Hyperthermia

[Hawk]

I appreciate your tenacity on this topic but some of this, and some of what you just stated, we have already covered. Additionally, I have a few other priorities other than digging this stuff out for further discussion.  This is why I said I was winding down on this in my last post.  Due to this I will simply say the following for now.  If I think time justifies it I will add more.

Check out our resource library for information on heat reducing scar tissue in general.  It is in the documents on scarring and is good reading.  Other information on heat/scarring/fibrosis is widely documented as you already mentioned.  Capsulitus (frozen shoulder) is but one brief example.  I have a close friend that is an orthopedic surgeon and I have a good rapport with the head of a great physical therapy department that I may approach about these general issues. 

Also in the resource library is a document making a connection between circulation /oxygen/TGF B-1 and fibrosis of the penis. http://www.peyroniesforum.net/index.php/topic,130.0.html  I have had leading urologists mention circulation and fibrosis as though it is an understood.  With VED's, Viagra, arginine, nocturnal erections, etc. surely you do not discount the connection between circulation and Peyronies Disease.

I think the findings on cellular longevity (not the word I am looking for) of Peyronies Disease cells was on Pub Med but I cannot be sure.  It may have even used the word "immortality". It discussed the absence of apoptosis in Peyronies Disease cells and drew a similarity to keloids as I recall.  It may well have also been referenced as part of an earlier discussion on this forum.

That is it for now.  I am off to enjoy life with grand children, wife, son etc.

Cheers

[George999]

Hawk thinks that while it is possible that the type of heat energy played a role (almost anything is possible), I think there is easily enough established documentation on temperature and fibrotic conditions, temperature and circulation, Peyronies Disease and circulation, temperature and cell death, and the abnormal longevity of Peyronies Disease cells to establish the strong likelihood that temperature made any impact that was made in that study.  When stacked against the lack of established evidence for the type of heat being a factor on fibrotic tissue or cell life, I think that temperature is the obvious choice.

Peyronies Disease cells have been established in several studies to be prolific and to be absent the normal programmed cell death of typical cells, a condition found in cancer cells.

I just did a quick look for research on Peyronies and hyperthermia and came up with only one hit:

Role of hyperthermia in the treatment of Peyronie's disease: a preliminary study.
Perugia G, Liberti M, Vicini P, Colistro F, Gentile V.

Department of Urology, University of Rome La Sapienza, Rome, Italy.

OBJECTIVE: Previous experience in the treatment of plaque with hyperthermia in orthopaedics led the authors to investigate the effectiveness of this approach in patients with Peyronie's disease. PATIENTS AND METHODS: The study population comprised 60 patients (aged 36-76 years) with advanced Peyronie's disease. Patients were divided into two groups (A and B), with 30 in each. Group A patients underwent local hyperthermia treatment, with 30-min treatment sessions twice a week for 5 weeks. Patients received a total of 10 applications, which reached a local temperature of 39-40 degrees C. A second cycle was repeated after a 1-month interval for a total of 20 treatment sessions. Group B patients were treated with intra-plaque infiltrations using 10 mg verapamil; they received one infiltration once a week for 3 months. Differences between the two groups, as well as between variables (before and after treatment), were analysed using Student t-test and Fisher test. RESULTS: Hyperthermia significantly reduced plaque size and penile curvature and led to an increase in mean scores of erectile function (EF) domain, while verapamil had no such effects. Haemodynamic parameters were not significantly modified in either group. Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in terms of pain reduction during erection. CONCLUSIONS: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronie's disease.

PMID: 16019862 [PubMed - indexed for MEDLINE]

Do note that this is another one of those famous Italian studies.  I forthrightly acknowledge that there are a raft of hyperthermia/fibrosis studies out there, but in reviewing the listing I fail to find anything that look particularly applicable or interesting.  So if you wouldn't mind, I would appreciate you pointing out the documentation on fibrosis and hyperthermia.

I would also like to see any scrap of evidence you can find for Peyronies disease responding to improvements in circulation.  I can't find any.

Additionally, where is the research that establishes the "absent the normal programmed cell death" factor for "Peyronies" cells.  I am aware of the phenomenon of Collagen accumulation whereby cells involved in Peyronies are damaged to the point that they "sprout" abnormal amounts of Collagen on their surfaces.  I am also aware that the Collagen that becomes glycated does not turnover as often as normal Collagen.  But I have never seen anything attributing "immortality" to other than cancer cells.  I would really appreciate any studies ANYONE can find on this.

If we are going to dig into the area of Hyperthermia as it relates to Peyronies, lets do it right and get all of the relevant research out on the table.  Hawk asked for documentation and I provided what I can find.  I think now its time we see rest of the documentation for these other claims being made.

-  George

[Hawk]

First, I have been punished enough for this lively debate that broke out under "Oral Treatments" .  It took 40 minutes to figure out where to prune and trim that topic and to execute the move.

I am ready to wind down and am satisfied with the points:

George thinks he has found enough evidence to conclude it is likely that the type of heat energy made a significant impact on the Hyperthermia study.  He admits to some wild speculation,

Induced collagen turnover would be all but invisible in healthy tissue, but fibrotic tissue would reveal it dramatically.  OK, Hawk, I admit that this last part is just wild speculation on my part, but thats just how my brain operates.

I don't entirely fault wild speculation.  It can be both a asset and a liability.

Hawk thinks that while it is possible that the type of heat energy played a role (almost anything is possible), I think there is easily enough established documentation on temperature and fibrotic conditions, temperature and circulation, Peyronies Disease and circulation, temperature and cell death, and the abnormal longevity of Peyronies Disease cells, to establish the strong likelihood that temperature made any impact that was made in that study.  When stacked against the lack of established evidence for the type of heat being a factor on fibrotic tissue or cell life, I think that temperature is the obvious choice.

Peyronies Disease cells have been established in several studies to be prolific and to be absent the normal programmed cell death of typical cells, a condition found in cancer cells.

The fact is, that I have always questioned the entire study from method thru evaluation of results to conclusion.  Like J, after a while you have to ask what is with the Italian studies.  Europe gives us one-time miracles from hyperthermia, to ALC, Leriche technique that never spark enough interest for follow-up or fail to be reproduced. 

I still think ALC and hyperthermia are a no-lose treatments that will likely not hurt and possibly help.

[George999]

j, Remember, first of all, the problem in the case of Peyronies is not so much with the cells, since they are normal and not cancerous, the problem is with the extracellular matrix and an excessive build up of collagen.  It is highly unlikely that the cells at issue with Peyronies would respond to hyperthermia in the same way as cancer cells.  Remember also that the effects rendered in the second study I pointed out from the UK were demonstrated to be ENTIRELY unrelated to induced hyperthermia and were directly due to the RF frequency being delivered, not the heat being caused by that RF energy.  In the case of the study I referred to, the Microwave radiation was actually CAUSING fibrosis WITHOUT inducing any hyperthermia, but my point was and is that this demonstrates that Microwave radiation can and does effect tissue by components other than its ability to heat that tissue AND it can directly affect the extracellular matrix, which in the case of Peyronies is mostly glycated collagen.  Certainly all of this does NOT preclude the very real possibility of benefit from hyperthermia itself.  But it does leave open the possibility that the participants in the Italian study could have been getting a double benefit, from both the induced hyperthermia AND from the unique effects of microwave radiation on tissue.  And of course, as I pointed out before, they could also have been fudging the numbers on the results.  Who knows?  But if ANYONE can get the kind of spectacular improvement they got within just a few months just from the use of hyperthermia, I would certainly like to hear about it and I am sure many others would also.  - George

[George999]

j, I think we have a good discussion going here and I would like to comment further on it, but before I do, I really think it is probably time for Hawk to come in and move some of our recent posts back over to "Alternative Therapies" where they probably belong.  - George

[j]

I said that heat might break unwanted molecular bonds, but I don't think that was the idea behind the original study. What I recall is that it was based on the knowledge that temperatures around 43C will cause the death of cancer cells but leave normal healthy cells unharmed - and Peyronie's/Dupuytren's fibroblasts have some characteristics in common with cancer cells.

