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Author Topic: PENTOX & Other 1st Oral treatments per "Up To Date" Physician Reference & Studies  (Read 41923 times)

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newguy

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A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease.

Quote
OBJECTIVE To analyse the safety and efficacy of pentoxifylline sustained-release (PTX-SR) treatment in patients with early chronic Peyronie's disease (Peyronies Disease). PATIENTS AND METHODS In all, 228 patients with a mean (sd) age of 51 (9) years who had early chronic Peyronies Disease were randomized to receive 400 mg PTX-SR (Apo-Pentoxifylline, Apotex Inc., Toronto, Canada) twice daily (group 1, 114) or similar regimen of placebo (group 2, 114) for 6 months. A medical history was taken and the men had a complete physical examination. The following variables were assessed before and after therapy: penile curvature and penile artery spectral traces (end-diastolic velocity, EDV, peak systolic velocity, PSV, and resistivity index, RI, of the right and left cavernous arteries assessed with dynamic penile duplex ultrasonography), plaque characteristics (assessed by penile X-ray and penile ultrasonography), pain (assessed by visual analogue scale), erectile function (assessed by the International Index of Erectile Function, IIEF questionnaire), treatment satisfaction (assessed by Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire), and side-effects. Patient perception of penile curvature and plaque size, and mean weekly intercourse attempts were also assessed. RESULTS Overall, 36.9% of patients who received PTX-SR reported a positive response, vs only 4.5% in the placebo group. Of patients in PTX-SR group, 12 (11%) had disease progression, vs 46 (42%) in placebo group (P = 0.01). Improvement in penile curvature (P = 0.01), and plaque volume (P = 0.001) was significantly greater in patients treated with PTX-SR than placebo. The increase in IIEF total score was significantly higher in the PTX-SR group (P = 0.02). Mean PSV changes after therapy compared to baseline were statistically significant between PTX-SR (right, +11.4%, left, +11.7%) and placebo-treated (+0.2% and -4.2%, respectively) patients (both P = 0.04). CONCLUSIONS PTX-R was moderately effective in reducing penile curvature and plaque volume in patients with early chronic Peyronies Disease. Further studies with different treatment regimens are needed to better elucidate the beneficial effects of PTX-SR in Peyronies Disease.
- http://www.ncbi.nlm.nih.gov/pubmed/19863517

I haven't been around so much of late, so sorry if this has already been posted. It's good news cfrom where I'm standing, especially in relation to acting against disease progression and should be added to the evidence that people take to urologists when wishing to obtain pentox. It's a shame there isn't more info relating to the actual changes in curvature in percentage terms.

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ComeBacKid

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Measuring Curvature
« Reply #1 on: November 03, 2009, 07:01:57 PM »

Its hard to measure curvature, seems like my curve is never exactly the same in every erection, throw in some people have a twist at the base(which seems even worse) and throw in that sometimes people just get a semi-erection or have venous leakage and dont get "filled up," and this will always be a challenge to measure.  I guess a uniform way could be taken to attempt to measure it. 

Comebackid
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newguy

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Re: Measuring Curvature
« Reply #2 on: November 03, 2009, 10:57:09 PM »

Its hard to measure curvature, seems like my curve is never exactly the same in every erection, throw in some people have a twist at the base(which seems even worse) and throw in that sometimes people just get a semi-erection or have venous leakage and dont get "filled up," and this will always be a challenge to measure.  I guess a uniform way could be taken to attempt to measure it. 

Comebackid

Difficult but not impossible, if a slight margin of area is accounted for. I assume that they would induce a rigid erection and not measure a semi etc. Measurements of curvature is relevant to area's of research (studies of oral treatments, mechanical methods, xiaflex etc) and surgery, so it's something that we have to appreciate, even if it is imperfect.
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newguy

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Re: Pentoxifylline Study
« Reply #3 on: November 04, 2009, 12:17:35 AM »

Any comments from anybody on this study? I think it's positive!
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George999

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Re: Pentoxifylline Study
« Reply #4 on: November 04, 2009, 12:23:30 AM »

Any comments from anybody on this study? I think it's positive!

Finally they are beginning to discover what many of us around here already knew.  - George
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newguy

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Re: Pentoxifylline Study
« Reply #5 on: November 04, 2009, 10:49:33 AM »

Any comments from anybody on this study? I think it's positive!

Finally they are beginning to discover what many of us around here already knew.  - George

Yes, I think it's now very hard for urologists to deny patients pentox - or at least it should be. Some are stubborn, but this study really compliments Dr Lues observations and the existing and well known pentox case study. I'd like to see a PAV cocktail study sometime in the future, as it's not beyond the realms of possibility that it provides additional benefits. 
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brohu

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Suggestions
« Reply #6 on: November 04, 2009, 08:39:01 PM »

I am so glad that I found this website. Thanks to all of you who take the time to post information.

I am looking for something to try before going to a doctor.
I just started taking vitamin E. What else can I get over the counter that might help?

I noticed a curve in my penis when I was very young probably 13. I am now 24 and it has gotten gradually worse. I recently noticed that it has gotten worse again and I really need to do something about it.

I have seen posts about stretching. If someone could explain this to me it would be great. Just seems like it would make things worse to me.

Any ideas or advice would be great. I have notice that I am extremely young to be having this problem. Is there anyone else out there in their 20's with this problem?

Thank you.
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Skjaldborg

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Re: Suggestions
« Reply #7 on: November 04, 2009, 09:58:28 PM »

Hi Brohu,

It is possible you may have congenital curvature (a normal curve that you are born with) and not Peyronie's (scar tissue in the penis due to trauma and/or genetic factors that cause pain, curvature or indentations during erections). You will need to go see a doctor, preferably a urologist, to receive a proper diagnosis. I would not recommend starting any treatment until you go to a doctor and find out for sure what your condition actually is.

If your doctor tells you that it is not Peyronie's and instead you have congenital curvature, there are surgical options available to correct curvature.

On the other hand, if the doctor confirms Peyronie's I suggest requesting a prescription for pentoxyfilline (brand name: Trental), a pill which helps reduce inflammation and scar size and may help reduce curvature. If the doctor is reluctant to prescribe pentoxifylline, you may show him the studies located here showing that it is helpful for Peyronie's: http://www.peyroniesforum.net/index.php/topic,772.0.html If the doctor is still unwilling to prescribe, find another doctor who will.

There are some very knowledgeable people on this forum who have used various treatments to deal with Peyronie's and they will be glad to answer any questions you might have. But first, go see a doctor and find out what condition you have. By the way, I got this when I was 29 (I am now 30). There are several younger men (under 40) here with Peyronie's. It sucks, but it's not the end of the world.

Best of luck,

Skjald
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newguy

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Re: Suggestions
« Reply #8 on: November 04, 2009, 10:55:55 PM »



On the other hand, if the doctor confirms Peyronie's I suggest requesting a prescription for pentoxyfilline (brand name: Trental), a pill which helps reduce inflammation and scar size and may help reduce curvature. If the doctor is reluctant to prescribe pentoxifylline, you may show him the studies located here showing that it is helpful for Peyronie's: http://www.peyroniesforum.net/index.php/topic,772.0.html

and the new one:  http://www.ncbi.nlm.nih.gov/pubmed/19863517

It's getting to the stage where it's becoming difficult for urologists NOT to prescribe it. The evidence is building up. The advice from Skjaldborg is sound.
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George999

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Re: Pentoxifylline Study
« Reply #9 on: November 06, 2009, 10:18:05 AM »

Hopefully the Iranian abstract makes it into our resource section.  - George
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newguy

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Re: Pentoxifylline Study
« Reply #10 on: November 09, 2009, 10:15:16 PM »

Agreed. It would be nice to have access to the whole study. I wonder if there's any way of gaining access to it.
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George999

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Re: Pentoxifylline Study
« Reply #11 on: November 09, 2009, 11:07:52 PM »

Agreed. It would be nice to have access to the whole study. I wonder if there's any way of gaining access to it.

Unfortunately, access requires money.  And I don't know whether it can be freely distributed or if it is somehow copyrighted and restricted.  I have asked Tim if he can look into this very question when (if) he can find the time.  - George
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Tim468

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Re: Pentoxifylline Study
« Reply #12 on: November 12, 2009, 08:54:09 AM »

I will try to post a Word text version of this in our document/study folder.

Tim
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52, Peyronies Disease for 30 years, upward curve and some new lesions.

newguy

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Re: Pentoxifylline Study
« Reply #13 on: November 12, 2009, 10:17:07 AM »

I will try to post a Word text version of this in our document/study folder.

Tim

http://www.peyroniesforum.net/index.php/topic,1004.0.html

Thanks so much Tim. Perhaps any comment relating to the study should be conducted here, in order to keep the resource thread as clean and accessible as possible. There's now a significant body of evidence for patients to take to urologists in order to gain access to pentox :).
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UK

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Re: Pentoxifylline Study
« Reply #14 on: November 12, 2009, 10:33:58 AM »

what's the difference between early chronic (referenced in the study) versus just chronic anybody?
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Tim468

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Re: Pentoxifylline Study
« Reply #15 on: November 12, 2009, 08:45:43 PM »

Cross posted in the study folder (hopefully I can remove it there later:

My impressions of this study.

It is well done.

Numbers - adequate for good stats - this is not a 10 patient study.

Stats - well done with adequate controls for multiple comparisons.

Methods - did IIEF to assess erectile function, a good and validated study method. They injected one or two injections of Caverject to induce a firm erection, demonstrated to do a more reproducible erection for the purposes of a study than self measurements or measurements of "natural" erections (a common weakness might be that erections are better if a guy thinks he is better and thus has less stress. The injection removes this potential source of bias).

Results - Modest to very good - not stupendous. Again not a magic silver bullet. I think this reflects the multi-factoral nature of Peyronie's Disease and how one man may be quite different for the "same" disease.

Weakness (I think) - they identify Pentox as helpful for "early chronic Peyronie's Disease". The inclusion criteria are for disease of greater than 12 months. Thus, many would not call this "early", though it might be "early chronic" disease. I think that "early chronic" suggests that there is a "later chronic" form of the disease (how about more than 5 years? More than 2 years? - I dunno). But there is no criteria for cutoff for having had the disease for "too long" - no upper limit. Thus the "early" qualifier seems irrelevant.

Thus, this is mixed news. Treatment in early disease (i.e. as a first line of defense in the first 6 months, say) might yield better results. Speaking selfishly (as someone with chronic disease), this is exactly the kind of result I want to see - someone who is unlikely to have disease that is getting better spontaneously - meaning it was the drug that did it - not random chance. The control group bears out this impression - the very low improvement in the control group is consistent with a stable process that is unlikely to improve spontaneously (as opposed to acute trauma that may heal completely).

Thus, from my standpoint, a 47% improved or no progression result is outstanding. I'd take that any day.

