Is it possible to urinate the Peyronie's plaque out of the body?

Hello Dr. Herazy,

I have had Peyronie’s Disease for the past 18 months, with a penile curvature that is quite severe.

From 9/15 to 11/8/11, my urologist had me on a regimen of twice daily applications of Verapamil 30 ml Transdermal in PLO gel,80 mg/ml. As there was no discernible change in the curvature over the course of almost two months, it was decided to discontinue the Verapamil regimen.

However, since stopping, my recent urinations have contained a variable degree of light colored tissue-like particulate matter. Thus far, urinalyses have yielded nothing pathological, and thus the cause remains unknown.

My question is therefore: Is it possible that what I may be expelling in my urine are pieces of loosened plaque that have made their way into the urethra and out through the penis? My urologist thinks not, but the pharmacist does not rule out the possibility … despite believing it to be unlikely.

I might also add that the more such particulate matter being discharged during urination, the more discomfort I experience in the tip of the penis …. along with the occasional sensation of not having fully emptied my bladder.

Any answers, thoughts or recommendations would be very much appreciated.

Thank you,

Phil F.


Greetings Phil,

There is no anatomical connection between the opening of the urethra and the tunica albuginea of the shaft where your plaque is located.   Your pharmacist might be a great pharmacist, but knows noting of anatomy. If you actually did have a direct connection between the two you would be in the middle of a massively painful and bloody medical emergency, and you are not.

My guess from this end, with the limitation of knowing only what you have told me, is that you have an infection in the urethra – in spite of the negative urinalysis tests.  There are always false positives and false negatives in this kind of testing, and it is my guess that this is the case with you.  I suggest you go back to tell your urologist that your symptoms persist and that you would like another urinalysis done ASAP. 

After you get that situation cleared up I suggest you go to the PDI website to start some Alternative Medicine Peyronies disease treatment.   TRH



Is it OK to have sex if I have Peyronie’s disease?





There is much to say here.

First, do not stop your sexual activity; it is important that you basically continue as you always have, with the exception that you must be much more careful and defensive with your technique.  This is a huge subject, so perhaps to really understand it best you should get my book, “Peyronie’s Disease and Sex.”  It will help both of you to understand how to have a full sex life in spite of Peyronies.

Fewer doctors are using verapamil because of limited results – and you have seen this to be true for yourself already.  For more information, see my article,  “Peyronie’s and Verapamil.”     

Next, when you ask what kind of Peyronies treatment you can use to help yourself with your PD it is obvious you have not spent any time looking at the PDI website; it is loaded with hundreds of pages of information to answer this question.   To get you going in the correct direct go to start Peyronie’s treatment.  

You must protect your penis to prevent additional injury during sexual activity.  You do not have to worry about light contact or pressure during the day.   To protect the penis during sexual activity we have assembled a great list of effective penis supports that will reduce the chance of re-injury by sudden buckling or bending during intercourse.    Go to Sex Supports and Aids.     You never want to force your bent penis to make it straight.  Once you start treating your PD and you begin to cause your internal scar tissue to get reabsorbed your penis will be able to naturally straighten out.   Before that happens do not apply pressure to reduce your curved penis to make it straight.         

You really need to spend some time educating yourself in this critically important subject so you will know how to protect and assist yourself.    Probably the best single thing you can do to understand how all of this operates and how to help yourself is to get my first book, “Peyronie’s Disease Handbook.”  TRH

What is the benefit of taking Neprinol rather than Nattokinase and Fibrozym?

Hello Dr. Herazy,

Thank you for the great site.

I am getting ready to place my first order with you and have a couple of questions:

1)  In your opinion what if any is the benefit of taking Neprinol over taking Nattokinase & Fibrozym. I understand your philosophy of overwhelming the problem but it seems like taking all 3 is overkill and from my limited understanding taking Nattokinase & Fibrozym sounds better than Neprinol?

2)  You do not mention the 15% Verapamil topical solution from PDLabs which seems to have had quite a few scientific studies done on it and the results seem to be very positive. Any thoughts on this would be greatly appreciated.

Thanks–I look forward to placing my order and getting started on a treatment plan.


Greetings Richard,

1)  The benefit of taking the single product, Neprinol, rather than the two products, Nattokinase and Fibrozym, is that the Neprinol is more concentrated and should result in taking fewer systemic enzyme pills per day while having a higher dosage intake.   In addition, Neprinol contains the additional enzymes of papain and bromelain.   The cost is higher for Neprinol, but considering the higher level of enzyme in the product, it is less expensive in the long term.   Yes, taking three different forms of a systemic enzyme might be more than is necessary, but for some men it does make a difference.  There is no way to anticipate how anyone will respond to their therapy plan, so I encourage everyone to experiment with different combinations of therapy products to determine how their scars will respond as you go through different combinations of products.