Remember that microwaves and infrared are in some sense the same thing - just 2 different frequency ranges of electromagnetic radiation.  Microwaves are the high end of the radio spectrum - directly above them lies infrared - and just above that, the low end of the visible spectrum.  Microwaves can be bent, focused and refracted much like visible light. 

I don't know the science of why microwaves are used for hyperthermia instead of IR.  I tried IR because it was possible to due so at low cost, with off-the-shelf components.  Microwaves do penetrate more effectively than infrared - light won't penetrate the walls of your garage, but transmitter in your garage door opener does so easily.  So for tissue far below the surface, microwaves are more effective. For tissue at or near the surface, I don't know why there would be a difference.

[George999]

Hawk, You have asked for evidence, here it is:

Radiofrequency radiation (900 MHz) induces Egr-1 gene expression and affects cell-cycle control in human neuroblastoma cells.
Buttiglione M, Roca L, Montemurno E, Vitiello F, Capozzi V, Cibelli G.

Department of Pharmacology and Human Physiology, University of Bari, Italy.

Many environmental signals, including ionizing radiation and UV rays, induce activation of Egr-1 gene, thus affecting cell growth and apoptosis. The paucity and the controversial knowledge about the effect of electromagnetic fields (EMF) exposure of nerve cells prompted us to investigate the bioeffects of radiofrequency (RF) radiation on SH-SY5Y neuroblastoma cells. The effect of a modulated RF field of 900 MHz, generated by a wire patch cell (WPC) antenna exposure system on Egr-1 gene expression, was studied as a function of time. Short-term exposures induced a transient increase in Egr-1 mRNA level paralleled with activation of the MAPK subtypes ERK1/2 and SAPK/JNK. The effects of RF radiations on cell growth rate and apoptosis were also studied. Exposure to RF radiation had an anti-proliferative activity in SH-SY5Y cells with a significant effect observed at 24 h. RF radiation impaired cell cycle progression, reaching a significant G2-M arrest. In addition, the appearance of the sub-G1 peak, a hallmark of apoptosis, was highlighted after a 24-h exposure, together with a significant decrease in mRNA levels of Bcl-2 and survivin genes, both interfering with signaling between G2-M arrest and apoptosis. Our results provide evidence that exposure to a 900 MHz-modulated RF radiation affect both Egr-1 gene expression and cell regulatory functions, involving apoptosis inhibitors like Bcl-2 and survivin, thus providing important insights into a potentially broad mechanism for controlling in vitro cell viability. 2007 Wiley-Liss, Inc.

PMID: 17559061 [PubMed - indexed for MEDLINE]

The above study demonstrates, I believe, that application of microwave energy can have other components than simply hyperthermia.  There is no inference in the abstract that the observed results are due to induced hyperthermia and there seems to be the assumption from the beginning that they are characteristic rather of application of RF energy on living tissue and not induced hyperthermia.

Microwave radiation can alter protein conformation without bulk heating.
de Pomerai DI, Smith B, Dawe A, North K, Smith T, Archer DB, Duce IR, Jones D, Candido EP.

School of Life and Environmental Sciences, University of Nottingham, University Park, NG7 2RD, Nottingham, UK.

Exposure to microwave radiation enhances the aggregation of bovine serum albumin in vitro in a time- and temperature-dependent manner. Microwave radiation also promotes amyloid fibril formation by bovine insulin at 60 degrees C. These alterations in protein conformation are not accompanied by measurable temperature changes, consistent with estimates from field modelling of the specific absorbed radiation (15-20 mW kg(-1)). Limited denaturation of cellular proteins could explain our previous observation that modest heat-shock responses are induced by microwave exposure in Caenorhabditis elegans. We also show that heat-shock responses both to heat and microwaves are suppressed after RNA interference ablating heat-shock factor function.

PMID: 12753912 [PubMed - indexed for MEDLINE]

Here again in this study we see evidence of NON-HYPERTHERMIA effects of RF radiation.  This whole issue is so very complex and, with all due respect, I find it highly simplistic to argue that therapeutic microwave results ONLY in hyperthermia and can produce no other biological changes.  In fact, I find the second study highly interesting in that it alludes to "Limited denaturation of cellular proteins".  If indeed RF can induce changes in collagen independent of hyperthermia, then perhaps it can induce accelerated collagen turnover which just might explain the claimed efficacy of the Italian Peyronies study.  And if Peyronies itself is caused by faulty glucose metabolism, it would be reasonable to expect that those who demonstrated dramatic improvement in the study would later develop Peyronies symptoms all over again which just might explain why the whole thing was never pursued further.  Induced collagen turnover would be all but invisible in healthy tissue, but fibrotic tissue would reveal it dramatically.  OK, Hawk, I admit that this last part is just wild speculation on my part, but thats just how my brain operates. 

I stand by my statement.  - George

[Hawk]

George,

First off you don't have to defend glycation to me.  I have no issue with that topic and never meant to suggest i did.  I was making a point of your differing standards on differing topics.

I have often voiced skepticism and interest over the hyperthermia study just like I have the ALC study.  They have much in common.

As far as our area of disagreement it is this

1)  I argued that different sources of heat are not equal.  I stand by that statement.  I believe that both infrared and microwave, for example, include components that go BEYOND hyperthermia and are not at this point really well researched or understood.

  Would't you rather stand by evidence

It is clear you either have no evidence, or at least offer not one molecule of evidence that different types of heat have different physiological effects on the body, much less differences that would impact this study.  In addition to a lack of evidence, you don't even provide one trained scientist that voices a similar personal speculation.

I have to say that your statement about this sounds arrogant.  it is as though your opinion constitutes evidence.  You say it, then proceed as though that establishes it as credible. I find it as revolting as a member several months back that would routinely attack Pentox with the same lack of evidence.  That is not being a skeptic.  It is formulating a theory without any basis.

What kind of forum would we have if 75 or so other members just started saying things like " I think it is clear that VED's using a separate hand pump are more prone to draw oxygen depleted blood into the penis and I encourage more research on this."  Three or four statements like that a day on different topics would  degenerate the entire forum into a confusion of defending the obvious from sniping speculation.  We have had some of these.  One guy challenged Pasture's "theory" on bacteria.  Because he was a nut we could laugh and dismiss it but we don't have that luxery with you. If we all started stating theories with no evidence it would be utter destruction of the forum.

Had you said "I have a hunch that some day some one may find ......"

I make allowance for goofballs and potheads that have established this as their style.  It is only a credit to you that I expect better from you.


Present the convincing evidence for your quote or concede you have none!

[George999]

Hawk, I think we may be having a break down of communication on the hyperthermia issue.  And it is certainly more my doing than yours.  My points regarding hyperthermia were intended to be directed at the extremely proficient efficacy claimed in the study in question.

1)  I argued that different sources of heat are not equal.  I stand by that statement.  I believe that both infrared and microwave, for example, include components that go BEYOND hyperthermia and are not at this point really well researched or understood.

