Peyronies Society Forums

Hi -

I noticed my new uro was shaking the needle quite a lot while he was injecting.  What do you guys think?  Have your docs done this during VIs?  

MikeSmith:

Some docs do use the jab, shake and twist method of injecting verapamil for Peyronies Disease. However, from the results of my 12 injections by a very qualified uro experienced in Peyronies Disease, I would not ever again allow any injection in my most prized possession. I was given 12 injections of verapamil before realizing that they were only giving me more nodules, plaque and a very sore penis each and every time.

Maybe they work for some, but for me, it was wasted dollars and time plus the docs charges. I do have good insurance, but I prefer to spend my insurance dollars in a better manner than something that still does not have a very good track of success.

The above is just my personal observations as well as others I know who have had the same experience that I did.

Old Man

To Mike Smith - Also had Verapamil injections. Agree 100% with Old Man.

Thanks guys...damn this is frustrating... there is an article claiming 60% had good experiences but of course the last thing I want is more plaque.  

Btw, I was in SEVERE pain today when the lidocaine wore off - I almost went to the ER.  I had to take 2 percoset... I have no idea what he did .  It felt like someone took a knife and stabbed me repeatedly in the penis... which is basically what he did with the needle I assume.  I have never experienced pain like that in my life - and now I have this giant lump running around the mid-shaft like a tire.  Don't know what that's about...

I don't get what the docs are thinking...if this causes more trauma, why are they doing it?  Is that 60% number really "truly" satisfied patients (in the publication I read from a urology journal)?  I don't think there is 1 poster here who is happy with VIs...is there?  And I know my curve got worse after my first one for sure (though that could also be due to progression of the disease).  Hourglassing did not get worse.  

I certainly wouldn't object to stopping these painful & time consuming injections... I just am hoping to be in the 60% of people who saw improvements... my plaque is still "soft" my Dr. says - so maybe it would prevent more calcification... but the pain today was so severe I feel like my whole penis is gonna turn into 1 big scar.  

Mike I hate to say it, but any injection is bad for the penis. Many here got peyronies from the injection to get erection.  Reason why docs do it- 1. They get paid big bucks anytime they inject something.  2. They dont know of anything else.  They are just following  learned procedures from medical class.  Lenny

I don't want to come across as disagreeing here.... but let's get the facts straight.

1. First off, Dr. Levine also uses the "sewing machine" method for his VI injections. I had 6 and watched during each one so I can attest from personal experience. Levine stated this this was his improved delivery method over the straight injection type. The objective is to break up and surround the plaque as much as possible with the Verapamil. It would only make sense that any of his "trainees" would do the same.

2. The injection does cause temporary trauma. There is some pain and bruinsing afterwards, but usually subsides in a few days. Why would one subject their penis to this...... because the trauma in most cases is temporary, and Levine does boast a 60% rate in those who see "some improvement".

3. Have VI's done more harm than good? In certain people yes. I clearly respect Old Man's bad experience and point of view on this matter. There is always a risk with any type of treatment. And there have been a few that have had bad experience with VI's. I'm always amazed at how this gets turned into "most".....  or "almost everyone", etc.  Did the VI's help me?...... no. I was in the 40% who didn't see an improvement, but I was willing to try all options. But I can tell you from personal experience that I had no ill side effects from the VI's. For me it was worth the try. And I for one believe Levine's results so I think there are many men out there who had positive experiences with the VI's.

So the bottom line is that the injections are not fun, a bit of pain and temporary trauma. Are there some documented cases of long term trauma..... yes. But we can't ignore the published 60% improvement rate. We have often asked ourselves where these 60% are at, and why we don't have more success stories on our forum as a result. But wouldn't it make sense that if they did see improvement that they likely are not surfing the internet for a site like ours looking for help?

my .02 worth

I can agree with all of you on both sides of the point. I had 12 injections last year. I had a lot of pain, bruising, and swelling. It will be one year next month since my last injection and my penis is still bruised. While I was taking the injections I was way too sore and bruised to even use the VED afterwards.

After my 8th injection I started to experiance the shrinkage factor. Iam not sure if it was just timing or the injections theres no way to tell for sure. I went through with the injections after a lot of thought because the doctor said its all they had to try and decrease the pain and maybe stop the progression. When I got finished I didnt get anything from the injections but a bruised penis and a lighter wallet.

Do I think they mite of did more harm I think quite possabily. Would I do them again no I would not. IMO I think they get more of the effect by the needle swiss cheesing the plaque then the injection its self.

