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Author Topic: VERAPAMIL Injections results (Positive & Negative)  (Read 37565 times)

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james1947

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #100 on: January 01, 2013, 02:51:15 AM »

Very good results from Verapamil Injections in combination with using VED and Traction Device.
Quote from DO post:
Quote
I am being treated at Columbia Medical center in NYC. With Verapamil injections and with use of a pump 30 minutes a day and the andro extender( 2-4hours per night) for the last 90 days, I have had a 30%  improvement. The painful erections are gone! Dr. Peter Stahl is so professional and good at giving injections, I am so lucky to have found him. I travel from Connecticut to NYC  every 2-3 weeks! He thinks another 90 days of therapy will be needed and I will follow his suggestion. If you could see how much 30% is compared to what it was ...it is major!


James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

BrooksBro

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #101 on: January 01, 2013, 08:09:28 AM »

As with many medications and therapies, improvement seems to be on an individual basis.  The physicians assistant that did my 12 verapamil injections said patients fall into one of three categories: significant improvement, some improvement, and little improvement.  You don't know your outcome until you try.
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funnyfarm

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #102 on: January 01, 2013, 11:01:16 AM »

The posts I have read on the forum seem to mirror your PA assessment.   Has anyone been injured or had worsening symptoms from the VP injections.   From what I have gathered so far, it seems safer than xiaflex.
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When you are in tune with the unknown, the known is peaceful.

james1947

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #103 on: January 02, 2013, 09:40:43 PM »

BrooksBro

  ;D :) :(

James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

peter123

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Re: Injection w/ new doc - moving/shaking the needle
« Reply #104 on: August 12, 2020, 09:15:44 PM »

You @old man make me. Ridiculously suicidal. Destroying every hope I have and had
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THIS USER HAS BEEN BANNED FROM FORUM FOR REPEATED RULE VIOLATIONS He never had Peyronies Disease but has body dysmorphia and his pastime was to attack all treatments, medical resources, and opinions.

TonySa

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #105 on: August 12, 2020, 10:14:02 PM »

Peter, you’ve been suicidal ever since you joined here.  Please take responsibility and seek treatment rather than blaming others.  Also, your off topic of this thread.  IMO
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PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

peter123

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #106 on: August 13, 2020, 12:46:55 AM »

I have an appointment tomorrow. It's not like I'm doing nothing. Sorry for being off topic
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THIS USER HAS BEEN BANNED FROM FORUM FOR REPEATED RULE VIOLATIONS He never had Peyronies Disease but has body dysmorphia and his pastime was to attack all treatments, medical resources, and opinions.

Bud luck

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #107 on: August 15, 2020, 09:33:47 AM »

I don't trust the medical community at all, all the medical studies and articles are bias. Doctors want to make money by lying. Recently I read a study done by Dr Levine saying that all the patients that had narrowing, dentation, hourglass deformity and "hinge effect" got better with Verapamil injections. So I went to the Urologist and I show him the study, he said that the injections can make my Peroynes worst. Why there is no one that find the cure for this disease
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My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My Erectile Dysfunction is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

peter123

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #108 on: August 15, 2020, 02:09:51 PM »

your urologist is probably an idiot. nr 1 peyronies expert in the world probably knows a little better. and how should they make you "worse". there is no single study suggesting it makes it worse. take any treatment and you'll gonna find some who got worse from it. its one of the most mentally haunting diseases you can find
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THIS USER HAS BEEN BANNED FROM FORUM FOR REPEATED RULE VIOLATIONS He never had Peyronies Disease but has body dysmorphia and his pastime was to attack all treatments, medical resources, and opinions.

peter123

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Re: Has Anybody Had Verapamil Injections-Results?
« Reply #109 on: August 27, 2020, 08:51:13 PM »

I had 6 of them and am convinced it made my peyronies worse.  Let me explain.  The original plaque seemed to have been reduced in size (which may have happened on its own).  However, the numbing shots added a new larger plaque right below the initial plaque.  It started to develop after the 3rd injection (out of 6).  I'm pretty confident it was the shot that did it because the numbing needle was being poked in several locations.  I went to see Dr. Levine on a trip to Chicago to get his opinion.  He injected me with some solution to get me erect for the exam.  Three months later I have a small plaque at that injection site.  I don't think it is worth the risk.  Search this forum and you will find more negative posts about it than positive.


can't make this crap up. any given treatment that you can come up with people are coming in in droves suggesting it made them worse. absolutely ridiculous. especially the suggestion that the numbing shots gave you peyoronies. this forum is worse off because of opinions like this "I dont think any treatment is worth it" why dont we just all get an implant peyrosucks
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THIS USER HAS BEEN BANNED FROM FORUM FOR REPEATED RULE VIOLATIONS He never had Peyronies Disease but has body dysmorphia and his pastime was to attack all treatments, medical resources, and opinions.