2)  I argued that I would like to see references to multiple studies delineating the effectiveness of hyperthermia.  So far no one has referenced any.  You refer to studies indicating the effectiveness of hyperthermia for other forms of fibrosis.  Certainly that would indicate that it would be effective for Peyronies.  I am aware at this point that those studies are out there, I have pulled up a list of a number of abstracts.  But as I also indicated, I do not pretend to know very much about this area.  I do recognize that different forms of heat are not the same and then somehow we bounced over to hyperthermia in a generalized sense.  I did assert that it is an area ripe for investigation.  I certainly wasn't discounting it out of hand.  I WAS discounting the phenomenal results of the study in question as deriving from hyperthermia.  As for hyperthermia in general, I honestly said I would like to see other studies.  And yes, I will accept effectiveness with other forms of fibrosis.

3)  I then reiterated my disbelief at this particular study.  If it indeed was so successful, why wasn't it followed up?  Unfortunately, I suspect that the outcomes of some of these studies get tweaked a bit to advance the careers of those managing the study.  I am not going to say that that was what happened in this case, but one has to wonder.

So where exactly are we not agreeing on this issue?  - George

[Hawk]

The problem comes when one tries to rely on the conclusion of one study in isolation.  When you have multiple studies involving different research teams all reaching a similar conclusion, you have pretty reliable guidance.  In the case of a single, never replicated study, you can toss a coin on it.

- George

George,

I don't think that is where the problem lies.

Your attempts to understand and unravel things you are untrained or uneducated to unravel is heroic.  In so doing you come up with a lot of interesting data.  I think at times individuals invest enough in an endeavor that they put on blinders and loose all objectivity.  The result is, that they can only apply rational thought if it supports THEIR opinions.  They then embrace the irrational if necessary to reject opinions outside of their effort.

The facts are sad but these are the facts.  THERE ARE NO REPRODUCIBLE STUDIES of any of the supplements you recommend either alone or in combination in correcting Peyronies Disease.  Most of the supplements you recommend have never even been associated with Peyronies Disease by anyone but you.  You base your endorsement soley  on deductive reasoning of a mind untrained in medical research, physiology or any associated field.  No one here has reported even anecdotal improvement from them.  You then turn around and in an instant postulate theories wild guesses about types of heat and physiology that no one in medicine, or physics have ever postulated.  You then promote such guesses to dismiss a  study outside of your efforts. You do so even though the mechanisms of temperature on tissue, injuries, and blood flow are well documented.  You do so even though the effects of blood flow on Peyronies Disease are a central theme.

I have no doubt it is honest and unintentional, but therein lies the problem.

George,

You are not a skeptic on the hyperthermia study.  I am a skeptic on that.

You are in fact doing nothing short of wild guessing that you know the source of improvement in that study.  You whip out a concept never advanced about differing forms of heat being the issue rather than temperature.  You seem to dismiss solidly established documentation of temperature increasing blood flow and being used in other forms of fibrosis, and in being used to reduce scarring in burn victims, in reducing penile shrinkage in prostatectomy patients.  You do this in favor of nothing but your thought of what could be possible.

I find it an in-credible turn from sound reasoning.  A turn from the probable to pure speculation.  A turn from the conclusions of trained experts to the baseless hunch of an unprofessional. 

The hoops you jump through unnoticed by yourself to get there is all the more amazing BECAUSE you would never stand by for someone jumping through such hoops to discount Vitamin E, ALC, glycation theory, etc etc.etc.

The only common thread I see is that one of these was not presented by you and that makes me wonder if you have developed blinders. 

You know I think well of you.  That is not a personal attack but a glaring observation I could not help but make.  Maybe it should have been made in private but your argument was made in public.

[j]

My experience was that your nervous system is evolved to reliably alert you if your skin temperature gets to the danger point.  My thermocouple and meter were calibrated and accurate.  If I wasn't watching it, and my skin got near 43C, it stung and I quickly readjusted things.  To hurt yourself I think you'd have to really get carried away.  NEVERTHELESS I repeat that I'm not a medical professional or a biologist and have no real knowledge of what hyperthermia might actually do to tissue.

I'm not discounting hyperthermia.  It makes sense to think that elevated temperature might cause molecular bonds to break in the collagen matrix.  But like many other proposed therapies, the heat might have to be prolonged and extremely well targeted to have any effect.

Hyperthermia is pleasant; it probably enhances circulation; it feels psychologically right.  So it's not hard to imagine a strong placebo effect, especially in a supportive clinical setting.

[Hawk]

I want to thank Tim for the entirity of the study on hyperthermia.  It is an interesting read and an interesting topic for several reasons.  Any time this topic comes up, I feel it is reckless not to emphasize the warning contained in this study.

This study used temperature between 102 - 104 degrees F.  The researchers conclude temperatures of 107.6 degrees F are safe for limited periods but stress that temperatures of just 113 degrees F can result in irreversible cell damage.

The researchers list other interesting information including the depth of Peyronies Disease plaque, the correlation of skin temperature to plaque temperature, and the duel mechanism by which they conclude temperature improved the outcome for these patients.  The entire study is worth reading but possibly should be moved just due to its length.

I remain skeptical of this study but interested since temperature is used on such a wide range of tissue injuries, and conditions ranging from frozen shoulder to tendon injury.

Hyperthermia may lead to changes in cell metabolism and treatment at a high temperature (45°C) can result in irreversible cell damage, even cell necrosis, as reported in the literature [16-18]. However, at a lower temperature (39-42°C), provided the time of heating is limited, changes in cell metabolism do not lead to permanent cell damage. Mild heating promotes the above-mentioned effects that result in a beneficial therapeutic action. Indeed, it has been reported that damage incurred in tissue is related not only to temperature but also to length of heating time [28].

A temperature of 39-40°C, with a limited time of heating, has been chosen in the present treatment protocol to avoid the risk of possible cell damage involving the underlying anatomical structures, with particular attention being focused on the penile neurovascular bundle and urethra. The plaques in the penis can never be more than a few mm from the surface and even the deepest are only a few mm between the albuginea and the skin. Therefore, the surface temperature is similar to the deep plaque temperature.

[George999]

How it can be that a study showing what seems to be spectacular success (observable improvement within months claimed) with a disease so difficult to treat receives literally zero followup even from the investigators involved in the study itself.  And this is after almost three years have passed.  But there is ongoing study in this area: Treatment of Peyronie's disease with hyperthermia, vitamin D and testosterone: a randomised controlled trial.  - George

[j]

It's easy to ridicule this study, but of course I didn't use microwaves, and there might be other factors of which I'm not aware.  But I think it's fair to say that without any sort of clinical followup, or any interest generated in the medical community, the study has no real value.  It's just another UFO report.

[flexor]

When this report first surfaced, we only had the abstract, and we wondered if the penis was under traction during the heating.

The full report includes the statement:

"A penile applicator with supports is used to maintain the penis in an extended position and to position the thermocouple on the plaque to be treated."

How far do you extend a penis before it becomes traction ?

[George999]

The Italian study "worked" because, of course, the subjects were Italian and anything seems to work with Italians.  In j's case, he was using a treatment for reptilian Peyronies and since he is not a reptile, it was unsuccessful.  Next question?

[Hawk]

J,

As always, I enjoy your posts.

There were 2 phrases in that post I found priceless.

I let others guess which 2

Hawk
 

[j]

Are we talking about that Italian hyperthermia "study" again?

I gave this a serious try about a year ago. I used a ceramic IR emitter (no visible emissions) from a pet store.  Medical hyperthermia uses microwaves; but heat is heat, and Peyronie's plaque probably isn't far from the surface. Reptiles in captivity will use these IR emitters to raise their core temperature (a ceramic emitter is supposed to put out lower-frequency IR that penetrates deeper).  I used a digital meter and thermcouple probe to monitor skin temperature and maintained it at about 41C or slightly above.  I did about 20 sessions of 30 minutes each, with days off in between.