Tim
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52, Peyronies Disease for 30 years, upward curve and some new lesions.

newguy

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Re: Pentoxifylline Study
« Reply #16 on: November 12, 2009, 10:48:24 PM »


Thanks for posting the pdf! This will really help to spread the word, and hopefully make more urologists offer pentox instead of 'wait and see, here's vitamin E' :)

I'd quite like to see a study on men with very long term peyronie's (5 years+) to see if there is any difference in impovement rate. Levine stated that quite often, several years after peyronie's development plaque cannot even be felt (but the shortening/curvature may remain). I wonder if these changes also impact the type of treatments that are useful. The nearest I found to an answer previously was this radiation induced fibrosis study (breast tissue):  http://www.ncbi.nlm.nih.gov/pubmed/16260695  Here it seems to be the case that long standing fibrosis can be helped, but it may take considerably longer to see the maximum benefit. Whether this translates to peyronie's is anyones guess, but to me is does suggest a scenario where if any improvement is seen early on(within 6 months), it's a good idea to stick with it to see if further improvements can be seen.

This stance becomes even more conpelling when we consider evidence from multiple pentox studies (for other conditions) of a 'rebound effect' when treatment is stopped. I'd definitely say that the suggestion of 6 months treatment by many urologists is too short.

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cowboyfood

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Re: Pentoxifylline Study
« Reply #17 on: November 12, 2009, 10:55:07 PM »

Tim,

Here is the study's definition of the "three phases of Peyronies Disease:"

"There are three phases through which the disease processes, i.e. acute, early chronic and chronic [8].

The acute inflammatory or active phase usually lasts 6–18 months and is characterized by permanent spontaneous pain which increases on erection or there is only pain during erection, and palpable and tender plaque, which is iso- or hypoechoic on dynamic Doppler ultrasonography (US).

It is then followed by the early chronic phase characterized by pain during erection; penile curvature with no difficulty with vaginal penetration; palpable hyperechoic plaque(s) with no pain and calcification with a total area of <2 cm2 limited to albuginea; and no arterial involvement and venous leakage on dynamic Doppler US.

The last phase is the chronic or stable phase, characterized by pain during erection; penile curvature affecting vaginal penetration and ED; palpable hyperechoic plaque(s) with no pain, with a total area of >2 cm2, and calcifications; arterial involvement, and venous leakage on dynamic Doppler US [8]"

and, footnote [8] credits:
Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int 2001; 88: 63–7

Interestingly, ALL participants reported experiencing painful erections before entering the study (if I read it correctly).

CF
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Currently:  L-Arginine (2g), Vit D3)

jackp

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Re: Pentoxifylline Study
« Reply #18 on: November 13, 2009, 12:12:16 AM »

CBF

I have had peyronies since 1995. I have never had any pain in my penis from peyronies.

Jackp


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ComeBacKid

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Re: Pentoxifylline Study
« Reply #19 on: November 13, 2009, 02:39:07 AM »

I've seen improvements from pentox and I got on it during year 7 of peyronies.

This study says more of what we've been saying all along, Pentox works well, get on it !!!!!!  The earlier the better, don't WAIT!

Comebackid
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Tim468

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Re: Pentoxifylline Study
« Reply #20 on: November 15, 2009, 09:36:41 AM »

Thanks for finding that cbf.

The weird thing is that this is an artificial definition. "Early" refers to time - yet time is not really part of that definition.

Also, the final stage ("chronic") is defined as painful - yet many men with stable long-standing disease report that the pain has gone away.

These criteria also ignore the effects of long lasting but progressive disease (like I have).

Simply put - this definition is not that exclusive or inclusive for the purposes of a study. I wish they would come up with a better way of classifying this disease!

Tim
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52, Peyronies Disease for 30 years, upward curve and some new lesions.

newguy

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Re: Pentoxifylline Study
« Reply #21 on: November 15, 2009, 02:31:29 PM »


Tim - We don't appear to have many insights into the ways in which pain (or lack of) can impact different stages of peyronie's disease (at least in people suffering from long term pain). Perhaps that should be the actual emphasis of a future study. It could be split into three groups:

A group of men never experiencing any peyronie's pain at all
A group who suffered short term peyronie's pain
A group with long term peyronie's pain

I suppose the typical route for peyronie's disease (if there is such a thing) involves relatively short term pain, then eventual disease stability. Very little appears to be known about those suffering from very long term pain though, or long term progression (with or without pain). This type of patient even appears to leave Dr Levine and co scratching their head, and saying "i'll operate anyway, despite the pain, because it's probably nerve damage".

In the case of those with long term progression, with or without pain, it begs the question, what impact does pentox really have. It may be the case for instance that the condition can improve at six months, but if the pentox is stopped, it will gradually get worse again. There is already a "rebound effect" noted in some conditions treated by pentox, in people with conditions that are not known to progress, so it could be doubly important to take pentox for much longer than 6-12 months for those with long term peyronie's progression.

On a more positive note, if peyronie's in some men can slowly worsen over the years, perhaps with pentox use it can gradually improve over a period of years too, rather than only months.
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George999

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Re: Pentoxifylline Study
« Reply #22 on: November 15, 2009, 03:08:34 PM »

I really think that all of these "classifications" are artificial.  They seem to be hand offs from earlier days when Peyronie's was something rare and mysterious and when doctors tended to try to define it without any real substance to work with.  Now they are learning more about it, but they are holding on to the lore of the past.  Somehow medicine tends to be that way.  For doctors there is perceived safety in doing it the way it has always been done without regard to whether there is any evidence to support it.  But they cling tenaciously to what they "know" is true.  I think a part of this has to do with liability issues.  If they are challenged, there is safety in numbers.  After all, 99% of the medical community CAN'T be wrong.

As for the rebound effect, I experienced it really intensely when I quit ALC.  The result was intense pain and the appearance of new curvature.  At this point it has been two weeks since I stopped taking Pentox.  So far, no rebound whatsoever.  No pain and no new deformity.  No evidence of progression at all.  So either I am in that so called "stable" phase or the Vitamin D and Low Dose Naltrexone are covering me.  - George
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ComeBacKid

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Re: Newguy
« Reply #23 on: November 15, 2009, 09:00:17 PM »


In the case of those with long term progression, with or without pain, it begs the question, what impact does pentox really have. It may be the case for instance that the condition can improve at six months, but if the pentox is stopped, it will gradually get worse again. There is already a "rebound effect" noted in some conditions treated by pentox, in people with conditions that are not known to progress, so it could be doubly important to take pentox for much longer than 6-12 months for those with long term peyronie's progression.

On a more positive note, if peyronie's in some men can slowly worsen over the years, perhaps with pentox use it can gradually improve over a period of years too, rather than only months.

Newguy,

Your right, pentox can slowly heal you over time, longer than six months, I noticed this, and yes your right, once you get off of it, you slowly get worse.  However for the first year off pentox I did not get worse, then a 8 day stint of drinking everyday with a bunch of co-workers who hit the bar everyday from 5pm-1am whilte away at a work related training seemed to fire up my peyronies or get it started again, or just inflame it if it was already getting worse.

Once you stop the pentox you will get worse again, but at  a slow rate, so slow you won't notice it for months upon months. Alcohol makes you get worse even faster as alcohol causes liver fibrosis and severly dehydrates you.

Knowing these two things, stay on pentox as long as possible, years, and avoid alcohol at all costs, I avoid even a glass, I don't even drink it anymore at all, maybe one glass of wine per year at my current rate.

Comebackid
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BentYoung

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Re: Suggestions
« Reply #24 on: November 15, 2009, 11:56:47 PM »

brohu,

It appears that you and I have a lot in common. I too have had issues since about the age of thirteen with curvature and hour glassing. I am 24 now and have just begun to grasp the scope of my problem. I have been to a handful of uros now (including a world -renown one) and they cant seem to diagnose me with Peyronies Disease. My ultrasounds are normal and everything looks good, but I know there is a problem. Hang in there...
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Skjaldborg

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Re: Pentoxifylline Study
« Reply #25 on: November 16, 2009, 02:04:38 AM »

I plan on staying on pentox for at least another 6 months. After that, I may taper off the dosage to 2 pentox pills per day down from 3. Perhaps Dr. Lue will refill for longer, I'm not sure as of now.

As for "inflammatory foods" and alcohol, there's no evidence that they affect Peyronie's. There is evidence that in excess, white sugar, flour, bacon and beer will make you fat. Therefore, I eat healthy, exercise and enjoy beer in moderation. I have had this for almost 9 months now and have noticed no worsening and actually have had some improvement due to pentox (less pain, smaller lumps/nodules). So booze hasn't caused me any problems.

Also, alcoholism causes liver fibrosis, moderate drinking does not.

If you don't drink, great. If you drink too much, quit. If you have a healthy lifestyle that includes alcohol, keep enjoying in moderation. I think we tend to obsess about one cause or another with disease because it's so stressful and of course, currently has no cure. Personally, I choose to keep living my life as I see fit. I don't want Peyronie's to control every aspect of my life unless I have good evidence to the contrary. My 2 cents.

-Skjald
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newguy

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Re: Newguy
« Reply #26 on: November 17, 2009, 06:31:28 AM »


Your right, pentox can slowly heal you over time, longer than six months, I noticed this, and yes your right, once you get off of it, you slowly get worse.  However for the first year off pentox I did not get worse, then a 8 day stint of drinking everyday with a bunch of co-workers who hit the bar everyday from 5pm-1am whilte away at a work related training seemed to fire up my peyronies or get it started again, or just inflame it if it was already getting worse.

Once you stop the pentox you will get worse again, but at  a slow rate, so slow you won't notice it for months upon months. Alcohol makes you get worse even faster as alcohol causes liver fibrosis and severly dehydrates you.


In some cases peyronie's sadly does appear to progress over a period of years. I would think that for these men pentox will be very useful since it appeared to be successful at stabilising conditions in this study. In many men though, the condition becomes stable after a certain period of time, so I certainly wouldn't suggest that long term pentox is for all men. It's best to take it on a case by case basis really. If a person does notice a worsening of their condition when they stop taking it, it is probably something that's useful for them to continue taking.
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E_Scapegoat

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My Treatment
« Reply #27 on: December 30, 2009, 02:31:12 PM »

Hello all, I just got my prescription for Pentox, Trazodone, a sample thing of 5mg Cialis (they were supposed to prescript 30x5mg, but for whatever reason I got 6x5mg with 1 refill) from my general practicianer. My Urologist was VERY opinionated about Peyronies, although he told me his method wasn't "perfect" and would only prescribe Potaba, Vitamin E, and Verapamil Injection. Out of ignorance and despiration I got a few verapamil injections, and it honestly feels like it got worse for the 2 weeks i took them, so I do NOT recommend verapamil, though it might help some, its painful and not worth the risk.

It seems like you should fine an openminded doctor who is willing to SPEND TIME prescribing what you are willing to try, or else you might just get 1 prescription of something that doesnt help. You do NOT want to go to someone who will talk to you 2 minutes about it, give you his opinion and say "see you later!" I recommend emailing Dr. Tom Lue the Peyronies expert from San Francisco if you want a reliable reference, as he sent me a pdf case study and knowing that a pro told me to take certain drugs, someone who is openminded and doesnt know much of peyronies can be more willing to do this.

My situation is I am getting married in 2.5 weeks and am eager about my "performance". My issue is not that I have a huge curve, but that it seems to just "jut" to the left, from the base, and have a very bad ED for my age.

