0 Members and 1 Guest are viewing this topic.
QuoteIn this study, Hellstrom et al. have investigated the efficacy and safety of intralesional IFN-alpha2b in one of the few large-scale, blinded, placebo-controlled studies to address this type of therapy for Peyronies Disease. ... Furthermore, a spontaneous remission rate of 13% and a reduction of pain with the passage of time could confound assessment of the outcome.
QuoteSpontaneous remission may occur in about half the cases over several years.
QuoteThere is a plethora of treatments for this condition, telling you all you need to know about their efficacy. Spontaneous remission makes controlled trials difficult to interpret.
QuoteCertain numbers of cases will have spontaneous remission of the disease process.
QuotePeyronie's disease is one of the interesting urologic entities, whose etiology and pathogenesis as well as its therapy is not fully understood. Changes of collagen metabolism are under discussion, traumatic genesis has been described as well. Spontaneous remission is well known. Therapeutic measures include conservative management with a variety of drugs, each of which is not very effective. Operative strategies aim for correction of symptoms.
QuoteThe natural history of Peyronie's disease.Gelbard MK, Dorey F, James K.Division of Urology and Biostatistics, UCLA School of Medicine.The natural history of Peyronie's disease was evaluated in 97 men by means of a questionnaire. Disease duration ranged from 3 months to 8 years. Questions addressed pain, bending, ability for intercourse, over-all effect of the disease, psychological effects, treatments received and degree of disease progression. Approximately 40% of the patients found pain, bending, ability for intercourse and over-all effects to be unchanged during the course of the disease. Bending and ability for relations worsened in 40% of the patients during the same interval, while only 6% had worsening of pain. Of the patients 77% reported psychological effects due to Peyronie's disease, which improved in 28%, did not change in 36% and worsened in 36%. Over-all, 13% of the patients believed the disease to be one of gradual resolution, 47% believed there had been little or no change and 40% believed that the disease pattern was one of gradual progression. We found no statistically significant association between disease duration and spontaneous improvement in penile bending. A similar lack of statistical significance was found when improvement in a variety of categories was compared in patients who received no therapy versus those who received a variety of conventional medical therapies.PMID: 2231932 [PubMed - indexed for MEDLINE]
Quotebut it is documented in the case of Peyronies,
QuoteIf we are going to argue that Peyronie's can never heal spontaneously, then why do any of us think that anything we are going to do, or try to do, are going to make it heal?
QuoteBut the fundamental truth is that our bodies are in flux, and the conditions to form scar may change into conditions that favor healing. It may have to do with something like a balance of inflammatory mediators, or co-morbidities like diabetes or vascular disease coming under better control.
QuoteUnless we chose to redefine Peyronie's as an irreversible lesion when most discussions state that some spontaneous resolution does occur, I see no reason to keep arguing that point.
QuoteYou cannot at the same time reject recovery on the basis that the cells are not proven normal with a tissue examination under a microscope when in fact, the deformity is gone.
Quote from: Liam on August 04, 2007, 12:56:03 PMI just said it does not heal itself, not that it is an "irreversible lesion".
Quote from: WikipedaSpontaneous remission is a catch-all expression by the medical faculty for any healing that is not due to medical treatment. Cases of spontaneous remission are a good example of statistical outliers due to the large numbers of individuals alive and the corresponding incidences of disease. The term anecdotal evidence is often mentioned by medical researchers in conjunction with cases of spontaneous remission, since such cases seldom are part of a formal scientific study following scientific methods, but are instead described by those who directly experienced the healing in the form of testimony.Traditional medical practice ascribes the effect to rationally explainable influences that simply lack observation. Advocates of faith healing and alternative medicine contend that the expression is a convenient means for dismissing alternative sources of efficacy.
QuoteRegardless, it's not going to significantly change anything with the disease or how we approach it.
QuoteWhat really troubles me about your position is that it seemingly excludes the possibility of such underlying forces.
QuoteOnce we know WHY some people get better as opposed to others who don't, that is really useful information IF we can pin it down.
QuoteHow do you explain improvement, then, in placebo groups?
Quote from: Liam on August 04, 2007, 05:26:02 PMNow my question. If the process turns off, will the fibrotic tissue and/or plaque stay forever?
Quote from: Larry H on August 01, 2007, 03:23:42 PMHowever, there is one solid fact of importance and that is that the study indicated that 22% of the cadavers autopsied had tunical lesions. Now when I first read this my take was that these 22 men had undiagnosed Peyronies Disease, but when thinking about what asymptomatic, fibrotic lesions means I'm not so sure. My laymans simplistic definition would be "a non-diseased abnormal change to the tunica caused by trauma" (this also squares with the Lue paper suggesting the lesions developed from the natural course of aging and sexual activity). I stand to be corrected if I'm off base with my definition, but if I'm substantially correct does it mean that these men did in fact have undiagnosed Peyronies Disease, or the precursor to Peyronies Disease. Any thoughts?