The doctor who performed my injectons also knew and followed Levine. Each plaque they would push the needle around in 15 to 20 times a piece.

This is just my experiance I wouldnt tell someone to do it or not to do it. I think you have to really sit down and think it through and decide for ones self. In the end I did it and now I dont have to wonder well if I would of done it would I be better would it of worked etc. Now I have it crossed off my list and makes my decisions easier with less choices. As Les said they also gave me the odds going in to it.

Thanks everyone for giving your thoughts on this.  I appreciate it.  I understand there are clearly two sides so I am glad to hear both.

Woodman, you're still bruised?  Do they have any idea why?  That's kind of scary.  I had that happen to my eye once - it went away around 4 mos.  I thought it was going to be permanent... at least it made me look like a tough guy...ha.   A black and blue penis is a little different.

It's interesting that my VERY first uro (Dr. Vitimin E, I will call him...since that's all he told me to do & come back in 6 mos)  said the shots would be "unethical" to do as a first line move.  Now, I can see his point.  I guess unless you try the first step, going more invasive is not the right thing to do.  However, I played this game with my sinuses for years - constant medrol & levaquin... and finally gave up and had surgery - which solved the problem.  So, I figured - let's skip the Rx nonsense (pentox was making me jittery...not sure if arg does much, vit E isn't proven, etc...) and just go to the injections, fast size, and VED (which I've had some trouble with since I haven't shaved.)  

I agree that the happy 60% would probably not be on this board since they likely moved on with their lives.  Also, for those of you who did not get results - were you in a later stage?  I got this in December so I am thinking maybe the VI will prevent the early scar from calcifying... but it's all just theoretical.

When I saw Dr. Mulhall he told me that he had no where near the 60% success rate (it was more like 25% if I remember correctly.) There was also a considerable downside risk (I don't remember the percentage although I think it was around 15%).  I decided not to go with the injections.

ohno

The downside to penile injections for ED are peyronies and corporal fibrosis. I tried the injections and they only made my condition worse.

Most me that try quit very quickly. There are some few success stories but they are very few.

My recommendation is not to use injections, and if you do know the risk.

Jackp

Yes Mike, I actually went to see Levine after a while and asked him about the bruising. He explained to me that the bruising can take up to a year to go away. I dont think its common from what I gather. I think juist like you having a tremendous amount of pain with the injections.

I think each person is a little diffrent and there tissue and make up is too. I too also had to quit taking Pentox. I had a lot of swelling too after the injectons. After each one the swelling was diffrent. I would contact Dr. Levine and ask him about the pain & swelling etc. that you are experiancing.

I had been using fast size 4-6 hrs a day prior to the inejction... maybe that made it more prone to get sore?  I don't know when I'll be able to use it again... not now certainly.  

I just found a link on this site showing a small survey of people who got VIs... and again, most were unhappy or saw no results.  I don't know if I am going to continue w/ this.  

I'm done with the VIs (verapamil injections). The total length has gone down by 3/4" to 1" (hard to measure due to curve and ED when holding a ruler).  The upward curvature due to the dorsal plaque is almost 90 degrees.  Before, it sort of still looked almost normal at 30 degrees.  Now, it is clearly not in the normal range at all.  The dorsal plaque is much harder than it was before the injections, and it is bigger.  The side plaques seem to be less noticable but the narrowing and hinge effect is still there...actually, it has gotten worse even though it is harder to feel the plaques.  Girth beyond (toward the head) the plaque has been reduced by 1/4" roughly...so that part is narrower too.  

During this time I have taken pentox 0-2x per day - It affected my sleep so in total, I went through about 150 pentox tabs in 5 months w/ a similar # of 500 mg arginine tabs - probably not a theraputic level.  I haven't been that careful to count my time using fastsize, but it's probably around the 40-50 hour range.  I have only started the VED use regularly in the last week or so since I had a lot of confusion w/ it earlier.  

So, I'm not sure if I'd recommend the VIs to someone or not bc I don't know what would've happened had I not had them...and I was also in the "ideal" stage (the doctors thought) to respond to VI (pre-calcificaiton).  However, it didn't work...and it did not increase girth, contrary to the 100% in Levine's 14-person study (though I would technically need 7 more for that to be fully comparable... I don't want to continue).    I would probably recommend the VED first - before even fast size... just based on what I've read on different boards and I think it's more convenient to use that for 30 minutes than wear the FS device for 4 hrs per day at least.  The VED is just a little intimidating at first and hard to get exactly right so I set it aside for too long after I got it.  Now that I can use it properly, I am pissed I did't just start with that since it is the least invasive and traumatic method to approach all of this and I had a circumfrential scar which would've benefitted from the 360 degree stretch.  I think fastsize might be aggrivating the dorsal plaque, potentially even lengthening it.  Anyway, I was putting off taking my "after" pics until a few days ago but I did and they're just pretty bad.

