Peyronie’s Disease Treatment - Medication
Men who once had a straight penis and then notice a change where they have a bent penis when erect most often have Peyronie’s Disease. If diagnosed with Peyronie’s disease, especially with significant penile curvature, it is important to find an experienced specialist to review options for Peyronie’s disease treatment. The main goal of Peyronie’s treatment is to correct penile curvature, especially when the penis curve interferes or prevents sexual intercourse. While a number of non-surgical treatments are currently available, these treatments are generally not highly effective.
Non-surgical Peyronie’s disease treatment is not effective because of the nature of the disease. Penile curvature is generally related to the development of a dense inelastic plaque within the penis. In order for creams, pills or other treatments to be effective, they need to change the affected tissue from a dense scar back to elastic, supple, and healthy tissue. To date, no pill or cream has been shown to be highly effective in achieving that goal. The following is a list describing some of the more common medications used in Peyronie’s disease treatment, although this represents only a partial list of all available treatments. Most of these Peyronie’s treatments are used early in the course of the disease (early immature disease) when the curve can potentially get worse, or stay the same, or improve.
For decades, Vitamin E has been commonly prescribed Peyronie’s disease treatment because it is inexpensive and can be an effective treatment for scarring (of the skin). In the past, when men wanted to try a pill, Vitamin E was suggested as an option because although we did not necessarily think it would be effective, but it was only a Vitamin. There is now evidence indicating that there is no efficacy, and therefore, we no longer mention this as an option.
Colchicine is an inhibitor of cell division that is most commonly used to treat gout. The cells particularly affected by Colchicine are called granulocytes, which are the cells that are involved in inflammation. A downside to this treatment is that many patients have adverse reactions to the medication, including gastrointestinal side effects and leukopenia, which is a lowering of the white blood cell count in the blood. We used to indicate that this is an option when patient’s had painful erections early in the course of their Peyronie’s Disease, but we have not prescribed this in years.
This medication is composed of potassium p-aminobenzoate and is considered an antifibrotic medication, which means that Potaba is thought to prevent fibrosis (scarring) by increasing oxygen uptake at the tissue level. In order for the medication to be effective, patients are required to take large doses every day for months at a time. The recommended daily dose is 4 (0.5gram) tablets or 6 capsules, and the number of pills patients are asked to take discourages many from going with this Peyronie’s treatment. This medication was popular in the 1990s but is no longer in use.
Unlike the other treatments listed above, Verapamil is not a tablet or pill. Rather, it is Peyronie’s disease treatment that is applied as a topical cream, but also can be injected directly into the penis. Verapamil is a calcium inhibitor that is often used to treat hypertension. It is thought that the this medication may alter fibroblast function. Fibroblast cells are involved in wound healing after tissue injury. It is called “transdermal” as supposedly, the medication can travel through the skin into the plaque leading to a beneficial change. Certainly this medication is effective in increasing the income of those who promote and sell this drug. However, there is no clearly established proven efficacy for this medicaiton being a Peyronie’s Disease cure or effective treatment in the peer-reviewed published literature.
Pentoxifylline is a medication that has been used for many years for the treatment of intermittent leg cramping (claudication). It has gained recent attention as a potentially effective Peyronie’s disease treatment. Trental is now at the Center for Reconstructive Urology what Vitamin E was 20 years ago at our Center. It is a medication we offer when patients are wanting a pill for treatment. It is not clearly established that this medication is effective, but there has not been proven that no patient has any benefit.
Many men are now contacting our Center asking about treatment with Stem Cell injections, Shockwave Treatment, “P-Shot” treatment, and “Gainswave” (soundwave) treatments. In other cases, they come to us with curvature after having paid a considerable amount of money to have ineffective treatment. These options are being promoted and marketed aggressively to men with Peyronie’s Disease. In some cases, all a man has to do is enter his zip code, and will be provided with a list of Providers near them. These providers are generally not Fellowship Trained Peyronie’s Disease treatment experts exclusively specialized in the treatment of men with penile-urethral-genital disorders, and often there is a financial relationship between the doctor and industry. As it true with many of the previously promoted medical therapies, the above treatments have not been conclusively proven to be ineffective. However, we do not offer these options at our Center.