As far as I could tell it did nothing; but of course I wasn't in Italy.

[Tim468]

Here is the text minus the figures and tables:

Please note that this is microwave heat technology. The last reference (in bold) may be worth digging up...

************************

Objective: Previous experience in the treatment of plaque with hyperthermia in orthopaedics led the authors to investigate the effectiveness of this approach in patients with Peyronie's disease.

Patients and methods: The study population comprised 60 patients (aged 36-76 years) with advanced Peyronie's disease. Patients were divided into two groups (A and B), with 30 in each. Group A patients underwent local hyperthermia treatment, with 30-min treatment sessions twice a week for 5 weeks. Patients received a total of 10 applications, which reached a local temperature of 39-40°C. A second cycle was repeated after a 1-month interval for a total of 20 treatment sessions. Group B patients were treated with intra-plaque infiltrations using 10 mg verapamil; they received one infiltration once a week for 3 months. Differences between the two groups, as well as between variables (before and after treatment), were analysed using Student t-test and Fisher test.

Results: Hyperthermia significantly reduced plaque size and penile curvature and led to an increase in mean scores of erectile function (EF) domain, while verapamil had no such effects. Haemodynamic parameters were not significantly modified in either group. Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in terms of pain reduction during erection.

Conclusions: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronie's disease.
Keywords: Hyperthermia; Peyronie's disease; electromagnetic waves 

Introduction
Peyronie's disease is an inflammatory condition involving the tunica albuginea of the penis, the epidemiology, incidence and pathogenesis of which are not clearly defined. Several hypotheses have been advanced, such as perivascular inflammation, trauma during sexual intercourse and a genetic pre-disposition related to HLA-DQ5. The course of the disease tends to run over 1-1.5 years. As soon as remodelling of the plaque is complete, pain related to the inflammatory process tends to decrease and the effects of the lesion become static or even improve spontaneously [1-3].

Treatment, therefore, is not unequivocal and the specialist relies on personal experience using oral drugs, local injections with various kinds of pharmaceutical agents, laser, ultrasound or shockwave applications aimed at making the situation tolerable until surgical correction is feasible [4-7]. Radiotherapy, on the other hand, may give rise to adverse effects - e.g. tissue atrophy - and may be useful only 'for severe pain during the acute phase' [8]. However, Cavallini et al. [8] have suggested that verapamil is the most active and useful treatment for the fibrocalcific scars associated with Peyronie's disease [9]. In the authors' opinion, the 3-month follow-up described in other studies is too short. Some authors have used extra-corporeal shock wave therapy [10]; to the authors' knowledge, though, no mention is made of control studies. A metanalysis of clinical trials has appeared, but these data were not considered valid. Furthermore, ESW treatment for Peyronie's disease is not 'evidence-based therapy'. This approach was not used, since reports in the literature are not favourable [11]. A large number of patients (65-70%) with Peyronie's disease present an advanced stage of the condition at diagnosis. In this case, the best treatment, until now, has been intra-plaque infiltrations of verapamil [12]. Still, 15-20% of these patients show disease progression even after this therapy [12] and these data have led to the search for more effective treatment with the fewest possible side effects.

Previous experience with hyperthermia in orthopaedics in the treatment of plaque and tendinous fibrosis [13-23] led the authors to investigate the possibility of using this same mode of treatment in patients with advanced Peyronie's disease, comparing the outcome of this treatment with that following verapamil infiltration into the plaque.

Patients and methods
The study population comprised 60 patients, mean age 62 years (range 36-76), with a mean duration of symptoms before diagnosis of 13 months (range 7-16). The disease was diagnosed and staged by means of case history, glycaemia, glycosuria and glycosylated haemoglobin levels and a physical examination. Photographs were made during erection, which was induced with intra-cavernosal PGE1. Basal and dynamic (with intra-cavernosal PGE1 10 mcg) colour Doppler ultrasound (US) was performed before and after completion of treatments. The IIEF-15 (International Index of Erectile Function) questionnaire [24] was administered to evaluate sexual function. All patients presented an advanced stage of La Peyronie's disease, with pain during intercourse, penile curvature affecting vaginal penetration and/or erectile dysfunction.

Physical examination revealed no painful penile plaques. At basal and dynamic colour Doppler US, plaques had the appearance of single or multiple hyperechoic lesions or calcifications >18 mm2, possibly with septum or cavernosal tissue infiltration.

None of these patients had previously been submitted to any form of treatment for this condition and none had previously received PDE-5 inhibitors. Some patients presented associated disorders such as Dupuytren's disease (three patients, 5%), hypertension (12 patients, 20%) and diabetes (11 patients, 18%).

Patients, including also those with associated disorders, were randomly assigned to one of two groups (A and B), with 30 patients in each; patients were not stratified by calcification in plaques. Group A patients underwent local hyperthermia with the FLEXITERM CX 2000 (Nuova Pragma, Rome, Italy) device according to the following schedule: hyperthermia treatment reaching a local temperature of 39-40°C, lasting 30 min, twice a week for 5 weeks, for a total of 10 applications. A second cycle, with the same characteristics as the first, was repeated after a 1-month interval - for a total of 10 treatment sessions. Group (B) patients received a single injection of 10 mg verapamil (diluted to 10 cc total volume with injectable saline). The solution was distributed throughout the plaque using a 5/8 inch 25 gauge needle on a 10 cc Luerlock syringe, once a week for 3 months.

The 'FLEXITHERM CX 2000' device has the following components:

Heating is applied to the tissue with a microwave antennae 'head' operating at a frequency of 40.68 MHz.
Surface temperatures are maintained using a temperature-controlled bolus.
Copper thermocouples are used to constantly monitor skin temperature.
Computer-controlled software is used to maintain constant temperature.
A penile applicator with supports is used to maintain the penis in an extended position and to position the thermocouple on the plaque to be treated. The supports are also designed to protect the testicles from electromagnetic wave damage.

Data were collected 6 months after the last treatment and the initial assessments were repeated. Plaque size was evaluated using US; penile curvature was assessed using photographs during erection, which was induced with intra-cavernosal PGE1 injection according to Kelami's [25] method; pain during intercourse was quantified by means of the international pain scale (0, no pain; 1, slight pain; 2, moderate pain; 3, severe pain) [26], with results being classified as positive or negative depending on whether pain regressed or not; and mean scores of the EF domain were obtained by means of the IIEF-15 questionnaire [12]. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistivity index (RI) of the right and left cavernosal arteries were obtained by dynamic colour Doppler US (with intra-cavernosal PGE1 10 mcg). Progression of disease was defined as an increase in pain during erection and/or plaque size and/or penile curvature and/or EDV and/or decrease in IIEF score and/or PSV and/or RI [12] with results being classified as progression or no progression. Side effects were classified as present or absent.

Differences in plaque size, penile curvature, mean scores of EF domain, PSV, EDV and IR were analysed before and 6 months after the end of treatment in the two groups using Student t-test. A paired Student t-test was performed in the same group of patients (before vs after treatment) and an unpaired Student t-test was performed between the two groups of patients (A vs B). Differences in pain, disease progression and side effects were compared before and 6 months after the end of treatment in the two groups using Fisher test.

Results
All patients in both groups showed complete disappearance of the pain after a few treatment sessions, with a reduced pain score at the end of treatment.