My first question is, it seems like there is something prohibiting bloodflow on the left base primarily, because when erect i can move the penis all the way to the left, but i can not move it all the way to the right, and seems like the range of motion is limited. Should I "stretch" the range of motion to the right, to open up the left side of the base?

Otherwise, I am consistently taking the Pentox and Trazodone, but would taking a daily dose of cialis aid my healing process?

I am 20 years old AND getting married here so I want to destroy my Peyronies! I will update my status if things seem to be changing, but feedback would be great
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Nemo

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Re: My Treatment
« Reply #28 on: December 30, 2009, 02:49:02 PM »

Long before I ever had Peyronie's, my penis, when erect, wouldn't "go left" ... in other words, I could lay my erection down to the right as far as I wanted, but I could only go to about 11 o'clock on to the left.  It never caused any problems, it was just how my ligamanets were situated, I guess, and I always assumed it was because I "dress to the right" ...

So I wouldn't necessarily attribute this to Peyronies Disease - it may just be the way you're put together.  Were you like this before Peyronies Disease or not?

Nemo
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despise

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Re: My Treatment
« Reply #29 on: December 30, 2009, 09:50:18 PM »

Hello all, I just got my prescription for Pentox, Trazodone, a sample thing of 5mg Cialis (they were supposed to prescript 30x5mg, but for whatever reason I got 6x5mg with 1 refill) from my general practicianer. My Urologist was VERY opinionated about Peyronies, although he told me his method wasn't "perfect" and would only prescribe Potaba, Vitamin E, and Verapamil Injection. Out of ignorance and despiration I got a few verapamil injections, and it honestly feels like it got worse for the 2 weeks i took them, so I do NOT recommend verapamil, though it might help some, its painful and not worth the risk.

It seems like you should fine an openminded doctor who is willing to SPEND TIME prescribing what you are willing to try, or else you might just get 1 prescription of something that doesnt help. You do NOT want to go to someone who will talk to you 2 minutes about it, give you his opinion and say "see you later!" I recommend emailing Dr. Tom Lue the Peyronies expert from San Francisco if you want a reliable reference, as he sent me a pdf case study and knowing that a pro told me to take certain drugs, someone who is openminded and doesnt know much of peyronies can be more willing to do this.

My situation is I am getting married in 2.5 weeks and am eager about my "performance". My issue is not that I have a huge curve, but that it seems to just "jut" to the left, from the base, and have a very bad ED for my age.

My first question is, it seems like there is something prohibiting bloodflow on the left base primarily, because when erect i can move the penis all the way to the left, but i can not move it all the way to the right, and seems like the range of motion is limited. Should I "stretch" the range of motion to the right, to open up the left side of the base?

Otherwise, I am consistently taking the Pentox and Trazodone, but would taking a daily dose of cialis aid my healing process?

I am 20 years old AND getting married here so I want to destroy my Peyronies! I will update my status if things seem to be changing, but feedback would be great

I have the same exact problem to where the peyronies is at the left of the base and farther up the shaft. I recently just bought a VED and im hoping that will help some with the bend. I think physical exercises are probably the best bet mixed with good oral medication such as pentox, trazodone, and Vitamin E full spec for extra blood thinning support. Maybe you should consider VED or traction. I also think hot baths might help a slight bit. I admit it hasn't done anythin great for me but I think with pentox, trazodone, and the VED protocol it will definitely help in the fight of eliminating the disease. I just asked my gf of 6 months to marry me and she said yes =] we are dumb, young, and in love! both 18 years old =] so I only wish you the best! Keep positive and do everything you can to better yourself.
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MikeSmith

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Help w/ Dosages & Confirmation of Rx drugs
« Reply #30 on: January 14, 2010, 09:47:24 AM »

Hi,

I have been recently diagnosed with this...but I've had symptoms dating back about 6 months.  I wanted to make sure I understood all the recommendations and dosages on here bc I have a doctor in my family who is open to prescribing me things.  The first urologist I saw just told me to wait and see for it to heal on its own.  I'm only 30, and I'm very concerned it will just get worse...and it's already shrunk quite a bit and looks really deformed with two dents on either side.

Pentox (This is Trental, right?)  - 400 mg 2x per day
Trazadone - 25 mg at night
Vitamin E - 400 mg (how many times per day?)
L-Arganine (not sure of dose)

If anyone can let me know if I have things right (at least, for these meds) I would appreciate it.  I couldn't find exactly how much people were taking of various things, and I wanted to double check that Pentox is Trental.   

Also, I have 2 big dents on either side with (what feels like) a ring of scar tissue right below the dents.   Are there any devices that would help this kind of peyronie's?  I don't really have a left or right curve... just 2 big dents...and there is a backwards curve above the dents.  Thanks for any help.  Considering how depressed I have been, this forum has been really helpful.
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George999

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Re: Help w/ Dosages & Confirmation of Rx drugs
« Reply #31 on: January 14, 2010, 11:02:44 AM »

Pentox (This is Trental, right?)  - 400 mg 2x per day

Dr Lue who is the Pentox guru prescribes Pentox (Trental) 400mg 3X per day.  You need to go to the resource library on this site and print out the PDF documents by Drs Lue and Levine regarding Pentox and give copies of these to your friend.  He will need this information in order to provide you with the best possible help.  - George
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MikeSmith

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Re: Help w/ Dosages & Confirmation of Rx drugs
« Reply #32 on: January 14, 2010, 12:08:07 PM »

Thanks - I don't think I saw the resource library...I'll go look.  I was just reading through those top "overview" posts.

(edited to add - where are the PDFs?  I can't seem to find them... nevermind:  http://www.peyroniesforum.net/index.php/board,10.0.html )
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George999

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Re: Help w/ Dosages & Confirmation of Rx drugs
« Reply #33 on: January 14, 2010, 08:00:44 PM »

Oh, and also get a copy of the Pentox study from Iran as well.  - George
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LWillisjr

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Re: Help w/ Dosages & Confirmation of Rx drugs
« Reply #34 on: January 14, 2010, 09:21:46 PM »

mikesmith1010,
I would encourage you to also starte either VED or traction therapy right away. Don'rt wait and let things get worse.

Les
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Les - 8 yrs Peyronies Disease free
My History

Tim468

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New Article on Pentox
« Reply #35 on: August 23, 2010, 07:33:24 AM »

Here is another article. Not everyone responds to Pentox - suggesting again that this disease is really a collection of varying diseases with different etiologies and probably different treatments.

Tim

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

AU Safarinejad, Mohammad Reza.  Asgari, Majid Ali.  Hosseini, Seyyed Yousof.  Dadkhah, Farid.

IN Department of Urology, Shaheed Modarress Hospital, Shahid Beheshti University, Tehran, Iran. safarinejad@unrc.ir

TI A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease.

SO BJU International.  106(2):240-8, 2010 Jul.

AB OBJECTIVE: To analyse the safety and efficacy of pentoxifylline sustained-release (PTX-SR) treatment in patients with early chronic Peyronie's disease (Peyronies Disease).

PATIENTS AND METHODS: In all, 228 patients with a mean (sd) age of 51 (9) years who had early chronic Peyronies Disease were randomized to receive 400 mg PTX-SR (Apo-Pentoxifylline, Apotex Inc., Toronto, Canada) twice daily (group 1, 114) or similar regimen of placebo (group 2, 114) for 6 months. A medical history was taken and the men had a complete physical examination. The following variables were assessed before and after therapy: penile curvature and penile artery spectral traces (end-diastolic velocity, EDV, peak systolic velocity, PSV, and resistivity index, RI, of the right and left cavernous arteries assessed with dynamic penile duplex ultrasonography), plaque characteristics (assessed by penile X-ray and penile ultrasonography), pain (assessed by visual analogue scale), erectile function (assessed by the International Index of Erectile Function, IIEF questionnaire), treatment satisfaction (assessed by Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire), and side-effects. Patient perception of penile curvature and plaque size, and mean weekly intercourse attempts were also assessed.

RESULTS: Overall, 36.9% of patients who received PTX-SR reported a positive response, vs only 4.5% in the placebo group. Of patients in PTX-SR group, 12 (11%) had disease progression, vs 46 (42%) in placebo group (P = 0.01). improvement in penile curvature (P = 0.01), and plaque volume (P = 0.001) was significantly greater in patients treated with PTX-SR than placebo. The increase in IIEF total score was significantly higher in the PTX-SR group (P = 0.02). Mean PSV changes after therapy compared to baseline were statistically significant between PTX-SR (right, +11.4%, left, +11.7%) and placebo-treated (+0.2% and -4.2%, respectively) patients (both P = 0.04).

CONCLUSIONS: PTX-R was moderately effective in reducing penile curvature and plaque volume in patients with early chronic Peyronies Disease. Further studies with different treatment regimens are needed to better elucidate the beneficial effects of PTX-SR in Peyronies Disease.

PT Journal Article.  Randomized Controlled Trial.
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52, Peyronies Disease for 30 years, upward curve and some new lesions.

George999

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Re: New Article on Pentox
« Reply #36 on: August 23, 2010, 10:33:05 AM »

Tim,  I am more and more convinced it is a syndrome as opposed to a disease with various metabolic pathways being compromised in various degrees for unique reasons in different individuals.  I also believe it is LOOSELY associated with metabolic syndrome.  I think this Iranian team is really onto some things with Peyronie's.  I think their recent success with CoQ10 has legs and that we will be hearing more about CoQ10 and Peyronie's in the not too distant future.  IF there are multiple vectors that are causal factors in the case of Peyronie's, which I believe is the case, it is only going to be truly reversed by blocking multiple causal factors which is likely NEVER going to be achieved by any one drug or therapy.  Thankfully, both ALC and Pentoxifylline are helpful to many Peyronie's sufferers and both are dirt cheap.  Now we have CoQ10 out there, which unfortunately, is not dirt cheap, but offers far more hope than things like Neprinol which have no controlled studies behind them and are also extremely expensive.  Since I have already been taking CoQ10 at 100mg/day (mainly for hypertension) and my doctor has been after me to increase that, I have upped the dosage to 400mg and will shift to the more effective Ubiquinol form as soon as my current conventional CoQ10 is exhausted.  And, of course, I will update everyone here as to whether good things or nothings occur as a result.

NOTE:  IF ANYONE REPLIES SPECIFICALLY AS TO COQ10, PLEASE REPLY ON THE COQ10 THREAD, NOT THIS ONE!
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newguy

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Re: New Article on Pentox
« Reply #37 on: August 23, 2010, 12:24:59 PM »

From what I can see, this is the same study that was carried out a while back. I too noticed that it was published on pubmed and co recently. I agree with the assessment that there are various routes towards men developing various symptoms which is typically placed under the peyronie's umbrella. Until we know more I believe it is advisable for us to use all tools at our disposal.
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MikeSmith0

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Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #38 on: November 08, 2010, 05:06:32 AM »

A lot of doctors & hospitals subscribe to this service now because it's faster & more efficient than the academic journals.  Top docs author brief, easy to read articles...e.g. Lue is a author on the Peyronies Disease article.

http://www.uptodate.com/home/index.html

I have the peyronie's surgical and nonsurgical management monographs from up to date.  If your doctor won't give you pentox, then ask if they subscribe to this.  Also, I attached the treatment section below.  Note also, vitamin E does not get a favorable review.  For those of you having a hard time w/ your docs, ask if they subscribe to this.  I pasted the treatment section below w/ references.