peter123

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Re: Has Anybody Had Verapamil Injections-Results?
« Reply #110 on: August 27, 2020, 09:07:41 PM »

The last three posts have echoed what I've heard dozens of people tell me over the last couple of years.  I have no interest in proving verapamil injections work or don't work.  When we took a look at topical verapamil in our PDLabs report we couldn't conclude it worked there either.  No one has yet to show me any study that proves verapamil does anything to dissolve the plaque or do anything positive for peyronies sufferers.  With Pentox we at least have a few studies showing it works.  I wouldn't inject anything into my penis until I saw at least a handfull of studies that showed the drug being injected actually worked.  I think the injection itself could cause minor damage, but would be worth it if the drug being injected actually worked, thats my own personal view on the matter.

Comebackid

nothing of this is true. there are actual studies on verapamil while the only rct on pentox has been retracted
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THIS USER HAS BEEN BANNED FROM FORUM FOR REPEATED RULE VIOLATIONS He never had Peyronies Disease but has body dysmorphia and his pastime was to attack all treatments, medical resources, and opinions.

TonySa

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #111 on: August 27, 2020, 09:13:42 PM »

There’s a study which I thing compared injection of xiaflex, verapamil  and water.  Some improvement in all, and the most improvement in order listed.
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PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Drew

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #112 on: April 05, 2021, 04:24:45 PM »

I found this YouTube video of a May, 2020 lecture by Culley Carson (Prof. Emeritus at U.N.C.) with an overview of all possible Peyronies Disease treatments. After 5 minutes of basic history, it starts to get interesting.  Not sure if this post belongs here, but I wasn't sure where else to post or how to start a new topic. Moderators can move it to another place if they see fit, but it helped put options in perspective for me.

https://www.youtube.com/watch?v=vCtQTQ-l_bA
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70 y.o., Peyronies Disease start 11/2019, 85 degree, verapamil series, RestoreX traction, EV, manual, infrared, oral meds, married

Bud luck

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Re: VERAPAMIL Injections results (Positive & Negative)
« Reply #113 on: September 17, 2021, 10:28:40 PM »


Injection therapy for Peyronie’s disease: pearls of wisdom
William O. Brant, Amanda Reed-Maldonado, and Tom F. Lue

Additional article information

Peyronie’s disease (Peyronies Disease) is a localized connective tissue disorder of the penis that may result in formation of plaque, penile deformity, pain, erectile dysfunction and emotional stress. It can affect the tunica albuginea, septum, or intracavernous struts leading to curvature, shortening, indentation, or hourglass deformity of the erect penis. Because it is a localized disease, a focal therapy seems to be the most rational approach. Additionally, patients are understandably hesitant to have surgery on the penis. This commentary summarizes the combined experience of verapamil and Xiaflex injection by the authors. Other practitioners use interferon and other medications. We do not use these and therefore have eliminated this from the discussion.

Verapamil injection
Although not FDA approved for use in Peyronies Disease, verapamil has been used commonly for many years (1-3). Verapamil is administered as 10 mg in 10 cc of NS, every 2 weeks. Our practice is to perform a penile block, use a 21 g needle to administer the medication, and to give six injections prior to reevaluation of the clinical situation. If there is good improvement but not quite enough, the patient may elect to have another six injections of 20 mg in 10 cc.

Although the number of patients receiving verapamil has decreased since the FDA approved Xiaflex, there still is a patient population that seems to benefit from this medication. Unlike Xiaflex, verapamil is given in a larger volume. In other studies, injection of saline alone has a good response rate, and it is unclear to us the relative role of the drug itself versus the hydro-distension effect of the large volume of saline.

Cost
Verapamil is substantially cheaper than Xiaflex, and thus may be used when insurance coverage or other financial considerations prohibit the use of Xiaflex.

Pain
Although Xiaflex is not uncomfortable to receive, some patients have significant pain for up to 48 hours after the injection, with rare patients having discomfort beyond this period. Verapamil is more painful to receive, likely due to the volume of fluid, but is not significantly painful thereafter. It hastens the resolution of Peyronies Disease-related pain. Although many studies have noted that resolution of pain is an eventuality in Peyronies Disease patients, it is often a considerable source of bother in those patients who have it, and resolution of pain as rapidly as possible is a very desirable outcome. We have found that Xiaflex may be extremely uncomfortable in patients in whom pain is a predominant symptom.

