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Non-Traditional Treatments for Peyronies Disease



Non-Traditional Treatments for Peyronies Disease
We define Nontraditional treatments as treatments that have not been widely prescribed, recommended, or practiced by doctors having an interest in, and experience with Peyronie's Disease. There can be many reasons why a treatment is not more widely prescribed. A treatment could be dismissed by a majority as being ineffective, or it could simply be a newer treatment that is not widely known. In this latter case, there may be few opportunities for other physicians to become trained in the technique. In some case, availability of equipment could be an issue.
Non-Invasive - Non-invasive treatments include oral and topical treatments that have been widely recommended or prescribed by doctors over the years, and that continue to be prescribed.

Pentoxiphylline (pentox or Trental) - Pentox has been used in humans in a variety of inflammatory and fibrotic conditions. The mechanism is not fully understood; pentox blocks the transforming growth factor (TGF) B1- mediated pathway of inflammation, prevents deposition of collagen type 1, and acts as a nonspecific (PDE) inhibitor. pentox's observed suppression of collagen production in Peyronie's cells in tissue culture, as well as its efficacy in other fibrotic disorders, have resulted with it being offered to patients for treatment by a limited number of physicians. Further studies will soon be completed but initial results seem to indicate that pentox is a useful treatment for Peyronie's disease.

Vacuum Erection Device (VED) - VED's have long been prescribed for erectile dysfunction but they are one of those treatments that have recently moved from the category of "Alternative Treatment" to "Non-traditional Treatment" as more urologist begin prescribing them for treatment of Peyronies Disease. These are primarily a clear rigid plastic tube with a small pump that creates a vacuum around the penis. This vacuum causes an erection by drawing blood into the corpra cavernosa tissue. Medical quality VED's can be purchased without a prescription but Medicare and many insurance companies will pay part of the cost with a prescription. Inferior, low-cost VED's from adult novelty stores should be avoided since they can cause excessive pressure leading to more severe damage to the penile tissue. All VED's should always be used conservatively, with caution and under a doctors guidance. With proper use a VED should never cause pain or discomfort.

Invasive

Lariche technique - This surgical technique has recently been used with success in Europe on the stable phase of Peyronies Disease. We know of no place that it is offered in North America or the specifics of why its is not offered. We will report when we have an answer to that question. The procedure takes place during day surgery. A local anesthetic (penile block) of 1% Xylocaine is used. After a constricting ring is put in place at the root of the penis, an erection is induced by a physiologic serum in the cavernosa. A preoperative ultra-sound is used to confirm that the plaque can be seen, and its clinical position. After manual location of the plaque, it is lacerated using an 18 gauge needle, making several passes, with the specific objective of fragmenting the fibrous or calcified tissue. The degree of penile straightening is verified with a new induced erection. When the straightening is judged satisfactory, a compressive dressing is put in place for 3 hours. Patients are discharged the same day, and reviewed at 1 month and 3 months. An early resumption of sexual activity is recommended, in the absence of which an erection should be induced daily with vacuum for 1 month. The effectiveness is judged by the straightening of the penis and the resumption of sexual activity.