Sorry to hear about your experience. I am never going down that path - and like you, there is only one of me, and I will never know what different steps along the way might have led to, if taken.

Tim

I was slated for a 6-injection course of treatment in the fall of 2008, at a rate of one injection per month. My curvature was to the left about 60 degrees, plus I had a pronounced ring of scar tissue causing a bottleneck about 3" from the base of the penis. Pre-Peyronies Disease size was an even 8" erect.

The injections were very painful. I had some concerns about how the urologist decided where he would inject. No tests were done - no ultrasound, not even an examination of the erect penis.

After the first 3 injections there seemed to be some softening of the plaque. Two injections had been to the relatively unaffected side of the penis and one injection to the affected side.

The fourth injection was also into the least-affected side. It caused haemorrhaging. My whole penis turned black. Afterward, the scar tissue from the haemorrhaging plus the natural progression of the disease meant that I was now not only bent to the left but twisted. The bend stabilized somewhere around 160 degrees. Yes, that is not a typo: I bent to the side so much that my penis was facing back at me, almost a full circle. No way of measuring length - the astonishing part was that erections were still possible. Unfortunately, the pain was severe and sexual activity was not possible.

I just had graft/plication surgery on July 26th.

Thanks for sharing your account brightdog. I'm pleased that you're now in a much better position post surgery. I hope more men continue to both positive and negative verapamail injection posts, because others may well benefit from from as part of their decision making process. From a personal perspective, I've always been quite scared of the idea of anybody injecting my penis with anything. I'm not saying that it's something I'd rule out if the right treatment came along in future, but I wouldn't opt for verapamil injections.

I just read your 'My History' post. It sounds like you've been treated really badly by lots of medical professions and haven't had much luck with your condition. Here's hoping that the surgery is successful and the start of a new beginning.

Wow brightdog, i hope the surgery went ok for you.  I can't believe that happened w/ the injection.  Do you have any updates from surgery?


I also wanted to add to my initial assessment of the verapimil injections...  I am the 2nd person to report a discoloration of the penis (black and blue) that still has not faded - 2+ months after the last injection.  And, after seeing my ultrasound I am more convinced that the injections caused more problems and trauma.  There was zero benefit...and all that happened was that I got more calcium deposits everywhere.

Quote from: MikeSmith on August 21, 2010, 02:15:21 AM
Wow brightdog, i hope the surgery went ok for you.  I can't believe that happened w/ the injection.  Do you have any updates from surgery?

There were a few mistakes made at the hospital with regard to blood thinners and dressings, and I ended up with an infection that slowed down my healing. So here I am on day 31 post-op. There is no pain - hooray. However, there is also no real erection. At this point, I would not be able to have intercourse. Mind you, the stitches have not dissolved. The scabs on the head finally washed off today, so at least I am starting to look more normal - except for those clear stitches sticking out all over.

I have an appointment with the specialist on September 8th. He has already recommended traction, but without an indication of when to start. I couldn't start it while I still had unhealed wounds, but I am thinking this weekend might be the time.

I am trying not to panic. I understand the recovery of function from this operation takes time and therapy. But I'm getting older by the minute and would like to use my equipment before I'm written off!

Quote from: Brightdog on August 26, 2010, 05:56:39 PM
I have an appointment with the specialist on September 8th. He has already recommended traction, but without an indication of when to start. I couldn't start it while I still had unhealed wounds, but I am thinking this weekend might be the time.

I am trying not to panic. I understand the recovery of function from this operation takes time and therapy. But I'm getting older by the minute and would like to use my equipment before I'm written off!

Hi Brightdog - Maybe you shouldn't start traction when you're able to achieve an erection. It may be that the recent happenings concerning your member have reached such a point that the healing process is takings its time. Also, remember that the VED is capable of helping your achieve an erection, so it you go too long without having one, that might effectively kick start things. Also, ED meds and supplements have been lifesavers for many men here, so hang in there are hopefully things will work out for you. Hopefully your specialist will help with any concerns you have, so I hope the appointment goes well!