MEDICAL MANAGEMENT — Options for the management of Peyronies Disease include observation, medical, or surgical therapy, depending upon the severity of the disease. There are few trials examining the efficacy of the available treatment options. Most studies are hampered by low patient numbers, lack of control groups or reproducibility, and/or the inability to distinguish efficacy from spontaneous improvement of the disease process [24]. Critical appraisal of contemporary literature identifies widespread use of inappropriate clinical endpoints, especially improvement in penile pain, as pain resolves spontaneously in the vast majority of patients. Improvement or resolution of penile deformity (curvature measured after an erection elicited by intracavernous injection) remains the gold standard by which therapies should be measured, while rigorous measurement of plaque size as a secondary endpoint may also be useful. It is important to note, however, that a reduction in plaque size has not been shown to correlate with reduction in curvature [25,26]. (See 'Natural history' above.)
Critical analysis of non-surgical approaches indicates that there is no mode of treatment able to relieve all symptoms for men with Peyronies Disease. Nonetheless, early medical intervention while the disease is still evolving is more likely to have therapeutic effect compared with intervention when the disease is stable or even calcified. Thus, the need for early diagnosis and consideration of treatment of Peyronies Disease is important.
We suggest initiating medical management in Peyronies Disease patients without a penile deformity causing sexual dysfunction and whose Peyronies Disease has persisted for less than 12 months, regardless of previous medical therapy. We suggest using pentoxifylline as first-line oral therapy with moderate to severe curvature (>30 degrees). In patients who do not have a good response (ie, decrease in penile deformity), intralesional injections of verapamil or interferon alpha-2b may also be of benefit, and can be used in conjunction with pentoxifylline.
Observation — Watchful waiting is an appropriate option for select patients with Peyronies Disease. We suggest observation for men with stable, mild curvature (≤ 30 degrees) who have satisfactory erectile function, although large observational studies and randomized trials are lacking in this patient population. Such patients who undergo observation should be told that Peyronies Disease may progress with worsening curvature or formation of new penile plaques in the future. If mild curvature worsens or causes sexual dysfunction, medical and/or surgical management should be considered. (See 'Indications for urology referral' above.)
Oral therapy — Oral therapy is indicated in men with moderate to severe curvature (30 degrees or more). We suggest pentoxifylline for first-line oral therapy.
Pentoxifylline — The exact mechanism of action of pentoxifylline is not known. Pentoxifylline blocks transforming growth factor (TGF)-beta 1-mediated inflammation, prevents deposition of collagen type I, and acts as a non-specific PDE inhibitor. In a rat model, both sildenafil and pentoxifylline reduced the plaque size in tunical fibrosis induced by injection of TGF beta-1 [27]. This agent has been previously used in humans for a variety of inflammatory and fibrotic conditions.
There are very few studies evaluating the use of pentoxifylline in the treatment of Peyronies Disease [28,29]. In a six-month, blinded trial of pentoxifylline (400 mg po bid) versus placebo in 228 patients with Peyronies Disease for < 12 months, mean reductions in penile curvature were significantly better in the pentoxifylline group (-22, -20, and -40 degrees compared with baseline in those with dorsal, lateral, and ventral curvature, respectively) compared with an increase in curvature of +31, +22, and +27 degrees, respectively, in the placebo group [29]. Total plaque volumes, erectile function, and peak systolic velocity of blood flow through the cavernous arteries improved significantly for the pentoxifylline group compared to the placebo group. Pentoxifylline was safe and well-tolerated in this study. Further investigations are required to optimize patient response, including optimum dosing and duration of treatment, as well as use in combination with intralesional treatments.
Encouraged by pentoxifylline's observed suppression of collagen production in Peyronie's cells in tissue culture [30], as well as its efficacy in other human fibrotic disorders, we have been offering patients treatment with pentoxifylline (400 mg po tid) as a treatment option for Peyronies Disease since 2002. The earliest meaningful improvement in degree of curvature may take four months or more. The patient may be reassessed in four to five month intervals. If interval improvement is observed, pentoxifylline may be continued up to two years.
Vitamin E — Vitamin E is a potent antioxidant that is thought to reduce collagen deposition within the injured tunica albuginea. Although Vitamin E is a widely used agent for Peyronies Disease in the US, there is little evidence to support its superiority over placebo [31-33]. As examples:
In a randomized, double blind trial of 236 men with Peyronies Disease, Vitamin E did not significantly improve penile curvature or plaque size compared to placebo [32].
In a trial of Vitamin E alone or in combination with carnitine (n = 236), there was no significant improvement in penile curvature or plaque size compared to placebo [32].
In contrast, vitamin E was effective in men with mild curvature when used in combination with colchicine. In a randomized trial report of 45 men with mild curvature (<30 degrees) and <6 months from Peyronies Disease onset, there was improvement in plaque size with colchicine (1 mg/twice daily) and Vitamin E (600 mg/day in two divided doses) combination treatment compared to ibuprofen [33].
Given the lack of efficacy as monotherapy in randomized trials, Vitamin E is not a recommended treatment option for Peyronies Disease.
Potassium para-aminobenzoate — Potassium para-aminobenzoate (Potaba™) is an antifibrotic agent that has been used in a variety of disease states. It is thought to increase tissue levels of monoamine oxidase, thereby decreasing levels of serotonin, which are thought to contribute to scar formation. Although potassium para-aminobenzoate has been available for decades, very few studies have examined its efficacy in the treatment of Peyronies Disease.
In a 12-month trial, in which 103 men with Peyronies Disease were randomly assigned to potassium para-aminobenzoate (3 g four times/day for one year) versus placebo, a greater proportion of patients in the active treatment group achieved the primary outcome, defined as a reduction in plaque size and/or reduction in penile curvature of at least 30 percent (74 versus 50 percent) [34]. However, the data were not analyzed by intention to treat, and therefore it is unclear if potassium para-aminobenzoate protects against Peyronies Disease progression. Further studies are warranted.
Current evidence does not support potassium para-aminobenzoate for first-line therapy of Peyronies Disease. Potassium para-aminobenzoate carries a significant cost, requires the patient to ingest up to 24 tablets daily, and is known for its low tolerability due to gastrointestinal side effects.
Colchicine — Based upon basic science and animal model investigations of Peyronies Disease, colchine inhibits collagen synthesis and subsequent fibrosis. Although observational studies demonstrated improvement in penile pain and curvature [35,36], a randomized, placebo-controlled trial (n = 78) did not demonstrate any difference in plaque size or penile curvature between colchicine (0.5 to 2.5 mg daily) and placebo [37]. Colchicine was effective in men with mild curvature when used in combination with vitamin E [33]. (See 'Vitamin E' above.)
Gastrointestinal side effects are relatively common. Additionally, colchicine may cause bone marrow suppression. Due to the side effect profile and lack of efficacy, colchicine is not commonly used to treat Peyronies Disease.
Tamoxifen — Efficacy of tamoxifen in the treatment of Peyronies Disease has not been shown in controlled trials to date. It is unlikely that an adequate tamoxifen concentration can be attained in the Peyronie's plaque via oral administration [3]. In a randomized, double-blind trial of tamoxifen versus placebo (n = 25), there was no difference in correction of curvature (46 versus 42 percent) [38].
Carnitine — Carnitine, an acetyle coenzyme-A inhibitor, has shown mixed results in comparison to other medications or placebo, as illustrated by the following blinded randomized trials:
In a trial of carnitine versus tamoxifen (n = 48), the improvement in curvature was greater in the carnitine group (15.9 versus 8.4 degrees) [39]. It is unclear if this difference represents a meaningful clinical effect.
In another trial of men with advanced Peyronies Disease (n = 60) treated with intralesional verapamil, carnitine significantly reduced penile curvature (11.8 versus 1.9 degrees), plaque size (7.6 versus 1.3 mm(2)), and need for surgery while increasing the International Index of Erectile Function score, compared to tamoxifen [40].
In a trial of carnitine alone or in combination with Vitamin E (n = 236), there was no significant improvement in penile curvature or plaque size compared to placebo [32].
Intralesional drug therapy — Intralesional drug injections are generally safe and well-tolerated (figure 4). There are three intralesional drug treatments that have shown efficacy in randomized trials: verapamil, interferon alpha-2b, and collagenase.
There is currently no clinical role for the use of corticosteroid injections into Peyronie's plaques, as little supportive data exist, and therapy carries a risk of tissue atrophy or obliteration of native penile tissue planes which can make surgical correction more difficult [3,41].
Verapamil — Intralesional verapamil is thought to influence fibroblast metabolism by increasing collagenase activity and concurrently decreasing collagen production [42].
Most [41,43-45] but not all [46] trials have shown improvement in symptoms and penile plaque/curvature with intralesional verapamil therapy. In a systematic review including four prospective studies of patients with mild Peyronies Disease (including only one small randomized, placebo-controlled trial), verapamil showed some benefit in penile curvature, plaque size, and penile pain [41]. Verapamil injection is safe, well-tolerated, and commonly used as part of non-surgical Peyronies Disease management.
Interferon alpha-2b — Limited clinical evidence suggests that interferon alpha-2b treatment may be efficacious for mild to moderate Peyronies Disease. The interferons (IFN) are low molecular weight proteins that are known to inhibit the proliferation of fibroblasts, increase collagenase activity, and decrease collagen production [41]. In a non-randomized trial (n = 117), where investigators where not blinded to treatment arm compared with placebo, men treated with interferon alpha-2b had greater improvement in curvature and plaque size [47]. Interferon injections appear safe, with a primary side-effect of flu-like symptoms in some patients.
Collagenase — Collagenase, a purified bacterial enzyme targeting collagen for breakdown, has shown some efficacy in improving plaque size and curvature in small, observational studies [48]. In a randomized trial of collagenase versus placebo in 49 men, there was a small, but significant improvement in curvature (maximal change of 15 to 20 degrees) in the collagenase group [49]. The treatment effect was mostly limited to patients with mild curvature (<30 degrees, plaque size <2 cm). Treatment was well-tolerated. A larger multicenter clinical trial is underway.
Topical therapy — Topical therapy (eg, verapamil, superoxide dismutase) is not currently recommended for the treatment of Peyronies Disease outside of clinical trials. In a randomized trial, topical verapamil gel was better than placebo in eliminating pain on erection, decreasing plaque size (84.7 versus 55 percent), decreasing curvature (61.1 versus 43.6 percent), and improving erection quality in patients with Peyronies Disease [50]. However, it is uncertain whether topical therapy has an effect on penile plaques, as topically (transdermal) administered verapamil gel has not been shown to penetrate into the tunica albuginea [51].
In a randomized, placebo controlled, crossover series in 39 men, liposomal recombinant human superoxide dismutase did not demonstrate significant effects upon plaque size or penile curvature, although decreased penile pain was observed over the eight week treatment course [52].