There is a fairly new “kid on the block” injection therapy being used to treat Peyronie’s Disease when the disease is stable and there is at least 30 degrees of curvature (not downward). It is called Xiaflex (collagenase clostridium histolyticum). The manufacturer was Auxillium (now owned by Endo Pharmaceuticals). Xiaflex is a medication that is injected into the plaque inside the penis. Prior to Xiaflex injection, a different medication is injected into the penis to produce an erection to identify the area of maximum curvature, and that is marked. Then, another different medication is injected into the penis to cause the erection to subside. The Xiaflex is then injected into the plaque itself where marked. This injection is repeated a couple of days later, and is followed by another visit to the Urologist several days later for a “modeling” procedure where the penis is bent where the objective is to break up the plaque. These visits and injections is called a “cycle”. There can be up to 4 cycles, but we have seen more than 4 cycles given to men for treatment. Once this product was approved by the FDA, it could not be offered at the University of California, Irvine without approval by the hospital formulary committee. Dr. Gelman worked for over 16 months in 2014-5 to obtain this approval, and this is a Peyronie’s Disease treatment option currently offered by the Center for Reconstructive Urology at the University of California, Irvine.
The initial data in support of the effectiveness of this medication was from clinical trials paid for by the manufacturer. Once this drug had FDA approval, there was a major effort to market this product to Urologists and also directly to patients. One example was a lecture to Urologists in Southern California attended by Dr. Gelman. The speaker was sponsored by the manufacturer, and the presentation slides were provided to the speaker by the manufacturer. During the talk, Dr. Gelman noticed that some of the slides depicting graft surgery were our illustrations used without permission. All of our surgery illustrations were commissioned and drawn by Fairman Studios for our use for educational purposes. It is not uncommon for other Urologists interested in promoting similar practices to “borrow” our slides, but in this case, the paid Peyronie’s Disease Specialist speaker did not even know he was using Center for Reconstructive Urology images within his talk because it was given to him for the purpose of promoting a product.
When Dr. Gelman first established the Center for Reconstructive Urology in 1998 at the University of California, Irvine, he was the first expert in Peyronie’s Disease treatment in Orange County, CA and only 1 of 3 Urology Specialists in Southern California with who had expertise in performing complex penile curvature correction surgery. The other 2 doctors have since retired. However, the introduction and promotion of Xiaflex has led to a dramatic increase in the number of Urologists who now treat Peyronie’s Disease as compared to Peyronie’s surgery, injection of Xiaflex is a relatively simple procedure, and non-University private practices of General Urology are not subject to a very lengthy committee institutional approval process. To be “Certified” to administer Xiaflex by the manufacturer, all that is required is that the Urologist watch a video, read a handout, and complete an enrollment form. No testing or hands-on training or Fellowship Training or sub-specialization is required.
At this time, there are 19 manufacturer “certified” Urologists in our zip code that are listed on the manufacturer website that were “trained” specialists. One potential downside of this trend is that when doctors are only comfortable offering 1 treatment option, that can lead to medical advice that favors that particular option at times to the point of not mentioning other (in some cases more effective) Peyronie’s Disease treatment options. As a result, we are now seeing many men who have been treated with Xiaflex and then are referred when there has been no benefit or worsening of the curvature. More recent data indicates that some patients can benefit from Xiaflex, but the results are inferior to surgery, especially when the curvture is severe.
The Center for Reconstructive Urology and Dr. Gelman do not sell any products for profit, and we never had financial relationships with pharmaceutical companies or device manufacturers. All instruments invented by Dr. Gelman are not associated with a royalty, and all lectures are given for free so there is no potential conflict of interest. This website contains no advertising, so all Peyronie’s disease treatment suggestions are made with the patient’s best interests in mind.
As most of the above listed Peyronie’s treatment methods are ineffective, many patients are left wanting to know how to cure Peyronie’s disease. In many cases, the best Peyronie’s disease treatment is surgery. There are primarily two different types of surgery, with Dr. Gelman advising the patient to undergo either a penile plication or penile graft surgery. Successful surgery will correct any noticeable signs of curvature, allowing for normal sexual intercourse.
These surgical procedures can be very complicated, and that is why patients should only trust an experienced surgeon with expertise in correcting penile curvature. At the Center for Reconstructive Urology, Dr. Gelman has over 20-years of experience and the expertise necessary to complete these surgeries with a very high success rate and a very low complication rate.