Hyperthermia significantly reduced plaque size in 60% of the patients treated. Indeed, the plaques disappeared completely in 10 patients (35%), seven patients (25%) showed a volumetric reduction of the plaques and the plaques remained stable in the other 12 patients (40%) (Table I and Figure 1).

The effects of hyperthermia on penile curvature are shown in Table I and Figure 1. There was a significant reduction in penile curvature after two cycles of treatment. Recurvatum completely disappeared in two patients and all patients reported better 'elasticity' of the treated area, which resulted in an improvement in intercourse.

Verapamil did not significantly reduce either plaque size or penile curvature (Table I, Figure 1). None of the patients in Group A presented disease progression, whereas disease progression was observed in five cases (20%) in Group B. Following two treatment sessions, only Group A patients showed an improvement in sexual performance, including improved erection and increased mean EF domain scores. The effects of treatment on right cavernosal artery PSV, EDV and IR, outlined in Table I and Figure 2, show that hyperthermia and verapamil did not significantly modify these haemodynamic parameters.

All patients tolerated hyperthermia treatment very well with no side effects. However, five patients (20%) submitted to verapamil infiltrations presented side effects, including mild loss of libido in three patients and mild epigastralgia in two. Despite these side effects, none of the patients withdrew from treatment.

Discussion
In this study, the authors have shown that, in patients with Peyronie's disease, penile tissue can be safely, selectively, uniformly and effectively heated to 39-40°C using computer-controlled 40.68 MHz microwaves, for an established period of time, according to the following characteristics: heating efficacy (ability to reach the required therapeutic temperature), homogeneity while heating the selected area, lack of over-heated zones, maintenance of the established temperature for the required time, selectivity (electromagnetic waves reach only the selected area) and ability to reproduce the same conditions for each treatment.

Hyperthermia has two main mechanisms of action. The first consists of dilatation of the micro-vessels with increased arterial and venous blood flow in the treated area by generating heat with an increased amount of oxygen, red and white cell components to repair cell and tissue damage and better venous drainage to eliminate toxins and oedemas [15, 18]. The second consists of an increased rate of cell metabolism resulting from the increased temperature, with consequent improvement in repair of cell and tissue damage [22, 23].

Hyperthermia, due to the positive effects previously outlined, is indicated mainly for a wide range of acute and chronic muscular and skeletal conditions due to vascular damage and resulting fibrosis involving tendons, ligaments and muscles [14-23].

The advanced stage of Peyronie's disease represents a clinical problem for which various types of treatment, including extracorporeal shock wave treatment, have been used [11, 12, 27]. To the authors' knowledge, though, these were not controlled studies and these findings, therefore, cannot be considered valid. It should also be pointed out that, in 10-20% of patients, disease progresses despite treatment, thus precluding the possibility of surgically correcting the penile deformity.

Patients suffering from advanced Peyronie's disease could reap remarkable benefits from hyperthermia. On the one hand, the increased blood flow is responsible for a sort of 'gymnastics' of the penile vessels, with improved erection. On the other hand, the increased possibility of repairing cell and tissue damage could result in lysis or modification of the plaques as well as the fibrosis related to this condition. In regards to the analgesic effect, hyperthermia acts on the nerve endings, inducing production of endorphins and reducing afferent fibre transmission [19, 20].

Hyperthermia may lead to changes in cell metabolism and treatment at a high temperature (45°C) can result in irreversible cell damage, even cell necrosis, as reported in the literature [16-18]. However, at a lower temperature (39-42°C), provided the time of heating is limited, changes in cell metabolism do not lead to permanent cell damage. Mild heating promotes the above-mentioned effects that result in a beneficial therapeutic action. Indeed, it has been reported that damage incurred in tissue is related not only to temperature but also to length of heating time [28].

A temperature of 39-40°C, with a limited time of heating, has been chosen in the present treatment protocol to avoid the risk of possible cell damage involving the underlying anatomical structures, with particular attention being focused on the penile neurovascular bundle and urethra. The plaques in the penis can never be more than a few mm from the surface and even the deepest are only a few mm between the albuginea and the skin. Therefore, the surface temperature is similar to the deep plaque temperature.

The choice of a temperature of 39-40°C was based upon that used in studies carried out in the orthopaedic setting in which no adverse effects on the tissues had emerged and only beneficial effects had been recorded. The majority of investigations or studies on Peyronie's disease are prospective series without controls and have been criticized for poor patient characterization [11, 12, 27].

The present study was a controlled study in which verapamil-treated patients acted as controls. Use of a positive control (verapamil infiltrations) was preferred to placebo, since these proved to be the most effective in the case of fibro-calcific scars. Also, verapamil infiltrations currently represent the treatment of choice in patients with advanced Peyronie's disease [12].

Patients were observed 6 months after the last treatment. This period of follow-up was a deliberate choice, as the improvements observed would be due to the effects of treatment and not to spontaneous changes in severity of disease, as may occur.

Qualitative data (pain reduction and disease progression) were analysed before and after treatment using Fisher test. Quantitative data (plaque size, penile curvature and mean scores of EF domain, PSV, EDV, IR) were analysed before and after treatment using Student t-test.

Hyperthermia significantly reduced plaque size and penile curvature (Table I, Figure 1) and increased mean scores of EF domain (Table I, Figure 1), while verapamil did not cause any change in these parameters. Haemodynamic parameters were not significantly modified in either group (Table I, Figure 2). Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in the reduction of pain during erection.

Use of hyperthermia in andrological disorders, which has not previously been reported in the literature, showed encouraging results, suggesting that hyperthermia is an effective conservative treatment for advanced Peyronie's disease because it is well tolerated and causes no serious side effects. It is of considerable benefit in reducing pain, plaque size and penile curvature and it increased the possibility of coitus in a significant number of patients. Moreover, considering the mechanism of action and results obtained, hyperthermia could also play an important role in the treatment of erectile dysfunction.

The beneficial effects observed in this investigation were based upon direct observations on the patients during the treatment. This study described a completely new treatment approach and the 'recognized mechanism', as already pointed out, is 'the increased ability in repairing cell and tissue lesions with lysis or modification of the plaques and fibrosis'.

The beneficial effect of the hyperthermia treatment was documented via direct patient observation and assessment. A completely new treatment approach was described, that suggests microwave heat at a moderate thermal dose can increase the cell repair in plaque formation and in fibrosis. Studies involving more patients and longer follow-up are necessary to determine the optimal thermal dose, treatment protocol and efficacy level.

Post edited - Warning about possible tissue damage highlighted in red by Hawk

[Tim468]

Seems like a tempest here for some reason.

I am cautioning against making assumptions that "heat" (ie temperature alone) caused the salutory effects in the Italian study (yes, it is another Italian study...).

My point about the equipment is that I can find no evidence that the company still exists, and that makes it REALLY hard to check out the methodology. I am left reading the report of a non-native English speaker that skimps on details and does not give me enough to really understand what similar heat therapy might be comparable.

IOW, I cannot tell if this is like a heat lamp, or if it is directed to a certain tissue plan.

One feature of directed microwave or ultrasonic therapy is that you can direectit to a certain depth in tissue. That would allow you to selectively heat up a tissue plan. IN the Italian study, they affixed the penis to a plate with a clamp, and "shielded" the rest of the groin, including the testes, from "radiation". These skimpy details suggest this was more than a lightbulb heating things up (and yes, I have tried that too myself - didn't help).

So, without the important caveats that the rest of the body needed to be shielded from wnat they were doing; that the heat was specifically directed towards the tunica and avoided adjacent tissues; and that the heat was created with specific coil and that this is not easily available - well, with all of that, it seems a stretch to say that a hot bath might reproduce the effects they found.