26   Hashimoto, K, Hisasue, S, Kato, R, et al. Outcome analysis for conservative management of Peyronie's disease. Int J Urol 2006; 13:244.
27   Valente, EG, Vernet, D, Ferrini, MG, et al. L-arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie's fibrotic plaque and related fibroblast cultures. Nitric Oxide 2003; 9:229.
28   Brant, WO, Dean, RC, Lue, TF. Treatment of Peyronie's disease with oral pentoxifylline. Nat Clin Pract Urol 2006; 3:111.
29    Safarinejad, MR, Asgari, MA, Hosseini, SY, Dadkhah, F. A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease. BJU Int 2009; :.
30    Garcia, MM, Bella, AJ, Lin, GT, et al. The effect of pentoxyfylline on cultured human tunical fibroblasts harvested from patients with Peyronie's disease. Can J Urol 2006; 13:3099.
31    Pryor, JP, Farrell, CR. Controlled clinical trial of vitamin E in Peyronie's disease. Prg Reprod Biol Med 1983; 9:41.
32   Safarinejad, MR, Hosseini, SY, Kolahi, AA. Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study. J Urol 2007; 178:1398.
33   Prieto Castro, RM, Leva Vallejo, ME, Regueiro Lopez, JC, et al. Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int 2003; 91:522.
34   Weidner, W, Hauck, EW, Schnitker, J. Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study. Eur Urol 2005; 47:530.
35   Akkus, E, Carrier, S, Rehman, J, et al. Is colchicine effective in Peyronie's disease? A pilot study. Urology 1994; 44:291.
36   Kadioglu, A, Tefekli, A, Koksal, T, et al. Treatment of Peyronie's disease with oral colchicine: long-term results and predictive parameters of successful outcome. Int J Impot Res 2000; 12:169.
37   Safarinejad, MR. Therapeutic effects of colchicine in the management of Peyronie's disease: a randomized double-blind, placebo-controlled study. Int J Impot Res 2004; 16:238.
38   Teloken, C, Rhoden, EL, Grazziotin, TM, et al. Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol 1999; 162:2003.
39   Biagiotti, G, Cavallini, G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int 2001; 88:63.
40   Cavallini, G, Biagiotti, G, Koverech, A, Vitali, G. Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease. BJU Int 2002; 89:895.
41   Russell, S, Steers, W, McVary, KT. Systematic Evidence-Based Analysis of Plaque Injection Therapy for Peyronie's Disease. Eur Urol 2007; 51:640.
42   Lee, RC, Ping, JA. Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res 1990; 49:463.
43    Nicolai, M, Cipollone, G, Iantorno, R, et al. Intralesional verapamil injection versus placebo in Peyronie's disease. J Urol 1998; 159:117.
44    Steiger, M, Ohlig, W, Ludwig, G. Verapamil versus placebo als injektionstherapie der induratio penis plastica: langzeitergebnisse einer doppel-blind-studie. Urologie A 1999; 38:S58.
45   Rehman, J, Benet, A, Melman, A. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single blinded study. Urology 1998; 51:620.
46   Shirazi, M, Haghpanah, AR, Badiee, M, et al. Effect of intralesional verapamil for treatment of Peyronie's disease: a randomized single-blind, placebo-controlled study. Int Urol Nephrol 2009; 41:467.
47   Hellstrom, WJ, Kendirci, M, Matern, R, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. J Urol 2006; 176:394.
48   Jordan, GH. The use of intralesional clostridial collagenase injection therapy for Peyronie's disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 2008; 5:180.
49   Gelbard, MK, James, K, Riach, P, Dorey, F. Collagenase versus placebo in the treatment of Peyronie's disease: a double-blind study. J Urol 1993; 149:56.
50   Fitch WP, 3rd, Easterling, WJ, Talbert, RL, et al. Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease--a placebo-controlled pilot study. J Sex Med 2007; 4:477.
51   Martin, DJ, Badwan, K, Parker, M, Mulhall, JP. Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol 2002; 168:2483.
52   Riedl, CR, Sternig, P, Galle, G, et al. Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study. Eur Urol 2005; 48:656.
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newguy

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Re: Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #39 on: November 08, 2010, 06:30:06 AM »

Thanks for this Mike. Hopefully it will result in some urologists getting with the times regarding pentox :). No mention of mechanical treatments there though is there (ved, traction)?
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George999

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Re: Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #40 on: November 08, 2010, 11:15:33 AM »

Take a close look a Dr Lue's referrences.  You will see how thoroughly the Iranian team is methodically testing substance after substance with very well designed studies.  I think we all owe THEM a debt of gratitude for moving the science of Peyronie's treatment forward in terms of possible medications.  Granted, Dr Lue pioneered the use of Pentoxifylline, but the Iranian team picked right up on it and did the kind of testing that could no way be funded in this country.  - George
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Re: Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #41 on: November 08, 2010, 09:58:41 PM »

newguy - there is more.. I just pasted in oral therapy below in that post.  I will add to it later on when I have access to that computer.  Traction is in there if i recall... probably citing the levine study.
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newguy

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Re: Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #42 on: November 08, 2010, 10:21:31 PM »

newguy - there is more.. I just pasted in oral therapy below in that post.  I will add to it later on when I have access to that computer.  Traction is in there if i recall... probably citing the levine study.

Great. I look forward to readin that. If VED isn't included in much detail, that may be because of the lack of studies available until very recently. Of course I haven't read it yet, so I'll try not to prejudge.

Take a close look a Dr Lue's referrences.  You will see how thoroughly the Iranian team is methodically testing substance after substance with very well designed studies.  I think we all owe THEM a debt of gratitude for moving the science of Peyronie's treatment forward in terms of possible medications.  Granted, Dr Lue pioneered the use of Pentoxifylline, but the Iranian team picked right up on it and did the kind of testing that could no way be funded in this country.  - George

I agree George. It's a relief that there are people out there putting the effort in to move us forward. CoQ10 for instance, who knows, maybe it won't be as effective as we hope, but it might be and the study is very positive. Without this study I doubt any of us would be taking it.
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MikeSmith0

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Re: Pentox & Other 1st Oral treatments- per "Up To Date" Physician Reference
« Reply #43 on: November 09, 2010, 05:50:53 AM »

Here's the whole thing:

Peyronie's disease: Diagnosis and medical management
 
Authors
William O Brant, MD
Anthony J Bella, MD, FRCSC
Tom F Lue, MD, ScD (Hon), FACS Section Editor
Michael P O'Leary, MD, MPH Deputy Editor
Pracha Eamranond, MD, MPH
 
Last literature review version 18.2: May 2010 | This topic last updated: February 12, 2010 


INTRODUCTION — Peyronie's disease (Peyronies Disease) is an acquired, localized fibrotic disorder of the tunica albuginea resulting in penile deformity, pain, and in some men, erectile dysfunction (ED). The disorder is named after Francois Gigot de la Peyronie, surgeon to King Louis XIV, who in 1743 described rosary beads of scar tissue extending the full length of the dorsal penis in a treatise on ejaculatory failure [1].

Peyronies Disease can resolve spontaneously in a minority of cases while others have stable disease. However, nearly half of patients will have worsening within one year. Peyronies Disease can be a psychologically and physically disabling disorder, leading to a lower quality of life. Diagnosis is generally straightforward, based on history and physical examination. Ultrasound can also be used to confirm fibrotic plaque.

The efficacy of medical management for Peyronies Disease is limited. Treatment options typically include oral or intralesional drug therapy. In most cases, medical management should be initiated once the diagnosis of Peyronies Disease is made. Surgical management may be considered for patients who have penile deformity compromising sexual function and whose Peyronies Disease has persisted for more than 12 months, regardless of previous medical therapy.

The diagnosis and medical management of Peyronies Disease will be reviewed here. Surgical management of Peyronies Disease and general issues relating to male sexual dysfunction are discussed separately. (See "Surgical management of Peyronie's disease" and "Overview of male sexual dysfunction".)

EPIDEMIOLOGY — Many clinicians, including urologists, have the misconception that Peyronies Disease is a rare condition, based on previous case reports documenting prevalence of ≤ 1 percent [2,3]. Contemporary estimates are several-fold higher, perhaps partly due to the introduction of PDE-5 inhibitors for erectile dysfunction leading to improved general awareness among patients and clinicians.

The current prevalence of Peyronies Disease is approximately 5 percent in men. Rates range from 3 percent in a community-based survey of 8000 men (mean age 57.8) to 16 percent among 488 men undergoing evaluation for ED (mean age 52.8) [4,5]. In 534 men undergoing routine prostate screening (without a specific urologic complaint), the prevalence of Peyronies Disease was 8.9 percent [6]. The mean age of those with Peyronies Disease was 68.2 years compared to 61.8 years of those without Peyronies Disease. The true prevalence of Peyronies Disease may be underestimated as men might be reluctant to report a condition to their clinician that they consider embarrassing, and/or older men may accept the condition as a by-product of aging.

PATHOGENESIS — The underlying pathogenesis of Peyronies Disease is unknown but is likely multifactorial with an interplay between genetic predisposition, trauma, and tissue ischemia. The underlying lesion of Peyronies Disease is a fibrous plaque(s) that contains excessive collagen, an altered framework of reduced and fragmented elastic fibers, and fibroblastic proliferation that alters penile anatomy. The fibrous plaque causes focal inelasticity and can compromise erectile function. Plaques may be fibrous, contain areas of calcification, or are completely ossified. Most authorities postulate that Peyronies Disease results from repeated minor blunt trauma to the penis during intercourse.

Peyronies Disease is thought to be due to a localized aberration of the wound healing process. For susceptible individuals, bleeding within the tunica albuginea, trapping of fibrin and inflammatory cells, and overexpression of matrix proteins secondary to upregulation of cytokines and growth factors in the local environment lead to plaque formation [7]. Excess fibrin deposition in response to microvascular injury and upregulation of transforming growth factor-1 results in one or more areas of plaque formation (figure 1) [8].

Risk factors — A family history of Peyronies Disease has been observed in 2 percent of patients [9]. Twenty-one percent of patients with Peyronies Disease may also have Dupuytren's contracture [10]. Patterns of gene expression in families with Peyronies Disease and Dupuytren's disease are similar, particularly in regard to collagen degradation, ossification, and myofibroblast differentiation [11].

Genital and/or perineal injuries, radical prostatectomy, plantar fascial contractures, tympanosclerosis, urethral instrumentation, Paget's disease, gout, and lipomas have been associated, albeit weakly, with Peyronies Disease [12,13]. Hypertension, smoking, hyperlipidemia, and diabetes have been proposed as risk factors, but they are more likely related to underlying erectile dysfunction, as current research does not show a relation between these factors and severity of penile curvature [13]. An association with vascular comorbidities is controversial [5,6,14], as is the role of overt trauma such as penile fracture [15].

Natural history — Although historical data suggested that the natural history of Peyronies Disease is often one of spontaneous resolution with conservative management, contemporary studies have shown that this is incorrect. Untreated Peyronies Disease resolves in only 12 percent of men, with 40 to 48 percent of men demonstrating worsening of curvature at 12 months, while curvature remains stable in the remaining men [16]. The mean change was 15 degrees in those in whom curvature improved, while the mean change was 22 degrees in those in whom curvature worsened.