Hey everone...oldman,....lwillisjr...et.al

I'm back on the board. Update:
I havent done a thing but sulk about my condition. I guess it seemed hopless to me from all the reading. There just aren't a lot of success stories here to give much confidence
in pursing treatment. But one that that has puzzled me and have been wondering about. I read a lot of posts that others leave talking about feeling nodules...plaque...etc.
My unit is about 80 degrees bent to the left. No twisting...no coke bottleing. But the darndest thing is...I cannot feel ANY hard tissue. Nothing. Yes...I did used to be straight as an arrow about 3 yrs ago. From my estimation...my condition has stabilized now and has been bent to this degree for about a yr.  I have no E.D.

However, I am back on the see-another-Uro-bandwagon.  This will be my third Uro coming Nov. 24th. I live in Houston. I have pretty much decided I want to forgo any injections, topical-scam cream, etc.   Any thoughts on my situation?

Welcome back.....  I don't know if this helps but there is a Dr. who has had poasitive comments here from the Houston area. I believe it is Dr. Lipshutz  (Don't know exact spelling so apologize). I'm sure you can search and find him. I think the first name is Larry.

not9inches- If you dont mind saying witch doctor did you chose to see on the 24th. Iam curious cause Iam in Houston too and am always looking for new doctors dealing in our condition in the Houston area.

Ive got an app. to see Dr. Lipshutz.  I'm not too sure about any injections however, Im wondering if he does surgery.

Dr. Lipshultz does plication and implant surgeries only. Hes doesn't do any incision or excision and grafting surgeries. He does follow Dr. Levines approach. His PA Mike Shoemacher is a nice person and will give you time to ansewer your questions if you speak to him in your visit(s).

Dr. Lipshultzs usually has his PA or an intern come in to get your history and examine you. Then after they are done he will come in to see you. The doctor is usually pretty busy so he moves in and out kinda quickly in my experiance so I would suggest to think of all the questions you would like to ask before hand and write them down. This way you don't forget them once your in the office.

If you have a appointment in the middle of the day and its your first visit be sure to allow for time to find parking etc. In the middle of the day the parking garages get pretty full in the medical center.

Please post back here after you see the doctor and tell us about your experiance.

If you have any questions about the doc etc. feel free to ask I would be glad to ansewer them if I can.

Good luck with your visit on the 24th!

Woodman

I have my first appointment with Dr. Levine in 3 weeks.  I hear a lot of men here have seen him before, and I understand his approach is usually verapamil injections, pentox, and traction.  I really want to get on pentox, and perhaps give traction a try, but has anyone really had any luck with VI's?  It seems as if no one has, or even more frightening a worsening of their Peyronies Disease.  If no one sees good results, why Dr. Levine still give them?  There must be a significant group of men not represented on this forum who have had success with it.  Just wondering what everyones thoughts were on this.

Levine will tell you that 60% of his patients see improvement. But it isn't just the VI's. It is a combination of Pentox, traction, and the VI's together. He believes this combined approach is most effective.

You will find guys on this forum who have had bad experience with injections, but I don't believe Levine was the one that did these. You will also find many like myself who had the VI's but did not see any improvement. And I also id not have any negative side effects from the VI's. I was willing to try whatever it took.

Les

My VIs showed some mild benefit before becoming a disaster (see my story in the relevant thread). I am not sure I can blame the procedure, though. I suspect the doc was not at his best when he was treating me (if you wish, you could translate that as "wouldn't listen and was possibly inebriated").

The treatment has been adopted as standard because of the absence of proof of the effectiveness of other treatments. And I don't know what it's like where you are, but where I live you have to do what the doctor says or you have trouble getting any treatment. That is changing - patients are learning that they can say "No" and the doc has to listen.

If you have a good doctor and you trust him, then he must have a solid belief the VI has a good chance of success.

willis-

Yes I have read that his success rate for the treatment is around 60%.  Im curious as to what the success rate is with just pentox and traction, I'm willing to bet it's around 60% as well.  I think most specialists still use VI's, just because it works in a theoretical sense. 

brightdog-

That is one of my biggest fears.  I have the type of Peyronies Disease that seems to inflame the tunica on the sides and ventral areas about half way up the shaft, so I get the hard flaccid and "waisting" that many talk about on here.  After hearing some of the other men's conditions, mine actually seems pretty mild.  I just have some hourglassing in the flaccid state, but only some indentations and a slight maybe 5 -10 degree lateral curvature erect, with no loss of length, but loss of girth.  So that being said, I think I'll go the pentox, traction/ved route, and hope for the best

I had VIs...which were not a good experience.  I think Levine knows how to do it better than others though... I'd do it with him if I were ever going to do it again.  They use a fairly thick needle to go in and stab your plaque over and over... so it's rough... though you're numbed, it still hurts when the lidocaine wears off...and you are bruised for 5 days or more.  I don't recommend it personally... it did not improve my curve but my hourglassing improved 6 months later (may have not been due to that though - hard to say).   See if there are spots open in the xiaflex trial.  Otherwise, maybe just do traction + oral meds.  