Especially given the fishy nature of these Italian studies that always find results that no one else can duplicate!

Tim

I will look for the original paper and post it.

[George999]

This is NOT the same as applying a hot pack or taking a warm bath. It is ludicrous to think we can mimic this when A) we can barely understand the report, and B) the device they use is not available and the company that made it seems to have gone out of business.

What Tim is pointing out here is that the researchers in question achieved their result using microwave radiation.  And that is ALL they used.  They ASSUMED that the results achieved were due to the hyperthermia induced.  But how could they know that the microwave radiation was not what achieved the results?  How could they know that the hyperthermia was not just simply a useless byproduct of the process?  One HAS to ask intelligent questions and read research with a critical eye.  This is one reason that very promising research never gets duplicated and thus gets thrown into the trash heap of history.  Unless there is ANOTHER study indicating that the hyperthermia itself is efficacious, I question the premise.  If the only physiological effect microwave radiation has is hyperthermia then perhaps it is time to turn in our electric blankets and heating pads for something new. 

It makes me crazy to be told that researchers conclusions do not make a thing fact by individuals that take the position that NO research is superior evidence to some research.

Did I say that???  If I did, I must indeed confess a moment of insanity.  But I think my point was that A) Some research IS superior to no research, but B) more research IS superior to some research.  Look, Hawk, the bottom line is that this study reported significant results over a few months with "hyperthermia".  If you or anyone else can duplicate these results I will be all ears and I am sure Tim will be as well.  Until that point though, I think we both have real questions about the "conclusions" reached in this study.  - George

[Hawk]

I really don't think that either Tim or myself are making any assertions about the effectiveness of "hyperthermia".  We are only suggesting that it is an area to be explored.

If that is the case, I am totally out of line.

I read

"This is NOT the same as applying a hot pack or taking a warm bath. It is ludicrous to think we can mimic this when A) we can barely understand the report, and B) the device they use is not available and the company that made it seems to have gone out of business.

The best one could do is find a similar device and read the literature on other ailments and see what comes up."

As meaning these were NOT the same and it is ludicrous to even think other means of inducing hyperthermia would be effective.

I will read more carefully in the future 

[George999]

I really don't think that either Tim or myself are making any assertions about the effectiveness of "hyperthermia".  We are only suggesting that it is an area to be explored.  It was you, Hawk, who suggested that all forms of heat have the same effect.  And frankly, yes, I am questioning that assertion.  I am saying that I don't know that to be true and I don't think you do either.  You are asking us for studies and evidence, but you have made a statement that all forms of heat have the same effect and you have not backed that statement up with any evidence.  And NO I am NOT saying you ARE reckless, I am only saying that I think the statement you made was reckless.  And I for one, have probably made more reckless statements than anybody including more than a few right here on this forum, so I am not trying to single you out for punishment or ridicule, I am just trying to discuss a concept that I think deserves more discussion even though I, myself, am not particularly interested in it.  So please don't take it as some sort of personal attack.  It was certainly not intended that way.

Regarding the particular study in question.  The fact that researchers "concluded" something does not make it fact.  Until the same results are achieved with a different form of heat, no one really knows.  Researcher's "conclusions" are often just "assumptions" based on observed results.  This is why there are often conflicting results when there are multiple studies on a given substance or therapy.  So from what I have read of this study so far, which admittedly is not a lot, I am not convinced that it PROVES that the efficacy was from the hyperthermia itself.  I have this nagging suspicion that it could in fact have been from the way in which that hyperthermia was achieved.  And this suspicion is only aggravated further by other recent studies I am seeing about tissue response to various forms of radiation, be it in the form of light, heat, electromagnetic, etc.  And I do think that we need to ask these critical questions when we read these studies that are not fully corroborated by other studies employing different methods.  Critically examining multiple studies allows one to see things in stereo in a sense and to observe things that are not visible in either study in isolation.  And when it comes to hyperthermia therapy for Peyronies, I would really like to see multiple studies before jumping to any set in stone type conclusions.  - George

[Hawk]

I really have to say that I think that it is a bit reckless to argue that all forms of heat are identical and have an identical effect on the body.  Heat is actually like light and comes in a wide range of wavelengths that can be either focused or broad spectrum.

Well, it has now been suggested I am ludicrous and reckless.

I think it is reckless and ludicrous to suggest, with absolutely no evidence, that which has never been suggested by any researcher.
For instance there is no such thing as heat therapy!  Yet you suggest that it is the type of heat and you know which type.

The facts tell us that there has never been a suggestion by any scientist or researcher that heat or a method of heat is at issue in treating Peyronies Disease.

Researchers (fools that they may be) concluded  that temperatures 0f 40C have efficacy.  Wild speculation that it was a specific piece of antiquated equipment or a specific type of heat are no more responsible than speculation that it was the position of the penis that caused the improvement.  Could it have been?.. Sure!  We could wildly and recklessly proclaim that the polycarbon in most VED tubes causes improvement rather than the Vacuum.  Why not?  Others have used such reasoning before on this forum.  Maybe the improvement hinged on the fact that they used European voltage rather than 110 AC.  Maybe the warm penis made them masturbate after the session and that caused improvement.  Who can say otherwise?

I have to ask what do you know about physics or this study that the scientist did not know?  I tend to think it is more responsible to accept the researchers conclusion rather than speculation.

Your basis of theory is that, it is not disproved therefore it is.

You and Tim offer not one shed of evidence.  You just say it over and over without addressing the evidence presented.

My basis is to accept the study conclusions in the absence of strong evidence for rejecting it.
What was that conclusion the researchers reached?
Hyperthermia to 40C has efficacy for Peyronies Disease  PERIOD

I am not sure how many more times I have to say "hyperthermia addresses temperature not heat or the type of heat it takes to bring about hyperthermia."

Objective: Previous experience in the treatment of plaque with hyperthermia in orthopaedics led the authors to investigate the effectiveness of this approach in patients with Peyronie's disease.Patients and methods: The study population comprised 60 patients (aged 36-76 years) with advanced Peyronie's disease. Patients were divided into two groups (A and B), with 30 in each. Group A patients underwent local hyperthermia treatment, with 30-min treatment sessions twice a week for 5 weeks. Patients received a total of 10 applications, which reached a local temperature of 39-40 degrees C. A second cycle was repeated after a 1-month interval for a total of 20 treatment sessions. Group B patients were treated with intra-plaque infiltrations using 10?mg verapamil; they received one infiltration once a week for 3 months. Differences between the two groups, as well as between variables (before and after treatment), were analysed using Student t-test and Fisher test.Results: Hyperthermia significantly reduced plaque size and penile curvature and led to an increase in mean scores of erectile function (EF) domain, while verapamil had no such effects. Haemodynamic parameters were not significantly modified in either group. Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in terms of pain reduction during erection.Conclusions: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronie's disease.   

[George999]

I really have to say that I think that it is a bit reckless to argue that all forms of heat are identical and have an identical effect on the body.  Heat is actually like light and comes in a wide range of wavelengths that can be either focused or broad spectrum.  Certainly a color blind person would argue that all forms of light are the same since they could not perceive the range of colors.  The same arguments would apply in the case of heat.  I am not sure there has been a lot of scientific investigation into the effects of specific frequencies of heat and their respective effects on cellular and extra-cellular function, and until there is, I don't think it would be wise to assume that the conventional wisdom, whatever that may be, is authoritative.  Get my drift here?  - George

[Hawk]

This is NOT the same as applying a hot pack or taking a warm bath. It is ludicrous to think we can mimic this...