The disease state may often be divided into an acute (or inflammatory) phase and a chronic phase. During the former, there may be penile pain, even when flaccid, and there are often dynamic changes of penile malformation. During the latter, pain resolves and the malformation stabilizes in its characteristics.

CLINICAL MANIFESTATIONS — The presenting symptoms of Peyronies Disease are penile pain, nodule or induration, penile curvature or shortening during erection, and/or sexual dysfunction. Penile pain occurs primarily during erection, and usually resolves within 12 to 24 months of Peyronies Disease onset (94 percent of 246 men who did not receive medical or surgical treatment reported complete resolution of pain, mean 18 months) [16].

Peyronies Disease deformities are varied but may manifest as curvature, indentation, palpable plaque or nodule, hour-glass narrowing, penile shortening (with or without curvature), or in combination. Peyronies Disease is most evident during erection, as tunical compliance is compromised and the paired corpora cavernosa are unable to expand normally. In a review of 307 men with Peyronies Disease, 46 percent had dorsal curvature, 29 percent lateral, and 9 percent ventral, with the remaining being a combination of curvatures [17].

Severe or complex curvature and compromised penile rigidity may make penetrative intercourse impossible. Erectile dysfunction is present in 20 to 50 percent of men with Peyronies Disease, and occurs due to deformity preventing coitus, flail penis (cavernous fibrosis or vascular compromise), performance anxiety (psychological), or impaired erections due to venoocclusive dysfunction. Patient and partner quality of life are significantly impacted, as men with Peyronies Disease are at increased risk of depression, lowered self-esteem, and relationship difficulties (especially maintenance of intimacy or dating), in addition to body-image issues and pain [16].

DIAGNOSIS AND ASSESSMENT — Diagnosis is usually apparent from patient history and penile examination. Patients can be given a preliminary diagnosis of Peyronies Disease when they present with classic symptoms of the disease: penile nodules (plaques), curvature, and/or pain. Possible associated disorders (eg, Dupuytren's contractures or vascular disease) and inciting events (eg, trauma or genitourinary instrumentation) should be evaluated. It is important to define the psychological effect of Peyronies Disease on the patient and partner, as well as determine the extent of associated erectile dysfunction.

Objectively, clinicians may measure penile length, plaque size, and penile curvature. In classical Peyronies Disease, a well-defined plaque or induration is palpable on physical examination, even if the patient is unaware. Among men with Peyronies Disease affecting the dorsal side of the penis, two thirds will have associated plaque (figure 2) [18]. Lateral or ventral plaques are less common, but when present, can result in more coital difficulties (figure 3). Plaques located primarily in the penile septum, or equally distributed on both the ventral and dorsal aspects of the penis, may cause penile shortening without angulation [19]. Abnormal tissue may extend beyond the palpable lesion or even into the corporal tissue [20]. It is often helpful to have the patient take photographs of the erect penis at home to characterize the deformity. If the patient cannot or will not do this, office pharmacoerection can be performed.

If the diagnosis of Peyronies Disease is uncertain after history and physical examination, imaging may be helpful. Various imaging modalities have been used to diagnose Peyronies Disease, including ultrasound, plain radiography, computerized tomography, and magnetic resonance. Ultrasound has the highest sensitivity for plaques in the tunica albuguinea compared to other methods [21]. Ultrasonography has additional advantages due to its easy availability, low risk, and ability to image and quantify both calcified and soft tissue elements of Peyronies Disease as well as assess vascular status if a reconstructive procedure is being considered.

Differential diagnosis — Typically the diagnosis of Peyronies Disease is clinically apparent, but infrequently it can present similarly to developmental penile deformities including congenital ventral curvature, chordee without hypospadias, or curvature associated with epispadias. A chordee is a curved erection of the penis usually due to a congenital lack of distensibility of the corpus cavernosum urethrae. A chordee can also be caused by gonorrheal infection, subsequent inflammation, and scar tissue formation. In contrast, Peyronies Disease occurs due to acquired lesions/plaques of the tunica albuginea.

Although rare, other conditions such as sclerosing lymphangitis or rare neoplasms (epithelioid or angiosarcomas) have been reportedly confused with Peyronies Disease [22,23].

INDICATIONS FOR UROLOGY REFERRAL — As Peyronies Disease is an uncommon condition and most primary care clinicians have limited experience in managing Peyronies Disease, the primary care clinician should refer the patient to a urologist when the diagnosis of Peyronies Disease is established, or in any patient with a penile deformity. The urologist can coordinate both medical and surgical therapy for Peyronies Disease. Surgical management may be considered for patients who have penile deformity compromising sexual function and whose Peyronies Disease has persisted for more than 12 months, regardless of previous medical therapy. (See "Surgical treatment of erectile dysfunction".)

MEDICAL MANAGEMENT — Options for the management of Peyronies Disease include observation, medical, or surgical therapy, depending upon the severity of the disease. There are few trials examining the efficacy of the available treatment options. Most studies are hampered by low patient numbers, lack of control groups or reproducibility, and/or the inability to distinguish efficacy from spontaneous improvement of the disease process [24]. Critical appraisal of contemporary literature identifies widespread use of inappropriate clinical endpoints, especially improvement in penile pain, as pain resolves spontaneously in the vast majority of patients. Improvement or resolution of penile deformity (curvature measured after an erection elicited by intracavernous injection) remains the gold standard by which therapies should be measured, while rigorous measurement of plaque size as a secondary endpoint may also be useful. It is important to note, however, that a reduction in plaque size has not been shown to correlate with reduction in curvature [25,26]. (See 'Natural history' above.)

Critical analysis of non-surgical approaches indicates that there is no mode of treatment able to relieve all symptoms for men with Peyronies Disease. Nonetheless, early medical intervention while the disease is still evolving is more likely to have therapeutic effect compared with intervention when the disease is stable or even calcified. Thus, the need for early diagnosis and consideration of treatment of Peyronies Disease is important.

We suggest initiating medical management in Peyronies Disease patients without a penile deformity causing sexual dysfunction and whose Peyronies Disease has persisted for less than 12 months, regardless of previous medical therapy. We suggest using pentoxifylline as first-line oral therapy with moderate to severe curvature (>30 degrees). In patients who do not have a good response (ie, decrease in penile deformity), intralesional injections of verapamil or interferon alpha-2b may also be of benefit, and can be used in conjunction with pentoxifylline.

Observation — Watchful waiting is an appropriate option for select patients with Peyronies Disease. We suggest observation for men with stable, mild curvature (≤ 30 degrees) who have satisfactory erectile function, although large observational studies and randomized trials are lacking in this patient population. Such patients who undergo observation should be told that Peyronies Disease may progress with worsening curvature or formation of new penile plaques in the future. If mild curvature worsens or causes sexual dysfunction, medical and/or surgical management should be considered. (See 'Indications for urology referral' above.)

Oral therapy — Oral therapy is indicated in men with moderate to severe curvature (30 degrees or more). We suggest pentoxifylline for first-line oral therapy.

Pentoxifylline — The exact mechanism of action of pentoxifylline is not known. Pentoxifylline blocks transforming growth factor (TGF)-beta 1-mediated inflammation, prevents deposition of collagen type I, and acts as a non-specific PDE inhibitor. In a rat model, both sildenafil and pentoxifylline reduced the plaque size in tunical fibrosis induced by injection of TGF beta-1 [27]. This agent has been previously used in humans for a variety of inflammatory and fibrotic conditions.

There are very few studies evaluating the use of pentoxifylline in the treatment of Peyronies Disease [28,29]. In a six-month, blinded trial of pentoxifylline (400 mg po bid) versus placebo in 228 patients with Peyronies Disease for < 12 months, mean reductions in penile curvature were significantly better in the pentoxifylline group (-22, -20, and -40 degrees compared with baseline in those with dorsal, lateral, and ventral curvature, respectively) compared with an increase in curvature of +31, +22, and +27 degrees, respectively, in the placebo group [29]. Total plaque volumes, erectile function, and peak systolic velocity of blood flow through the cavernous arteries improved significantly for the pentoxifylline group compared to the placebo group. Pentoxifylline was safe and well-tolerated in this study. Further investigations are required to optimize patient response, including optimum dosing and duration of treatment, as well as use in combination with intralesional treatments.

Encouraged by pentoxifylline's observed suppression of collagen production in Peyronie's cells in tissue culture [30], as well as its efficacy in other human fibrotic disorders, we have been offering patients treatment with pentoxifylline (400 mg po tid) as a treatment option for Peyronies Disease since 2002. The earliest meaningful improvement in degree of curvature may take four months or more. The patient may be reassessed in four to five month intervals. If interval improvement is observed, pentoxifylline may be continued up to two years.

Vitamin E — Vitamin E is a potent antioxidant that is thought to reduce collagen deposition within the injured tunica albuginea. Although Vitamin E is a widely used agent for Peyronies Disease in the US, there is little evidence to support its superiority over placebo [31-33]. As examples:


In a randomized, double blind trial of 236 men with Peyronies Disease, Vitamin E did not significantly improve penile curvature or plaque size compared to placebo [32].
In a trial of Vitamin E alone or in combination with carnitine (n = 236), there was no significant improvement in penile curvature or plaque size compared to placebo [32].

In contrast, vitamin E was effective in men with mild curvature when used in combination with colchicine. In a randomized trial report of 45 men with mild curvature (<30 degrees) and <6 months from Peyronies Disease onset, there was improvement in plaque size with colchicine (1 mg/twice daily) and Vitamin E (600 mg/day in two divided doses) combination treatment compared to ibuprofen [33].

Given the lack of efficacy as monotherapy in randomized trials, Vitamin E is not a recommended treatment option for Peyronies Disease.

Potassium para-aminobenzoate — Potassium para-aminobenzoate (Potaba™) is an antifibrotic agent that has been used in a variety of disease states. It is thought to increase tissue levels of monoamine oxidase, thereby decreasing levels of serotonin, which are thought to contribute to scar formation. Although potassium para-aminobenzoate has been available for decades, very few studies have examined its efficacy in the treatment of Peyronies Disease.

In a 12-month trial, in which 103 men with Peyronies Disease were randomly assigned to potassium para-aminobenzoate (3 g four times/day for one year) versus placebo, a greater proportion of patients in the active treatment group achieved the primary outcome, defined as a reduction in plaque size and/or reduction in penile curvature of at least 30 percent (74 versus 50 percent) [34]. However, the data were not analyzed by intention to treat, and therefore it is unclear if potassium para-aminobenzoate protects against Peyronies Disease progression. Further studies are warranted.

Current evidence does not support potassium para-aminobenzoate for first-line therapy of Peyronies Disease. Potassium para-aminobenzoate carries a significant cost, requires the patient to ingest up to 24 tablets daily, and is known for its low tolerability due to gastrointestinal side effects.

