Medical Therapies Stabilize, but Not Cure, Peyronie's Disease

MONTREAL — There is no cure for Peyronie's disease, but management can offer patients stabilization in its early phase, Dr. Laurence A. Levine said at a congress sponsored by the Canadian Society for the Study of the Aging Male.

The condition, first reported by Francois de la Peyronie in 1743, is characterized by the development of a penile plaque in the tunica albuginea of the corpora cavernosa. Deviation, shortening, and an hourglass-like shape can result. During the early inflammatory phase of the disease, patients can experience pain with erection.

Peyronie's disease is a disorder of wound healing that occurs in a genetically susceptible patient, probably in response to minor trauma, Dr. Levine said.

A proliferative fibrotic reaction results in an inelastic scar. Disturbances of collagen and elastin are seen, along with overexpression of cytokines such as transforming growth factor-β and imbalances of nitric oxide and nitric oxide synthase.

The standard treatment is surgery, but that must wait until the disease stabilizes and pain ceases. In the interim, and for patients unwilling to undergo surgery, therapies based on current thinking about pathogenesis can help.

“In a survey we did in Chicago, the most commonly used remedies were vitamin E and Potaba,” said Dr. Levine, of the department of urology at Rush Presbyterian-St. Luke's Medical Center, Chicago. Yet studies have found no benefit for vitamin E and only reduction in plaque size for the antifibrotic Potaba (aminobenzoate potassium). Colchicine, tamoxifen, and carnitine also have been found ineffective.

“The two oral agents I use are pentoxifylline and L-arginine,” he said. Pentoxifylline, given in a dose of 400 mg three times a day, is inexpensive, has low toxicity, and appears to have antifibrotic activity. L-arginine is an over-the-counter amino acid that is a precursor to nitric oxide and has been shown in vitro to have antifibrotic activity. The dosage is 500 mg twice a day.

Another approach is injection therapy. Steroids and superoxide dismutase have been tried and found to be ineffective or toxic. Studies have shown verapamil can reduce fibroblast proliferation, resulting in reduced production of collagen and other extracellular matrix macromolecules, he said at the meeting, which was cosponsored by the International Society for the Study of the Aging Male.

Uncontrolled studies have suggested up to 60% of patients can be helped with verapamil injections. “I use a multiple puncture technique with a short, five-eighths inch, 25-gauge needle.

“You don't want to use a smaller needle for fear of snapping it off in the scar,” he said. Verapamil 10 mg is mixed with 6 cc of saline to give a total volume of 10 cc, and the usual course of treatment is 12 injections at 2-week intervals.

Intralesional interferon has been used with some benefit, but “it does not appear to be as robust as what we see with verapamil,” he said.

Topical verapamil is popular. Manufacturers are making substantial claims about its efficacy, but there is no published evidence of benefit, according to Dr. Levine.

It does not penetrate into the tunica albuginea, he said.

Medical therapies also can be used in conjunction with mechanical stretching. Since studies have shown 50% of patients worsen with no treatment, it's important to treat early, Dr. Levine added.

MONTREAL — There is no cure for Peyronie's disease, but management can offer patients stabilization in its early phase, Dr. Laurence A. Levine said at a congress sponsored by the Canadian Society for the Study of the Aging Male.

The condition, first reported by Francois de la Peyronie in 1743, is characterized by the development of a penile plaque in the tunica albuginea of the corpora cavernosa. Deviation, shortening, and an hourglass-like shape can result. During the early inflammatory phase of the disease, patients can experience pain with erection.

Peyronie's disease is a disorder of wound healing that occurs in a genetically susceptible patient, probably in response to minor trauma, Dr. Levine said.

A proliferative fibrotic reaction results in an inelastic scar. Disturbances of collagen and elastin are seen, along with overexpression of cytokines such as transforming growth factor-β and imbalances of nitric oxide and nitric oxide synthase.

The standard treatment is surgery, but that must wait until the disease stabilizes and pain ceases. In the interim, and for patients unwilling to undergo surgery, therapies based on current thinking about pathogenesis can help.

“In a survey we did in Chicago, the most commonly used remedies were vitamin E and Potaba,” said Dr. Levine, of the department of urology at Rush Presbyterian-St. Luke's Medical Center, Chicago. Yet studies have found no benefit for vitamin E and only reduction in plaque size for the antifibrotic Potaba (aminobenzoate potassium). Colchicine, tamoxifen, and carnitine also have been found ineffective.