Tim, I do not think I am being ludicrous for concluding the results (temperature) can be duplicated,... quite to the contrary! 

Why would you think that we could not raise the temperature to 39 -40C   I am totally confused.  You fail to say WHY this is not the same as a heat pack or a hot bath.  Clearly the machine they used is no longer made but that does not mean hyperthermia for mankind has come to an end. 

Temperature IS Temperature. 

If I sun my penis on a flat rock (with sun screen of course) long enough to get the temperature of the tunica up to the designated level for the designated time, and frequency, there would be absolutely no reason to think that the source of the temperature has anything to do with it.  It is the 39-40C that is the issue.  In fact, truth be known, they have no evidence that 38C or 41C would not have worked as well.  Thus with any heat application.  If you go to different but GOOD physical therapists for the same injury, one physical therapist will use ultrasound, one shortwave, one microwave, one heat packs.  Depends on the equip they have and use.  Sometimes they don't use the same type from one visit to the next depending on what is tied up elsewhere.

That study concluded with:
"Conclusions: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronie's disease."
Their conclusions did NOT stress the efficacy of the Flexiterm CX 2000 in treating Peyronies Disease.

That particular study happened to use what they had available for general use.  It was not manufactured or purchased for this study.

[Tim468]

HEre are different methods I found:

"Control group: 30 patients will be treated with hyperthermia alone (30 minutes/day with infrared lamp of 150 W at a distance of approximately 20 cm of the plaque(s) and curvature) "

Details...

"patients underwent local hyperthermia with the FLEXITERM CX 2000 (Nuova Pragma, Rome, Italy) device according to the following schedule: hyperthermia treatment reaching a local temperature of 39–40
C, lasting 30 min, twice a week for
 5 weeks, for a total of 10 applications. A second cycle, with the same characteristics as the first, was repeated after a 1-month interval—for a total of 10 treatment sessions."

Here are more details:

(a) Heating is applied to the tissue with a microwave antennae ‘head’ operating at a
frequency of 40.68MHz.
(b) Surface temperatures are maintained using a temperature-controlled bolus.
(c) Copper thermocouples are used to constantly monitor skin temperature.
(d) Computer-controlled software is used to maintain constant temperature.

This is NOT the same as applying a hot pack or taking a warm bath. It is ludicrous to think we can mimic this when A) we can barely understand the report, and B) the device they use is not available and the company that made it seems to have gone out of business.

The best one could do is find a similar device and read the literature on other ailments and see what comes up.

Tim

[Dented]

It's what I read somewhere or heard from someone, could be wrong could be right. Don't take my word for it. I'll call it Hyperthermia from now on.

[Hawk]

My thoughts are that if Heat Therapy helps for Peyronies, it probably takes a long period of time of steady sessions...

I do not recommend baths or showers because the trick is to concentrate 104 degree heat on your penis, not your testicles, which are located outside of the body to remain at a lower temperature to begin with. It could damage your sex drive. 

Dented, when you say "I do not recommend baths.." "it could damage your sex drive" many readers would assume that you are making this recommendation based on studies or credible evidence of this statement.  Would this assumption on their part be correct or misleading?

If it is just a hunch, guess, or private theory based on personal thoughts, you need to specify that.  While I have seen studies that prolonged hot baths can reduce sperm count, I have never seen authoritative information that even suggested it has ever been linked to a reduction in testosterone production or sex drive.

It is also my suggestion that we call it hyperthermia or temperature therapy rather than heat therapy to avoid the confusion we have been over.  Heat has one purpose that has ever been suggested in these studies and that is to raise temperature.  Heat comes in 3 methods (often in combination).  Temperature is temperature.

[Dented]

My thoughts are that if Heat Therapy helps for Peyronies, it probably takes a long period of time of steady sessions. Some of the websites for Peyronies say that it has a minute chance improvement with no treatment over time. I think heat therapy might increase this miracle.

I do not recommend baths or showers because the trick is to concentrate 104 degree heat on your penis, not your testicles, which are located outside of the body to remain at a lower temperature to begin with. It could damage your sex drive. 

I wonder if someone has tested this, using heat several times a week for months or even a year and has any positive results.

[Hawk]

The methods I have read detail methods of directing heat to a specific plane, not generally warming things up.
Tim

You have identified the entire point of different heat types.   The development of radiating heat from a microwave (the total opposite end of the spectrum from xray) has the advantage of changing the temperature deep in tissue.  A physical therapist can raise the temperature of the interior of my knee joint without heating the skin and waiting for the heat to penetrate my knee with conduction or convection.  They used to get the same result with heat pads, it just took longer and was a hassle.  There should be no confusion.  It is not the microwave that does the job, it is the temperature that does it.

There is NO reason to think the penis would ever benefit from sophisticated targeted methods of transferring temperature to deep tissue.  Compared to a knee, the focus would be far beyond the penis much less the tunica nearest the heat source.  Hyperthermia is simply raising the temperature of the tunica.  This can be accomplished with infrared (radiant), a heat pad (conduction), or a glass of hot water (arguably conduction or convection)

[Tim468]

The methods I have read detail methods of directing heat to a specific plane, not generally warming things up. The use of tools that are not available, and which I did not completely understand from reading the methods, suggests that wea re not going to be able to do this at home with tools from Home Depot.

Tim

[Hawk]

George,

I stand pretty neutral on hyperthermia as a treatment. I think like many approaches we discuss, it is one of the things you cautiously do because it causes no harm, is easy, cheap, and the scant evidence that exists is positive.

Advantages:
Cheap
Done carefully it cause no harm (no one on this forum has every reported a even a slight negative result)
Cheap
It is known to increase circulation (blood flow) which puts some logic behind the theory
Pretty easy to administer
There are small studies suggesting that it helps Peyronies Disease and other small studies suggesting it preserves penis size post-prostatectomy
Cheap


Disadvantages:
No one on this forum has ever isolated heat as the source of any improvement (Joshua may have come the closest)
Studies are too small and too few to draw much of a conclusion
It is at least potentially damaging if an idiot goes into hotdog cooking mode. (like every single treatment for every single condition if taken to extreme)
It is not totally free 

Physics from a fool:(The difference between Heat and temperature)
Heat is not a "thing".  It is not matter, it is not even truly a state or condition.  It is a process.  It is the transfer of energy (molecules rapidly moving) in one place or object transferring their energy to molecules slowly moving in another place or object.  The transfer of energy can take place by conduction, convection, or radiantion (meaning it projects on something and warms it like the winter sun on your face).  All forms are used to heat our homes.  Each has advantages and applications but once heating takes place, and the temperature hits 70, it is 70.  The heating (transfer of energy) occurred.  Molecular movement has sped up because the energy was transfered from one object to another.  Energy has now been transfered and there is no more heat (transfer of energy).  There is only temperature (Measure of molecular activity).  The material that experienced heat now has a measurement of molecular movement or energy that we call temperature which is different than "heat"

I think the value of hyperthermia is established or refuted on whether sustained temperature of the penis at some given level, for some period of time, with some frequency, over some duration of months, works or fails.

I cannot accept that the method of transfer (radiant, convection, conduction) has anything to do with it and I have never seen anything in any study to suggest otherwise.

Temperature = The measurement of energy of molecular motion in matter
Heat = The transfer of this energy (known as temperature) from one area to another area of matter

Technically, there is no heat treatment.  The treatment is temperature or hyperthermia.  There is no reason to think the type of heat has any bearing.