2)  Most every medical treatment for PD is the same – one or two positive studies and a larger list of negative studies about it.  The same with topical verapamil from PDLabs of Texas. The different studies mentioned by PDLabs of Texas are intriguing, but are contradicted by other similar studies of topical verapamil.  When i first developed PD in late 2001 or early 2002 and found the PDLabs website on the internet and read those studies I also was impressed with their conclusions.  for this reason I used their topical verapamil product for about six months, during which time my PD worsened considerably and I developed overwhelming side-effects that caused me to stop using the product.  At that time I realized I would have to look outside traditional medical treatment for helping my PD and I began to intensely investigate Alternative Medicine options; eventually I came upon the concept and and treatment protocol that developed into the Peyronie's Disease Institute.   Over the years I have discovered more controversy about their findings – but this is typical of any kind of treatment for PD.  It seems PD is always tangled in controversy and exceptions.   TRH 

What can PDI do for my 20 year old Peyronie's disease?

hi, what can your method do for me and my 20 year old pd that started because of a sex accident?  bill 

Greetings Bill,

Thanks for the question.

Since you have given me no details of your problem, I can only answer with generalities. The longest standing PD case with which I have been involved was a fellow who had it for 12 years. You see, most of the men I work with are usually in the 18 month to 3 year time range with their Peyronie's disease.  I think this is so because the average person who has dealt with PD for several years tends to just give up on himself and his situation, and assumes there is nothing out there for him.  The MDs eventually convince them to stop trying to get help because they do not have any drug for Peyronies treatment, and that is a shame.

Folks like you usually are not looking for help and answers – unfortunately.  But in the early phase of PD, a guy will really burn up the Internet wires looking for answers to his unsettling predicament. Having explained all that, it is my opinion that based on the favorable changes in the 12 year PD problem I worked with, and several others in the 3-8 year range I have worked with, your 20 year old problem stands as much a chance to improve as these others.

A long time ago I learned to never doubt the ability of the body to heal.

Many men, and myself, were able to get back all lost dimensions and eliminate any detectible scar formation, so I know it can be done. I assume you have just started to look at the large PDI website. Bear in mind what we propose is really different in the past in two important ways:
     1. Synergy – grouping several therapies together at the same time.  If you are like most men who go the medical route, you probably used synthetic vitamin E for a short while and then did some POTABA or verapamil drug use later.  PDI approach is different because we advocate a combined treatment approach with many Alternative medicine therapies.
     2. Quality and quantity of Alternative Medicine
most men do not appreciate the need to hit these two factors fairly hard. I can guide you in this respect to perhaps a better conclusion than you had in the past. In addition to a few vitamins, we also propose several other concurrent therapies for your PD that you have not used. These are very important to achieve the desired end result. The more you do, the stronger your synergy, the greater your odds for some success.  If you want to broaden your thinking about Peyronie's treatment with natural methods see natural Peyronie's treatment.

If you want some help to do this right, and I assume you do, send some specific questions about treatment.  PDI has a different website from anything else you will find anywhere because we have a reasonably optimistic attitude and track record with this problem, and because we actually know and care about men who have this lousy problem. I am retired now from active practice, and since overcoming and curing my own Peyronie's disease, I have pretty much devoted myself to this cause in appreciation and gratitude for the gift that was given to me.

When you are ready to do something good to help yourself, let me know.   TRH

Too late for help after Peyronie's surgery?

Dear Dr. Herazy,

My husband developed Peyronie's disease almost seven years ago after an injury while making love. His urologist first did a series of injections with verapamil. When that did not help he talked us into surgery by saying that it was the only way to straighten his 90 degree curvature. The surgery went very badly and now his curvature is worse and he has no feeling in his penis. He has become withdrawn and is very angry with himself and takes it out on me. i am so glad to have finally found your non-drug website and only wish we had found it sooner before the surgery. Do you think it is too late for my husband to get help from your alternative medicine treatment ideas?

Thank you.

Marge V.


Greetings Marge,

Sorry to hear of your husband's bad reaction to surgery. 