“The two oral agents I use are pentoxifylline and L-arginine,” he said. Pentoxifylline, given in a dose of 400 mg three times a day, is inexpensive, has low toxicity, and appears to have antifibrotic activity. L-arginine is an over-the-counter amino acid that is a precursor to nitric oxide and has been shown in vitro to have antifibrotic activity. The dosage is 500 mg twice a day.

Another approach is injection therapy. Steroids and superoxide dismutase have been tried and found to be ineffective or toxic. Studies have shown verapamil can reduce fibroblast proliferation, resulting in reduced production of collagen and other extracellular matrix macromolecules, he said at the meeting, which was cosponsored by the International Society for the Study of the Aging Male.

Uncontrolled studies have suggested up to 60% of patients can be helped with verapamil injections. “I use a multiple puncture technique with a short, five-eighths inch, 25-gauge needle.

“You don't want to use a smaller needle for fear of snapping it off in the scar,” he said. Verapamil 10 mg is mixed with 6 cc of saline to give a total volume of 10 cc, and the usual course of treatment is 12 injections at 2-week intervals.

Intralesional interferon has been used with some benefit, but “it does not appear to be as robust as what we see with verapamil,” he said.

Topical verapamil is popular. Manufacturers are making substantial claims about its efficacy, but there is no published evidence of benefit, according to Dr. Levine.

It does not penetrate into the tunica albuginea, he said.

Medical therapies also can be used in conjunction with mechanical stretching. Since studies have shown 50% of patients worsen with no treatment, it's important to treat early, Dr. Levine added.

MONTREAL — There is no cure for Peyronie's disease, but management can offer patients stabilization in its early phase, Dr. Laurence A. Levine said at a congress sponsored by the Canadian Society for the Study of the Aging Male.

The condition, first reported by Francois de la Peyronie in 1743, is characterized by the development of a penile plaque in the tunica albuginea of the corpora cavernosa. Deviation, shortening, and an hourglass-like shape can result. During the early inflammatory phase of the disease, patients can experience pain with erection.

Peyronie's disease is a disorder of wound healing that occurs in a genetically susceptible patient, probably in response to minor trauma, Dr. Levine said.

A proliferative fibrotic reaction results in an inelastic scar. Disturbances of collagen and elastin are seen, along with overexpression of cytokines such as transforming growth factor-β and imbalances of nitric oxide and nitric oxide synthase.

The standard treatment is surgery, but that must wait until the disease stabilizes and pain ceases. In the interim, and for patients unwilling to undergo surgery, therapies based on current thinking about pathogenesis can help.

“In a survey we did in Chicago, the most commonly used remedies were vitamin E and Potaba,” said Dr. Levine, of the department of urology at Rush Presbyterian-St. Luke's Medical Center, Chicago. Yet studies have found no benefit for vitamin E and only reduction in plaque size for the antifibrotic Potaba (aminobenzoate potassium). Colchicine, tamoxifen, and carnitine also have been found ineffective.

“The two oral agents I use are pentoxifylline and L-arginine,” he said. Pentoxifylline, given in a dose of 400 mg three times a day, is inexpensive, has low toxicity, and appears to have antifibrotic activity. L-arginine is an over-the-counter amino acid that is a precursor to nitric oxide and has been shown in vitro to have antifibrotic activity. The dosage is 500 mg twice a day.

Another approach is injection therapy. Steroids and superoxide dismutase have been tried and found to be ineffective or toxic. Studies have shown verapamil can reduce fibroblast proliferation, resulting in reduced production of collagen and other extracellular matrix macromolecules, he said at the meeting, which was cosponsored by the International Society for the Study of the Aging Male.

Uncontrolled studies have suggested up to 60% of patients can be helped with verapamil injections. “I use a multiple puncture technique with a short, five-eighths inch, 25-gauge needle.

“You don't want to use a smaller needle for fear of snapping it off in the scar,” he said. Verapamil 10 mg is mixed with 6 cc of saline to give a total volume of 10 cc, and the usual course of treatment is 12 injections at 2-week intervals.

Intralesional interferon has been used with some benefit, but “it does not appear to be as robust as what we see with verapamil,” he said.

Topical verapamil is popular. Manufacturers are making substantial claims about its efficacy, but there is no published evidence of benefit, according to Dr. Levine.

It does not penetrate into the tunica albuginea, he said.

Medical therapies also can be used in conjunction with mechanical stretching. Since studies have shown 50% of patients worsen with no treatment, it's important to treat early, Dr. Levine added.