Non-curvature deformities
Verapamil seems to have a superior outcome for deformities that are not purely curvature in nature. These include waists, hourglass, and areas of instability or hinging. Although the deformity in these cases appears lateral, a lateral plaque is relatively uncommon and these defects usually are associated with a typical, dorsally located plaque. Our surgical experience has shown us that the area of indentation is a contracture, rather than an area of underlying corporal fibrosis. The dorsal plaque is associated with abnormalities in the intracorporal struts, which causes local contracture. Our theory is that verapamil and/or the associated hydrodistension allows the struts to expand and thus corrects these types of abnormalities.

Stage of disease
With stable disease and heavy plaque calcification, verapamil seems to have much less efficacy than when used in the context of early disease and softer plaques. Overall, we prefer to use Xiaflex in the context of stable plaques.

Xiaflex (collagenase clostridium histolyticum) injection
The main difference between Xiaflex and other injectable therapy is Xiaflex’s ability to dissolve the collagenous fibrous tissue within the plaque (4,5). However, Xiaflex also carries the risks of hematoma and penile fracture due to thinning/softening of the tunica albuginea. The modeling/stretching maneuver to expand/lengthen the contracture following Xiaflex injection is as important as the injection itself. Clinical trials have clearly shown that the combination of injection plus modeling has the best results in reduction of penile curvature.

Location of injection
Anatomically, the thinnest portions of the tunica albuginea are on the lateral aspect (3 and 9 o’clock positions) and between the corpus spongiosum and the cavernosa (6 o’clock position). At this time, the company does not recommend injection to the ventral plaque for fear of damaging the urethra. After more than 1,000 injections, we feel that the ventral plaque is not necessarily a contraindication as long as the plaque is clearly palpable, not calcified, and thick (>0.3 cm by ultrasound measurement). We have also found that ventral plaques respond, in these situations, as well as dorsal plaques. The urethra can always be spared as long as the plaque can be firmly pinched between the thumb and index finger. The injection should be directed to the 5 and 7 o’clock positions not 6 o’clock position. We have seen herniation, hematoma, and micro-rupture of the lateral tunica after injection of Xiaflex to the lateral aspect of the penis. Therefore, we do not recommend Xiaflex injection to lateral aspects of the penis for men with true lateral curvature. We have not injected Xiaflex to sites of intracavernous or septal fibrosis and therefore cannot recommend it at this time.

Injection technique
The instruction from the company is to insert the needle to the plaque and slowly withdraw while injecting Xiaflex solution. We feel that this may “waste” part of the injected Xiaflex because it is very difficult to be certain that the needle is still inside the plaque if one is injecting while withdrawing. Additionally, we have seen higher rates of ecchymosis and swelling, likely due to extravasation of Xiaflex outside of the plaque via the needle track. Instead, we prefer to forcefully inject Xiaflex to the plaque against the high resistance (Figure 1A,B). We also prefer to inject into at least two sites within the plaque to avoid rupturing the thin plaque with the total amount 0.25 mL. Of course, a large and thick plaque is not a problem with 0.25 mL.

Figure 1   
Figure 1
Penile ultrasound 5 minutes after Xiaflex injection into the plaque showing increased echogenicity from micro-bubbles in the plaque in (A) transverse view and (B) longitudinal view.
Since the volume of Xiaflex is small, it is important to pick the best spot for injection. This can be done in several ways, but we prefer to compare the palpable plaque with the patient’s erection and choose the site that corresponds to the site of maximum deformity. One author prefers to have the patient mark this site with a permanent marker the day prior to the injection so he has the correspondence of the palpable plaque, the patient’s subjective view of the area of maximum deformity, and the view of this area as seen on auto-photography. The other authors prefer to inject a vasodilator (most of time with 0.05 mL of phentolamine/papavarine solution) and self-stimulation to induce erection and mark it with a marker before giving the local anesthetic.

Patient taking anticoagulants
Discontinuation of an anticoagulant or antiplatelet medication for 5 days prior to injection is preferred. If contraindicated (e.g., cardiac stents that require aspirin), we teach the patient to apply a loose compressive dressing and change this daily for 2-3 days to prevent excessive ecchymosis.

To operate or not to operate
Bleeding during or after nocturnal erections can present with ecchymosis (bleeding within the subcutaneous tissue) (Figure 2) or hematoma (blood clots between Buck’s fascia and tunica) (Figure 3). In both conditions, a penile ultrasound to confirm the diagnosis is all that needed (Figure 4). Ultrasound examination of the tunica is operator dependent, and such examinations should only be done if the examiner is comfortable with this. On the other hand, if ecchymosis /hematoma developed suddenly during or after sexual intercourse, penile fracture is the most likely diagnosis until proven otherwise. If penile ultrasound confirms a sizeable tunical rupture, surgical repair is recommended.