Quote from: Liam on August 05, 2007, 12:09:55 PMIts hard to imagine a man making through life without a few dings on his tool . They don't all have to be Peyronies Disease....I can't believe 22% of the population have Peyronies Disease.
QuoteAsk the Experts about Erectile Dysfunctionfrom Medscape UrologySide Effects of Trimix TherapyQuestionI have a patient who is using Triple P as intercavernosal injection for erectile dysfunction. He found an article describing possible side effects (not Peyronie's) such as scarring and fibrosis. Is there evidence or concern for this outcome?Fred Freedman, MDResponse from Wayne J. G. Hellstrom, MD, FACS Professor of Urology, Tulane University Medical School, New Orleans, Louisiana; Chief, Section of Andrology and Male Infertility, Tulane University Hospital Medical Center, New Orleans, Louisiana Over the past 2 decades, self-injection therapy has proven to be both safe and efficacious, and is considered the best second-line drug therapy for the management of erectile dysfunction. The 3 vasoactive agents commonly used alone or in combination are papaverine, phentolamine, and prostaglandin E1 (PGE1 alprostadil).PGE1 (Edex/Viridal; Schwarz Pharma; Monheim, Germany, or Caverject; Pharmacia Corporation; Peapack, New Jersey) is the most widely used vasoactive agent because it is FDA-approved and the most researched. In the event of pain, which occurs in 30% of patients taking PGE1, or inadequate penile rigidity, clinicians may resort to off-label synergistic combinations, such as papaverine and phentolamine (bimix), or papaverine, phentolamine, and PGE1 (trimix).Fibrotic reactions with intracavernous injection therapy have been observed since the early 1980s. A variety of reactions, ranging from subcutaneous nodules, intracavernosal fibrotic areas, and penile plaques, have been reported. The occurrence of fibrotic reactions with the use of papaverine alone or papaverine/phentolamine combinations has ranged from 0.5% to 31% and appears to be correlated with the number of injections and duration of therapy.In addition to instructing patients to alternate the side and site of injection, there is a growing body of evidence that suggests that PGE1 causes less fibrosis. It is postulated that fibrosis is caused by production of key cytokines, with transforming growth factor beta 1 (TGFB1) being the most important. Of significance, recent studies have demonstrated that PGE1 suppresses the production of TGFB1, reducing the amount of fibrosis.Notwithstanding, patients on trimix combinations need proper instruction on the penile injection technique and routine clinical follow-up to identify new onset of fibrosis. In most cases, penile nodules that occur with injection therapy disappear within a few months of stopping.Posted 09/25/2002--------------------------------------------------------------------------------Suggested ReadingsLakin MM, Montague DK. Pharmacologic erection program. In: Hellstrom WJG, Erectile Dysfunction. The Handbook of Sexual Dysfunction. Lawrence, Kansas: Allen Press, Inc; 1999:70-74.Moreland RB, Traish A, McMillin MA, et al. PGE1 suppresses the induction of collagen synthesis by TGFbeta1 in human corpus cavernosum smooth muscle. J Urol. 1995;153:826-834. Shabsigh R. Intracorporal therapy. In: Mulcahy JJ, Erectile Dysfunction. Male Sexual Dysfunction: A Guide to Clinical Management. Totowa, New Jersey: Humana Press; 2001:245-251. Medscape Urology 4(2), 2002. © 2002 Medscape
QuoteIt has now been about 30 months since I stopped injecting and if anything, my fibrosis is progressive to this date. Can someone tell me that is TGF-B1 induced NON-Peyronies Disease fibrosis? Dr. Mulhall told me it was Peyronies Disease.
Quote from: Liam on August 06, 2007, 12:24:10 PMLet's say. for the sake of discussion, two people start with identicle fibrotic lesions from trimix (or other) injections. One progresses and one heals. This indicates two processes at work.
QuoteReally Do I understand you to say that If two people start with the same clinical presentation, and then progresses differently that it means they had different diseases
Quoteif it gets better it cannot be Peyronies Disease
Quote from: Liam on August 07, 2007, 11:15:31 AM* When they get better.....well you know the rest.
Quote from: Tim468 on August 15, 2007, 11:40:29 AMSo, I think that Induration that comes and goes is certainly not calcific, and probably not "fibrous" meaning characterized by (lots of) fibrotic dense collagenous tissue, but is more likely abnormal tissue (still probably fibrotic) that has some vasculariztion that allows swelling and shrinking of soft tissue. It seems by your history that it is almost certainly inflammatory.