There is no way I can answer your question directly, since there are far too many unknowns and variables.  However, I can tell you that many men who have had bad Peyronie's surgery results have seen a reduction of scar tissue after following a PDI treatment plan; some of these changes were very small and some were remarkably great.  The work is always long and difficult because of the complications of additional scar tissue, but always worthwhile for any reduction of numbness and reduction of other problems such as curvature and pain that can occur.  There is no way to tell ahead of time if your husband is capable of any change in his scar tissue, but if some can be made it could result in some degree of improvement of his current sad situation. 

I suggest that you get both of my books and that you and your husband read them, especially "Peyronie's Disease & Sex." 

Go slowly with your husband and do not push him too much to follow any of these ideas,  He is angry and scared about injuring himself more with any kind of additional treatment, and most of all he is embarrassed.  Give him some room to warm up to the ideas of safe Alternative Medicine care.  If he has any questions or hesitation please encourage him to email me directly.  I will try to help him as much as I can.    TRH

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.

Peyronie’s and Verapamil

Verapamil and Peyronie’s disease treatment

Verapamil is used in Peyronie’s disease treatment by injection directly into the Peyronie’s plaque or a topical Verapamil cream is applied to the skin over the Peyronie’s plaque.   For more information about this method, see Peyronie’s disease treatment via direct drug injection.

Verapamil is a calcium channel blocker of the phenylalkylamine L-type.  It works by relaxing the muscles of the heart and blood vessels. Verapamil is an anti-arrhythmic drug approved by the FDA in 1981 to treat hypertension, angina, cardiac arrhythmia, and recently, cluster headaches.  No oral or transdermal Verapamil is approved for Peyronie’s disease treatment.  Most used for Peyronie’s treatment is in the form of a topical Verapamil cream that is applied twice daily for many months.

There are many different companies that compete against each other with their own unique patented Verapamil formula, creating difficulty to know what to believe about the use of Verapamil for Peyronie’s disease treatment.

With so much competition among companies and unsafe practices of illegal companies, some even resort to making inferior and dangerous topical Verapamil cream products.  As a result, Peyronie’s patients who use counterfeit Verapamil have reported:

  • Changes in blood pressure, causing dizziness, fainting, heart beat irregularities, often requiring changes in other medications to become stabilized
  • Severe skin irritation
  • Skin burns and blistering

Peyronie’s Verapamil connection

As with many popular medications, the exact way Verapamil is supposed to benefit Peyronie’s disease is not entirely known.  Keep this in mind when someone says they do not know how vitamin E or acetyl-L-carnitine or PABA helps Peyronie’s disease.

It is proposed that long term use of Verapamil blocks calcium from entering into the Peyronie’s plaque or scar.  Another theory s that Verapamil increases fibroblast activity to make more collagenase that breaks down the Peyronie’s plaque or scar. However, calcium is an essential mineral that must have free access and movement in all tissues and hundreds of different normal and healthy chemical, enzyme and hormone functions of the body.  The body needs calcium to function normally and healthfully, and it does not do well when it is blocked by a drug like Verapamil.

Peyronie’s disease and Verapamil side effects

When taken topically or orally for Peyronie’s, Verapamil can cause side effects that may impair thinking or abnormal organ function because of calcium metabolism interference.   Care should be used when driving a car, operating dangerous equipment, or any skill in which mental alertness or memory is needed.

Verapamil and Peyronie’s disease warning

Men treating Peyronie’s disease with Verapamil must deal with extreme fatigue, loss of energy, blood pressure problems and skin reactions that often occur.  Also, if Verapamil is stopped suddenly any side effect or problem for which it is being taken (like Peyronies) may become worse.

You should not use Verapamil if you are allergic to it, or if you have:

  • Serious heart conditions, especially “sick sinus syndrome” or “AV block” (unless you have a pacemaker)
  • Low blood pressure
  • Recent heart attack

Personal experience with Verapamil and Peyronie’s disease

After attempting to treat my own Peyronie’s disease with topical Verapamil cream for eight months, my overall health suffered from weakness, fatigue, memory failure and low blood pressure caused by the Verapamil in my blood stream.  However, worst of all, while using Verapamil my Peyronie’s disease worsened.   The size of each Peyronie’s plaque increased and my Peyronie’s curve doubled.

Shortly after using Alternative Medicine to eliminate my Peyronie’s problem, I started the Peyronie’s Disease Institute with my MD colleagues I was working with at the time.  With this organization I communicate with dozens of men daily about their problems with PD.  Considering the information outlined above, it seems fewer and fewer medical doctors use Verapamil for Peyronie’s disease management.