Colchicine — Based upon basic science and animal model investigations of Peyronies Disease, colchine inhibits collagen synthesis and subsequent fibrosis. Although observational studies demonstrated improvement in penile pain and curvature [35,36], a randomized, placebo-controlled trial (n = 78) did not demonstrate any difference in plaque size or penile curvature between colchicine (0.5 to 2.5 mg daily) and placebo [37]. Colchicine was effective in men with mild curvature when used in combination with vitamin E [33]. (See 'Vitamin E' above.)

Gastrointestinal side effects are relatively common. Additionally, colchicine may cause bone marrow suppression. Due to the side effect profile and lack of efficacy, colchicine is not commonly used to treat Peyronies Disease.

Tamoxifen — Efficacy of tamoxifen in the treatment of Peyronies Disease has not been shown in controlled trials to date. It is unlikely that an adequate tamoxifen concentration can be attained in the Peyronie's plaque via oral administration [3]. In a randomized, double-blind trial of tamoxifen versus placebo (n = 25), there was no difference in correction of curvature (46 versus 42 percent) [38].

Carnitine — Carnitine, an acetyle coenzyme-A inhibitor, has shown mixed results in comparison to other medications or placebo, as illustrated by the following blinded randomized trials:


In a trial of carnitine versus tamoxifen (n = 48), the improvement in curvature was greater in the carnitine group (15.9 versus 8.4 degrees) [39]. It is unclear if this difference represents a meaningful clinical effect.
In another trial of men with advanced Peyronies Disease (n = 60) treated with intralesional verapamil, carnitine significantly reduced penile curvature (11.8 versus 1.9 degrees), plaque size (7.6 versus 1.3 mm(2)), and need for surgery while increasing the International Index of Erectile Function score, compared to tamoxifen [40].
In a trial of carnitine alone or in combination with Vitamin E (n = 236), there was no significant improvement in penile curvature or plaque size compared to placebo [32].

Intralesional drug therapy — Intralesional drug injections are generally safe and well-tolerated (figure 4). There are three intralesional drug treatments that have shown efficacy in randomized trials: verapamil, interferon alpha-2b, and collagenase.

There is currently no clinical role for the use of corticosteroid injections into Peyronie's plaques, as little supportive data exist, and therapy carries a risk of tissue atrophy or obliteration of native penile tissue planes which can make surgical correction more difficult [3,41].

Verapamil — Intralesional verapamil is thought to influence fibroblast metabolism by increasing collagenase activity and concurrently decreasing collagen production [42].

Most [41,43-45] but not all [46] trials have shown improvement in symptoms and penile plaque/curvature with intralesional verapamil therapy. In a systematic review including four prospective studies of patients with mild Peyronies Disease (including only one small randomized, placebo-controlled trial), verapamil showed some benefit in penile curvature, plaque size, and penile pain [41]. Verapamil injection is safe, well-tolerated, and commonly used as part of non-surgical Peyronies Disease management.

Interferon alpha-2b — Limited clinical evidence suggests that interferon alpha-2b treatment may be efficacious for mild to moderate Peyronies Disease. The interferons (IFN) are low molecular weight proteins that are known to inhibit the proliferation of fibroblasts, increase collagenase activity, and decrease collagen production [41]. In a non-randomized trial (n = 117), where investigators where not blinded to treatment arm compared with placebo, men treated with interferon alpha-2b had greater improvement in curvature and plaque size [47]. Interferon injections appear safe, with a primary side-effect of flu-like symptoms in some patients.

Collagenase — Collagenase, a purified bacterial enzyme targeting collagen for breakdown, has shown some efficacy in improving plaque size and curvature in small, observational studies [48]. In a randomized trial of collagenase versus placebo in 49 men, there was a small, but significant improvement in curvature (maximal change of 15 to 20 degrees) in the collagenase group [49]. The treatment effect was mostly limited to patients with mild curvature (<30 degrees, plaque size <2 cm). Treatment was well-tolerated. A larger multicenter clinical trial is underway.

Topical therapy — Topical therapy (eg, verapamil, superoxide dismutase) is not currently recommended for the treatment of Peyronies Disease outside of clinical trials. In a randomized trial, topical verapamil gel was better than placebo in eliminating pain on erection, decreasing plaque size (84.7 versus 55 percent), decreasing curvature (61.1 versus 43.6 percent), and improving erection quality in patients with Peyronies Disease [50]. However, it is uncertain whether topical therapy has an effect on penile plaques, as topically (transdermal) administered verapamil gel has not been shown to penetrate into the tunica albuginea [51].

In a randomized, placebo controlled, crossover series in 39 men, liposomal recombinant human superoxide dismutase did not demonstrate significant effects upon plaque size or penile curvature, although decreased penile pain was observed over the eight week treatment course [52].

OTHER TREATMENTS — Penile traction, iontophoresis, extracorporeal shock wave therapy (ESWT), and radiation therapy are other treatment approaches to Peyronies Disease, but none have been shown to be conclusively effective in randomized trials. Well-designed studies are needed to document a treatment effect, should it exist, prior to widespread use.

Penile traction therapy — Penile traction therapy, usually in conjunction with medical management, shows some efficacy with a good safety profile in pilot studies [53-55]. In a study of ten men with Peyronies Disease, nine of whom had failed medical therapy, traction therapy for two to eight hours a day for six months led to reduced curvature in all men (10 to 45 degrees), stretched flaccid penile length increased (0.5 to 2.0 cm), and erect girth increased (0.5 to 1.0 cm). There were no adverse events including skin changes, erectile dysfunction, or hypoesthesia. These results suggest traction therapy may become a non-surgical option for Peyronies Disease.

Iontophoresis — Several reports have investigated the effect of electromotive drug administration, also known as iontophoresis. Theoretically, electrokinetic transport of charged ionic molecules may enhance the delivery of transdermal medications to the target tissues, in this case the diseased tunica albuginea, thereby improving local penetration without systemic side effects [56]. Increased levels of verapamil were present after iontophoresis in surgically retrieved tunica albuginea specimens [56].

In a randomized trial of iontophoresis with verapamil (5 mg) plus dexamethasone (8 mg) compared to iontophoresis with 2 percent lidocaine in 96 men, there was objective improvement in plaque size and curvature in the verapamil group [57]. However, in another trial of iontophoresis with verapamil in 42 men with Peyronies Disease, there was no improvement in penile curvature compared to iontophoresis with placebo [58]. Further trials are needed, especially since it is unclear whether the electric current itself may be beneficial for wound healing [59].

Iontophoresis is well-tolerated, with the most common side effect being temporary erythema at the electrode site. If iontophoresis continues to prove efficacious, widespread acceptance of iontophoresis likely would occur since it can readily be performed at home [24].

Extracorporeal shock wave therapy — This modality remains an investigational treatment due to lack of well-designed trials with long-term follow-up. There are also concerns about the potential side-effects including penile fibrosis, secondary Peyronies Disease scarring, and development of erectile dysfunction [60].

There are limited clinical trial data evaluating the efficacy of ESWT for the treatment of Peyronies Disease [61-63]. An exploratory meta-analysis of predominantly observational studies determined that ESWT may be somewhat effective in improving penile pain and sexual dysfunction; however, there was insufficient evidence to determine its effect on penile plaque size and curvature [61]. The meta-analysis was limited by several factors, including lack of prospective studies, no blinding in any of the studies, and use of non-standardized outcome measures.

In a subsequent randomized trial comparing ESWT versus placebo in 100 patients who had not previously received Peyronies Disease-related treatment, there was a statistically significant decrease in mean plaque size (-0.6 versus +1.4 mm2) and curvature (-1.4 versus +1.8 degrees), which is of uncertain clinical significance [63].

Radiation therapy — Radiation therapy for the treatment of Peyronies Disease has yielded mixed results [64,65]. Although radiation therapy may reduce pain and penile curvature, it may also compromise erectile function, especially in the aging male [64]. Well-designed trials are required, as no prospective, randomized, placebo-controlled studies have been published. There is insufficient evidence to recommend radiation therapy at this time, particularly since secondary malignancy risks have not been quantified.

SUMMARY AND RECOMMENDATIONS


The underlying pathogenesis of Peyronies' disease (Peyronies Disease) is unknown and most likely represents a combination of factors including chronic minor injury and genetic susceptibility. (See 'Pathogenesis' above.)
The presenting symptoms of Peyronies Disease are penile pain, induration, curvature, and/or sexual dysfunction. Patient and partner quality of life are significantly impacted, as men with Peyronies Disease are at increased risk of depression, relationship difficulties, and body-image issues (see 'Clinical manifestations' above).
Diagnosis is usually apparent from patient history and penile examination. On exam, clinicians may observe a penile plaque and penile curvature or deformity. (See 'Diagnosis and assessment' above.)
When primary care clinicians have limited experience in managing Peyronies Disease, the primary care clinician should refer the patient to a urologist once the diagnosis of Peyronies Disease is established, or in any patient with a penile deformity. (See 'Indications for urology referral' above.)
For patients who do not have penile deformity compromising sexual function and whose Peyronies Disease has persisted for less than 12 months, we suggest medical management rather than surgical management (Grade 2C). (See 'Medical management' above and "Surgical management of Peyronie's disease".)
For men with stable, mild curvature (≤ 30 degrees) who have satisfactory erectile function, we suggest observation (Grade 2C). If mild curvature worsens or causes sexual dysfunction, we suggest medical and/or surgical management (Grade 2B). (See 'Observation' above.)
For the initial medical management of men with moderate to severe Peyronies Disease (> 30 degrees), we suggest oral pentoxifylline rather than observation (Grade 2B). An alternative option is intralesional verapamil, which may also be used concurrently with pentoxifylline. (See 'Medical management' above.)



