (plaque).  Typically these drugs are injected at 8-20  into the small area of the Peyronie’s plaque, and this is done at 10-12 office visits over as many weeks, for a total of  approximately 80-240 individual injections into a small area of the penis.    There is a large and growing group of doctors who no longer perform this procedure; they believe in injecting any drug into the shaft of the penis can aggravate or cause Peyronie’s disease  because of the trauma caused by this type of heavy needle trauma to the tunica albuginea layer of penis shaft.     No drug has been found to produce consistent positive effect:

  • Verapamil is a well known drug primarily to treat high blood pressure, is used because of its intended ability to stop creation of collagen — a major component of plaque tissue.  Fewer doctors are using verapamil injections than just a few years ago because of poor results.
  • Xiaflex injections have not yet been FDA approved for Peyronie’s treatment.  Xiaflex  research results have been delayed for years and the testing outcomes have been so heavily scrutinized because Xiaflex is a very potent enzyme that eats up any living tissue protein it contacts.  The maker of Xiaflex and the FDA know there is huge potential for problems when this drug is injected incorrectly.  In a perfect world no one makes mistakes, but when this drug is injected incorrectly the results are very bad.
  • Interferon and steroid injections have not been shown to reduce collagen formation significantly.

 

Peyronie’s Surgery

Nonsurgical treatment if recommended at all is usually attempted during the first 12 to 18 months of medial treatment.

Surgery is the considered within the medical community the  most effective way to correct the penile curvature associated with Peyronie’s disease.   Most surgeons consider someone a candidate for Peyronies surgery if they have:

  • Peyronie’s disease for more than one year
  • Inability to successfully penetrate for sexual intercourse
  • No pain and a stable structural penis deformity

Reconstructive surgery for Peyronie’s disease is a complex operation, requiring specialized techniques and experience.  The two most common Peyronie’s surgeries are:

  • Removal of the plaque with replacement using a tissue patch.  This procedure commonly results in partial or complete loss of erectile function, especially rigidity.
  • Removal or altering the penile tissue on the side of the penis opposite the plaque, known as the Nesbit procedure. It attempts to rebalance the penile curvature by removing a normal and healthy portion of shaft, resulting in reduction of erection length up to two inches or more as well as reduction of penile girth.

Unfortunately, these surgeries cannot guarantee normal penis function afterward, and at times result more scar formation than before the Peyronies surgery.    Loss of penile sensation (numbness), complete or partial ED can develop as a result of any of these surgical procedures.

Another surgery for Peyronie’s disease is penile prosthesis implantation in which several types of inflatable vinyl bulbs are inserted within the shaft after considerable penis tissue is removed, or a rigid locking device is inserted into the shaft much like opening and closing a pocket knife.   If any of these methods fail (as due to tissue rejection or unsatisfactory performance) the prosthesis is removed during a second surgery and the patient is permanently impotent and has only a partial penis as a remnant.   This treatment is reserved for men who have both significant Peyronie’s curvature and significant erectile dysfunction (inability to obtain or maintain an erection suitable for intercourse).

Most types of surgery produce positive results. But because complications can occur, and because many of the complications associated with Peyronie’s disease (for example, shortening of the penis) cannot be corrected, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.

Surgery risks

Risks of surgery for Peyronie’s disease include:

  • Diminished penile sensation
  • Shorter penis
  • Impaired ability to achieve an erection
  • Return of the curvature in rare instances

 

Iontophoresis

Iontophoresis uses a DC electric current to deliver a drug (verapamil or a steroid or a combination of both) through the skin of the penis.  Early research showed slight to moderate treatment effectiveness, but subsequent research was unable to duplicate meaningful reduction of pain, plaque size or penile curvature.  Few clinics make ionotophoresis services available for Peyronie’s treatment because of poor clinical results.

 

Vitamin Therapy

Some studies have shown that vitamin E improves Peyronie’s disease.  Research comments about successful use of vitamin E as a treatment for Peyronie’s disease always closes with a comment that further testing should be done to validate this level of effectiveness, but it is never done.  Additional vitamin E testing is not done by the drug companies because if the effectiveness of vitamin E was confirmed it would create a problem for them; the drug companies would spend time and money proving that vitamin E is beneficial against Peyronie’s disease, but they could not benefit from that research since there is no way to control the cost of vitamin E to make it as profitable as a drug.  For this reason they do not do further testing, so vitamin E – and other natural non-prescription low cost therapies that are commonly available to everyone – are not subjected to additional testing.  Under this strategy the drug and health care industries can forever say that vitamin E is an “unproven and untested” Peyronie’s disease treatment because they have kept it that way.

Similar studies have been done on para-aminobenzoic acid, PABA, a member of the B-vitamin family.   Since this common B-vitamin worked so well in Peyronie’s disease testing the drug companies decided to try a variation of it that was a drug that could be more profitable and more easily controlled; they did not want to invest research money and time in a therapy that did not have the profitability of a drug, so they made PABA into the drug POTABA.

Acetyl-L-carnitine and Co-enzyme Q are two other natural substances that have received favorable research results, and little additional interest after showing merit as a Peyronie’s treatment.