Figure 2   
Figure 2
Ecchymosis of penis and pubic area 3 days after Xiaflex injection.
Figure 3   
Figure 3
Hematoma at dorso-lateral aspect of penis 7 days after Xiaflex injection.
Figure 4   
Figure 4
Penile ultrasound 4 days after Xiaflex injection in a patient with hematoma. No obvious rupture/disruption of the tunica albuginea is noted.
Hourglass deformity or unilateral indentation
If the plaque is palpable at the dorsal or ventral aspect, we have injected Xiaflex into the plaque followed by daily stretching with a vacuum erection device with reasonably good results. If only lateral plaque is palpable, we do not recommend Xiaflex injection anymore because we have seen hematoma and herniation after Xiaflex injection in several cases.

Injection schedule
The package insert recommends two injections 1-3 days apart, followed by daily stretching and manipulation by the patient for 6 weeks. In some patients who developed severe skin edema and ecchymosis, we have waited up to 1 week to give the second injection. In some men with small plaque, we elected to give one Xiaflex injection followed by modeling to prevent potential tunical rupture.

Conclusions
If a patient is interested in the most definitive, rapid treatment of a stable Peyronie’s deformity, surgical approaches continue to be the gold standard. However, most of our patients are understandably hesitant to pursue surgery and are willing to undergo the inconvenience of repeated injections to achieve a less invasive approach to their deformities. Our combined experience with over 1,000 patients receiving verapamil and over 400 patients receiving Xiaflex has shown us that these medications can be very successful and satisfying, but rely on (I) careful consideration of the patient’s individual characteristics, (II) adherence to good techniques for injecting and (III) patient’s willingness to comply with their at-home physical therapy. Verapamil is appropriate for less stable disease and in softer plaques, whereas we prefer Xiaflex for more stable disease and denser plaques. We avoid Xiaflex in true lateral plaques (which are very uncommon). For technique, a fanning technique is appropriate for verapamil, administered via a 21 g needle for maximum hydrodistention. For Xiaflex, the needle should remain within the densest portion of the plaque, corresponding the point of maximum deformity, in order to minimize extravasation and subsequent ecchymoses. The best results are seen when patients comply with manipulation of the plaque, via a combination of stretching, gentle bending of the erect penis in the opposite direction of the curve, and massage of the plaque.

Acknowledgements
None.

Footnotes
Conflicts of Interest: The author TF Lue was a consultant to Auxillium Pharmaceuticals, Inc., the others have no conflicts of interest to declare.

Article information
Transl Androl Urol. 2015 Aug; 4(4): 474–477.
doi: 10.3978/j.issn.2223-4683.2015.08.09
PMCID: PMC4708590
PMID: 26812930
William O. Brant,1 Amanda Reed-Maldonado,2 and Tom F. Luecorresponding author2
1Department of Surgery (Urology), Center for Reconstructive Urology and Men’s Health, University of Utah, Salt Lake City, USA; 2Department of Urology, University of California, San Francisco, USA
corresponding authorCorresponding author.
Correspondence to: Tom F. Lue. Department of Urology, University of California, San Francisco, USA. Email: [email protected]
Received 2015 Aug 15; Accepted 2015 Aug 19.
Copyright 2015 Translational Andrology and Urology. All rights reserved.
See the article "Collagenase Clostridium Histolyticum: A Review in Peyronie's Disease." in Drugs, volume 75 on page 1405.
See the article "Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies." in J Urol, volume 190 on page 199.
This article has been cited by other articles in PMC.
Articles from Translational Andrology and Urology are provided here courtesy of AME Publications
References
1. Abern MR, Larsen S, Levine LA. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. J Sex Med 2012;9:288-95. Erratum in J Sex Med 2012;9:945. [PubMed] [Google Scholar]
2. Alizadeh M, Karimi F, Fallah MR. Evaluation of verapamil efficacy in Peyronie's disease comparing with pentoxifylline. Glob J Health Sci 2014;6:23-30. [PMC free article] [PubMed] [Google Scholar]
3. Chung E, Garcia F, Young LD, et al. A comparative study of the efficacy of intralesional verapamil versus normal saline injection in a novel Peyronie disease animal model: assessment of immunohistopathological changes and erectile function outcome. J Urol 2013;189:380-4. [PubMed] [Google Scholar]
4. Dhillon S. Collagenase Clostridium Histolyticum: A Review in Peyronie's Disease. Drugs 2015;75:1405-12. [PubMed] [Google Scholar]
5. Gelbard M, Goldstein I, Hellstrom WJ, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol 2013;190:199-207. [PubMed] [Google Scholar].
So Verapamil suppose to work on non curvature deformities
Logged
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My Erectile Dysfunction is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46
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