[George999]

Hawk, this begs an interesting question.  If heat can effectively treat Peyronies, then why haven't any of us gotten any results from hot baths.  I know a number of us have tried that route.  As I recall Rico had it down to an art form.  And I don't recall that he was getting much significant help from it.  So if heat is heat is heat, then that route has already been tried.  But if various forms of heat are indeed *different* (as the topic of this thread SEEMS to imply), then perhaps there is some hope in this direction.  Further thoughts???  - George

[Hawk]

Common guys,

Dented is right on with the last post.

In the interest of productive conversation, we cannot compare heat to xray radiation, or heat to stimulate circulation and loosen up tissue to heat used to cure brain cancer.

We all put heat on out penis if we take a shower, a bath, or ever sit in a hot tub, so lets not respond like it is some bizarre concept. 

We can compare traction to someone injured by a tow truck or VEDs to a severe damage from playing with an air compressor hose, but the fact is they have no relationship to the traction or VEDs and comparing them does not make a point.

[Dented]

I don't think heat therapy for head and brain problems contribute anything to a discussion on heat therapy for peyronies.

I am not proving or disproving heat therapy, just stating they are 2 very different structures. Like I said your brain is encased in skull, your penis is encased in skin and tunica.

I know some of you get your penis confused with your brain  , but don't let it get you in to trouble!

[jackp]

Hey guys Old Man has a valid point.
10 years ago my mother had a brain tumor. She tried the off label heat therapy. Original doctor gave her about 6 months she lived almost 7. Heat therapy did not help her.
What I understand that anything above 104 degrees is dangerous and apply that to an organ that is outside the body?
My$0.02
Jackp

[Old Man]

Hey guys:

Heat, heat and more heat being applied to a penis in the likes of infrared, et al!!! No way would I even think about using heat of any kind anymore on my prized possession!!!

I had 45 three minute radiation bombardments of my penis back in the 1950 for my Peyronies Disease symptoms. It literally burned the surface skin on the topside which peeled off and left a strawberry patch of red skin. If I even get a slight abrasion in that area, bleeding sets in and does not stop until it is cauterized in some manner.

So, bottom line, apply heat to your penises if you want to, but be aware that you can and will burn the skin if extreme care is not exercised. The maximum high temp would be about 105 degree F. if I were to apply any at all to my old tool!!!!

Old Man

[Dented]

Deep heat? I am not looking to bake my spongy cavernosum and urethra here. The Tunica is right below the skin right?

Alzheimers is located in the brain, which is covered by a large wall of bone... your skull.

[Hawk]

George,

My multiple personality disorder is in full swing.  Hawk, the Skeptic has taken over.

Heat is just the transfer of energy from one place or object to another.  I can see an argument for clinically applied microwave energy that has the advantage of deep heating a tissue without surface heating.  This means it transfers the energy right to the deep tissue while bypassing surface tissue, a process I have experienced many times.(not on my penis)

Once the energy is at the plaque however, I see no reason the plaque would respond to HOW the energy got there.  My gut tells me heat is heat (more accurately energy is energy).  Different types of heat refer to only the method of transfer, but the actual energy in every case is a speeding up of the molecules.  This of course triggers many responses in live tissue.

I am also curious about the phrase "tuned infrared"?

Hawk
PS: OK, I have about exhausted my memory stores of physical science except for knowing the threads on a traction device are an inclined plane.

[Tim468]

No data on acupuncture that I am aware of. However, it might make sense to poke the plaque full of needle holes and see if it doesn't break up (IOW ,using the Lariche technique).

As for the pH thing - again less data there than with more conventional medicine. Let us know what shakes out for you. Why would it help heal things - to make the body alkalotic?

Tim

[George999]

There is in fact research that indicates infrared to be effective against Alzheimer's which is a plaque based disease.  One could imagine that the same MIGHT hold true in the case of Peyronies.  But the evidence definitely points toward infrared and finely tuned infrared at that.  - George

[Hawk]

Dented,

I am far from an expert on infrared and my school days science needs some review but I think that some suggest that infrared does some deep heating.  My guess is that science does not bear that out and that is more the case with ultrasound tuned to heat the tissue below the skin.  I think temperature is temperature and the heat transfer would be similar with both sources. The penis is not so huge that it takes a long tome for the heat to penetrate to the tunica and below (at least in my case)

In any case, the fact that your heat pads get "very hot" is not a plus.  Heat much above 104 degrees F which is only warm, can damage tissue and cause cell necrosis (death). 

Be careful.

[Dented]

Is there something better about using a heat lamp / bulb over a heat pack?

The heatpacks I use can get very very hot, and secondly I alternate between the 2. My therapy session consists of 10 minutes of 1 pack, microwave the 2nd pack, 10 minutes of the other. I haven't really noticed any results but I have only been doing it a few days a week for like 2-3 weeks now.

[George999]

Just when everybody here thought that they had thrown the heat concept in the dustbin, here I am to say that high tech heat just might hold some answers.  I insert "high tech" because the kind of controlled heat required would be out of our capabilities right now, but who knows what the future might hold?

... Low level infra-red red is thought to stimulate the growth of cells of all types of tissue and encourage their repair. ... "The implications of this research at Sunderland are enormous - so much so that in the future we could be able to affect and change the rate at which our bodies age," ...

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=510172&in_page_id=1774

For those of us who follow every shred of research, there are potential answers everywhere.  Its the difference between seeing the glass half empty or half full.  There is huge reason for hope when it comes to Peyronies.  The secrets of the body are being unlocked at an unprecedented rate and, in many cases, many of those among us will likely be the beneficiaries.  So, I don't know where this post should be, but I wanted to bring this angle to everyones attention before that attention drifted.  But once again, the kind of heat WE are able to apply at this point is, indeed, most likely pretty useless.  - George

[George999]

While heat can reduce inflammation, I would think it would be hard to prove any benefit beyond that.  Since there is actually a study out there indicating efficacy for heat, referenced above, I will strike the preceding statement and concede that heat can possibly be beneficial.  (Edited March 14, 2008, 07:56:37 PM)   I suspect there is a lot more potential benefit in other approaches, even getting appropriate quality sleep time for example which DOES affect low level metabolic processes involved in healing.  In any case, there is simply no ONE approach that is going to be effective.  Truly effective therapy is going to involve multiple modalities at this point and probably far into the future.  - George

[Tim468]

Probably the best thing to do is place it as a new message in an area that is most closely linked to your preferred topic. This could be under "alternative therapies".

None of really use heat packs because it does not make Peyronie's better. Do you have Peyronie's? What have you tried?

Tim

[Tim468]

The value of heat therapy is hard to figure out. The best study was done using a device that directs heat very specifically to reduce heating of adjacent areas. None of us have had any benefit from using heat in any fashion, except to relax the tissues before traction is applied.

I don't think that a heat sock applied to the penis is going to be any worse than one applied to a sore neck - it is not going to melt our bodies away! That said, I don't think it is going to do much to help.

Dented, I hope you take Hawk up on his suggestion to read the "read this first" section. If nothing else, then none of us have to answer questions already answered there.

Tim

[pal-31]

Dented,

Can I ask why are you interested more in the heat therapy than the others ? There a few other therapies that some are using and are having some success. You could check the VED, traction, and even oral therapies like Pentox etc..

Good Luck,
Pal

[Nemo]

According to a study somewhere down below in this thread, you shouldn't go over around 104 degrees F.  I've been using one of those microwave rice socks (until I read that study) and it gets a lot hotter than that.  However, I stopped once I read that as the study says you can do damage to cells at high temps.  I never had any redness or pain or anything, so I'm keeping my fingers crossed I didn't do any damage!   Use low temps though to be safe.

Nemo