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11 Qian, A, Meals, RA, Rajfer, J, Gonzalez-Cadavid, NF. Comparison of gene expression profiles between Peyronie's disease and Dupuytren's contracture. Urology 2004; 64:399. 
12 Gholami, SS, Gonzalez-Cavadid, NF, Lin, CS, et al. Peyronie's disease: a review. J Urol 2003; 169:1234. 
13 Bjekic, MD, Vlajinac, HD, Sipetic, SB, Marinkovic, JM. Risk factors for Peyronie's disease: a case-control study. BJU Int 2006; 97:570. 
14 Usta, MF, Bivalacqua, TJ, Jabren, GW, et al. Relationship between the severity of penile curvature and the presence of comorbidities in men with Peyronie's disease. J Urol 2004; 171:775. 
15 Zargooshi, J. Trauma as the cause of Peyronie's disease: penile fracture as a model of trauma. J Urol 2004; 172:186. 
16 Mulhall, JP, Schiff, J, Guhring, P. An analysis of the natural history of Peyronie's disease. J Urol 2006; 175:2115. 
17 Kadioglu, A, Tefekli, A, Erol, B, et al. A retrospective review of 307 men with Peyronie's disease. J Urol 2002; 168:1075. 
18 Pryor, JP, Ralph, DJ. Clinical presentations of Peyronie's disease. Int J Impot Res 2002; 14:414. 
19 Bella, AJ, Sener, A, Foell, K, Brock, GB. Nonpalpable Scarring of the Penile Septum As a Cause of Erectile Dysfunction: An Atypical Form of Peyronie's Disease. J Sex Med 2007; 4:226. 
20 Brant, WO, Bella, AJ, Garcia, MM, et al. Isolated septal fibrosis or hematoma--atypical Peyronie's disease?. J Urol 2007; 177:179. 
21 Andresen, R, Wegner, HE, Miller, K, Banzer, D. Imaging modalities in Peyronie's disease. An intrapersonal comparison of ultrasound sonography, X-ray in mammography technique, computerized tomography, and nuclear magnetic resonance in 20 patients. Eur Urol 1998; 34:128. 
22 Ung, JO, Padera, RF, O'Leary, MP. Angiosarcoma of the penis masquerading as a Peyronie's plaque. J Urol 2002; 167:1785.
23 Hauck, EW, Schmelz, HU, Diemer, T, et al. Epithelioid sarcoma of the penis--a rare differential diagnosis of Peyronie's disease. Int J Impot Res 2003; 15:378. 
24 Hauck, EW, Diemer, T, Schmelz, HU, Weidner, W. A critical analysis of nonsurgical treatment of Peyronie's disease. Eur Urol 2006; 49:987. 
25 Ohebshalom, M, Mulhall, J, Guhring, P, Parker, M. Measurement of penile curvature in Peyronie's disease patients: comparison of three methods. J Sex Med 2007; 4:199. 
26 Hashimoto, K, Hisasue, S, Kato, R, et al. Outcome analysis for conservative management of Peyronie's disease. Int J Urol 2006; 13:244. 
27 Valente, EG, Vernet, D, Ferrini, MG, et al. L-arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie's fibrotic plaque and related fibroblast cultures. Nitric Oxide 2003; 9:229. 
28 Brant, WO, Dean, RC, Lue, TF. Treatment of Peyronie's disease with oral pentoxifylline. Nat Clin Pract Urol 2006; 3:111. 
29 Safarinejad, MR, Asgari, MA, Hosseini, SY, Dadkhah, F. A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease. BJU Int 2009; :.
30 Garcia, MM, Bella, AJ, Lin, GT, et al. The effect of pentoxyfylline on cultured human tunical fibroblasts harvested from patients with Peyronie's disease. Can J Urol 2006; 13:3099.
31 Pryor, JP, Farrell, CR. Controlled clinical trial of vitamin E in Peyronie's disease. Prg Reprod Biol Med 1983; 9:41.
32 Safarinejad, MR, Hosseini, SY, Kolahi, AA. Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study. J Urol 2007; 178:1398. 
33 Prieto Castro, RM, Leva Vallejo, ME, Regueiro Lopez, JC, et al. Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease. BJU Int 2003; 91:522. 
34 Weidner, W, Hauck, EW, Schnitker, J. Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study. Eur Urol 2005; 47:530. 
35 Akkus, E, Carrier, S, Rehman, J, et al. Is colchicine effective in Peyronie's disease? A pilot study. Urology 1994; 44:291. 
36 Kadioglu, A, Tefekli, A, Koksal, T, et al. Treatment of Peyronie's disease with oral colchicine: long-term results and predictive parameters of successful outcome. Int J Impot Res 2000; 12:169. 
37 Safarinejad, MR. Therapeutic effects of colchicine in the management of Peyronie's disease: a randomized double-blind, placebo-controlled study. Int J Impot Res 2004; 16:238. 
38 Teloken, C, Rhoden, EL, Grazziotin, TM, et al. Tamoxifen versus placebo in the treatment of Peyronie's disease. J Urol 1999; 162:2003. 
39 Biagiotti, G, Cavallini, G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int 2001; 88:63. 
40 Cavallini, G, Biagiotti, G, Koverech, A, Vitali, G. Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease. BJU Int 2002; 89:895. 
41 Russell, S, Steers, W, McVary, KT. Systematic Evidence-Based Analysis of Plaque Injection Therapy for Peyronie's Disease. Eur Urol 2007; 51:640. 
42 Lee, RC, Ping, JA. Calcium antagonists retard extracellular matrix production in connective tissue equivalent. J Surg Res 1990; 49:463. 
43 Nicolai, M, Cipollone, G, Iantorno, R, et al. Intralesional verapamil injection versus placebo in Peyronie's disease. J Urol 1998; 159:117.
44 Steiger, M, Ohlig, W, Ludwig, G. Verapamil versus placebo als injektionstherapie der induratio penis plastica: langzeitergebnisse einer doppel-blind-studie. Urologie A 1999; 38:S58.
45 Rehman, J, Benet, A, Melman, A. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single blinded study. Urology 1998; 51:620. 
46 Shirazi, M, Haghpanah, AR, Badiee, M, et al. Effect of intralesional verapamil for treatment of Peyronie's disease: a randomized single-blind, placebo-controlled study. Int Urol Nephrol 2009; 41:467. 
47 Hellstrom, WJ, Kendirci, M, Matern, R, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. J Urol 2006; 176:394. 
48 Jordan, GH. The use of intralesional clostridial collagenase injection therapy for Peyronie's disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 2008; 5:180. 
49 Gelbard, MK, James, K, Riach, P, Dorey, F. Collagenase versus placebo in the treatment of Peyronie's disease: a double-blind study. J Urol 1993; 149:56. 
50 Fitch WP, 3rd, Easterling, WJ, Talbert, RL, et al. Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease--a placebo-controlled pilot study. J Sex Med 2007; 4:477. 
51 Martin, DJ, Badwan, K, Parker, M, Mulhall, JP. Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol 2002; 168:2483. 
52 Riedl, CR, Sternig, P, Galle, G, et al. Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study. Eur Urol 2005; 48:656. 
53 Levine, LA, Newell, M, Taylor, FL. Penile traction therapy for treatment of Peyronie's disease: a single-center pilot study. J Sex Med 2008; 5:1468. 
54 Levine, LA, Newell, MM. FastSize Medical Extender for the treatment of Peyronie's disease. Expert Rev Med Devices 2008; 5:305. 
55 Gontero, P, Di Marco, M, Giubilei, G, et al. Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study. J Sex Med 2009; 6:558. 
56 Levine, LA, Estrada, CR, Shou, W, Cole, A. Tunica albuginea tissue analysis after electromotive drug administration. J Urol 2003; 169:1775. 
57 Di Stasi, SM, Giannantoni, A, Stephen, RL, et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol 2004; 171:1605. 
58 Greenfield, JM, Shah, SJ, Levine, LA. Verapamil versus saline in electromotive drug administration for Peyronie's disease: a double-blind, placebo controlled trial. J Urol 2007; 177:972. 
59 Ojingwa, JC, Isseroff, RR. Electrical stimulation of wound healing. J Invest Dermatol 2003; 121:1.
60 Muller, A, Akin-Olugbade, Y, Deveci, S, et al. The impact of shock wave therapy at varied energy and dose levels on functional and structural changes in erectile tissue. Eur Urol 2008; 53:635. 
61 Hauck, EW, Mueller, UO, Bschleipfer, T, et al. Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol 2004; 171:740. 
62 Hatzichristodoulou, G, Meisner, C, Liske, P, et al. Efficacy of extracorporeal shock wave therapy (ESWT) in patients with Peyronie's disease (Peyronies Disease)-first results of a prospective, randomized, placebo-controlled, single-blind study. J Urol 2006; 175(Suppl 4):320.
63 Palmieri, A, Imbimbo, C, Longo, N, et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie's disease. Eur Urol 2009; 56:363. 
64 Incrocci, L, Hop, WC, Slob, AK. Current sexual functioning in 106 patients with Peyronie's disease treated with radiotherapy 9 years earlier. Urology 2000; 56:1030. 
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snowydreams

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Pentox studies
« Reply #44 on: January 11, 2011, 10:36:56 AM »

Are there any other double-blind or placebo-controlled studies of Pentox for Peyronie's other than the Iranian study?
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George999

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Re: Pentox studies
« Reply #45 on: January 11, 2011, 11:22:28 AM »

Not at this time.  - George
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RoyRogers

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Mods, is there a consensus?
« Reply #46 on: November 30, 2011, 06:07:51 PM »

Hey guys,

I posted this in oral treatments because this sub-forum gets the most posts/views.

I'm wondering is there a consensus on available treatments?

For example, Is there a consensus that Pentox definitely works sometimes? That the VED definitely works sometimes?

How about a negative consensus? For example, is there a consensus that DMSO definitely does not work ever?

Is there any kind of definitive answers? Are there some treatments that you should definitely not waste your time with?
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Old Man

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Re: Mods, is there a consensus?
« Reply #47 on: November 30, 2011, 10:04:49 PM »

RoyRogers:

Based on my experience and that of others on and off the forum, the VED therapy works in most cases. Somewhere around the web it has been quoted as helping in about 80 to 90 percent of those who have used it.

Even if the VED therapy does not help with the curves/bends, hourglass effect and any other Peyronies Disease symptom, it does promote better blood flow into and out of the erectile chambers. In some cases, it has been reported to have restored the ability to have natural erections.

The above is just my 2 cents on the subject based on what I have learned over the years of having Peyronies Disease, ED and venous leakage.

Old Man
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Luciano

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Re: Mods, is there a consensus?
« Reply #48 on: December 01, 2011, 02:33:38 AM »

I think there is only consensus that some treatments might work...
There also is consensus that some treatments dont work at all.

But I think that all here agree that NO treatment works alone...

Usually people agree that a combination of: pentox, q10, low dose cialis and VED /Traction will give results to some of us.

But this will depend from individual to individual.

As to DMSO there are threads on that..  some say it helped them, some say its a waste of time and money.

Luc
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ppain

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Re: Mods, is there a consensus?
« Reply #49 on: December 01, 2011, 04:46:04 AM »

But I think that all here agree that NO treatment works alone...

Not so.  The reason people here tend to try compound treatments is that we have only one penis and the wish to maximize our chances of saving it.  If drug A taken alone works for 30% of men and drug B taken alone works for 30% of men, we hope that it's not the exact same 30% for each drug, and we hope there is no negative interference between the two treatments.  Then by taking both drugs together we figure there's somewhere between 30% and 60% chance we'll be helped, probably closer to 30%.  

Since this is a disease involving scar formation, a sensitive biochemical affair, we shouldn't just assume that there is no negative interference between drugs.  I'm taking Potaba + Pentox + CoQ10 and really worry that they'll cancel each other's possible benefits.  I've asked several doctors for their intuitions about this, without relieving my worry.  Dr. Safarinejad, author of the main studies on Pentox and CoQ10 did say that those two don't interfere negatively.

Almost all the drug research studies have been for single drug treatments.  They have definitely shown that Pentox taken alone works for some men and CoQ10 taken alone works for some men.  'Works' means significant reduction in curvature.  Rarely does a drug accomplish complete straightening.  In Dr. Safarinejad's studies Pentox reduced ventral curvature by 40% on average and CoQ10 reduced ventral curvature by 50% on average.  (Ventral curvature is my kind.)  Some treated men had more improvement than this and other men had less improvement and some men had an increase in curvature.  

The idea that taking both drugs will, for a particular man, result in a better outcome than both his taking the one drug alone and his taking the other drug alone has no foundation.  
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