New Combined Treatment Study

Combination of Penile Traction, Intralesional Verapamil, and Oral Therapies for Peyronie's Disease.

Introduction.  There is no current consensus as to the most effective nonsurgical therapy for Peyronie's disease (PD).

Aim.  This study aims to assess the benefit of penile traction therapy (PTT) when added to intralesional verapamil injections (IVIs) combined with oral L-arginine 1 g b.i.d. and pentoxifylline 400 mg t.i.d. in men with PD.

Methods.  Seventy-four men with PD completed 12 IVIs. Patients electing to add PTT were advised to wear the device for 2-8 hours daily and no longer than 2 hours per session. Subjective responses were measured using patient questionnaires. Stretched penile length (SPL) and erect penile curvature (EPC) using penile duplex ultrasound were measured. Response to therapy was defined as at least a 10-degree reduction in EPC.

Main Outcome Measures.  Change in SPL (cm) and change in EPC (degrees).

Results.  Thirty-five patients in group I vs. 39 patients in the PTT group II completed the protocol. Fifty-four percent of men in group II responded to therapy vs. 46% in group I (P = 0.75). Responders in group II had a mean EPC improvement of 26.9 degrees vs. 20.9 degrees in group I (P = 0.22). Mean PTT use was 3.3 hours per day, and men with >3 hours per day use gained 0.6 cm in SPL vs. 0.07 cm using less than or equal to 3 hours per day (P = 0.09), while men in group I lost 0.74 cm of SPL on average. Multivariate analysis revealed that duration of PTT use significantly predicts length gain (0.38 cm gain for every additional hour per day of PTT use, P = 0.007).

Conclusions.  There was a trend toward measured curvature improvement and a significant gain in SPL in men using the combination therapy protocol. Length improvement is related to duration of use of the traction device. Abern MR, Larsen S, and Levine LA. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease- http://www.ncbi.nlm.nih.gov/pubmed/22024053

This brand new combined therapy peyronie's disease study throws up some interesting results. It certainly poses questions about Verapamil, which currently has a less than positive reputation amongst patients, online at least. With traction removed from the picture the treatment regimen rather worryingly appears to have resulted in a slight loss of stretched penis length. However there was a fairly significant reduction in curvature. Perhaps the main curvature causing plaques are being reduced in size, while there is a slight continuation in loss of elasticity throughout the penis.

Adding traction resulted in a more significant curvature improvement and an increase in stretched length. This is a lesson already learned, as Xiaflex injections are also thought to be much more effective in conjunction with traction therapy - a process known as modelling. It's hard to gauge the effectiveness of pentoxifylline with these factors at play. I'd tend to fall back on results from previous studies, rather than draw any pentoxifylline specific conclusions here.

I think there are still some questions over how necessary verapamil injections are, when you consider that curvature improvements of this magnitude can often be seen in men using traction or ved therapy alone (without the need for painful injections). Also with traction you often see length increases too. That was not seen here when verapamil was done without modelling via traction.

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