You can try 1 VI and see if you want to put up with it.  I think he recommends 10 or 12.  I was done after 5... and a lot worse off.  I lost about 1 cm, had constant pain, and I think it is still discolored from all the black & blue I went through.  And the angle increased 10 degrees.  Now, I got the cm back w/ traction and time... and it went back down 10 degrees to where i started.

Thanks for the input mike,

I have seen the 60% success rate for levine, but other peyronies experts say only 25% such as Dr. mulhall.  Perhaps it's Levine's technique that gives him the highest success rate, but with me living 8 hours away, it would be someone else doing it on me, and i wouldn't trust them.

I'm going to give pentox and the ved/fastsize a go for 6 months(just ordered both today), and if nothing happens, maybe I'll think about VI's.  I will keep all of you posted, thanks.

If pentox, traction and injections are seen as his effective combo, I think I'd be inclined to skip the injections and try pentox and traction, both of which have a decent track record on their own.

Chefcasey

I saw my first urologist at the VA hospital at American lake in Tacoma WA.I came prepared from learning from this forum way before I became a member.I can not remember a good outcome from VI injections from any member.The PA ( urologist) mind you is not a doctor.Did not even look at my penis said he gives injections and has a 50% successful rate, I do not hear veterans glorifying his success. I said no that was not an option because what I have learned from others on this forum.Read its all here!

Then he asked me if wanted an implant with out even diagnosing me.Now were talking bull I had an on  hand any moment perfectly straight working unit before I had  Ed under any circumstance. But then again I had a perfect heart before my heart attack at 34. No way am I going to give up on my penis at 45 .To much at stake!


Fubar










Think about less intrusive therapy before you trust someone with your penis health.We only have one!

Fubar

Fubar

Quote from: chefcasey26 on December 24, 2010, 07:25:45 PM
I have seen the 60% success rate for Levine, but other peyronies experts say only 25% such as Dr. Mulhall.  Perhaps it's Levine's technique that gives him the highest success rate, but with me living 8 hours away, it would be someone else doing it on me, and i wouldn't trust them.

Keep in mind that Levine' success rate is not based on the VI's alone. It is based on the combination approach of the VI's, traction, and Pentox. I don't know about his VI technique but I do know he uses a "sewing machine" type method of doing the injection which he claims is more effective at delivering the drug to the treatment site.

Thanks guys

I saw Dr. Levine over the weekend.  He discussed his usual "3 prong approach", but said he didn't even think that my scar tissue was that bad to even attempt VI's, which made me feel pretty good to know it's not as bad as I thought.

However he did put me on pentox, and he was amazed at the knowledge I gained on Peyronies Disease just by reading this forum, so thanks to all of you.  I started traction today with an x4 labs device and following his reccomendation of .5cm increases every 2 weeks, starting 1 1/2 inches below my erect length.  That and some light ved usage (maybe 10 min a day to start), so I'll have my work cut out for me for at least the next 6 months.

Casey
Vi's are not very popular on this forum neighter the topical form. I was discouraged and chose not to take them on onset of this disease.Many have posted negative information about this medicine and procedure.Usually when i speak to someone new to the forum i tell them to look at older post a few years back because you find alot of good information that helps in  making good decisions.

You may be very lucky he chose not to recommend them.Their are those on the forum who noticed more plaque sites after veraprimal injections.Could be he has changed his thoughts on their effectiveness.

It is awesome that you were able to obtain a script for pentox.Please keepbus informed on your traction therapy.I wonder though if it is wise to use the ved and traction both on daily use though.I know some members do but I was told by a wise oldman that it may he a little to much.

So becareful take it slow, do not create more damage.

Fubar

Yea I didn't go with them.  Even Dr. Levine said that the curvature wasn't enough to even warrant them. 

As far as pentox, it's been about 2 weeks.  I haven't noticed too much change, although erections are more common now but they weren't a problem before anyway, I'll just have to wait and see. 

As far as traction and ved, I haven't really started a "routine" I would say yet.  I'm just doing light ved in the morning, maybe 10 minutes or so, and I'm still getting used to it.  Traction is tough to get used to, especially the hours per day, so all I'm doing right now is just using a gentle pull, not even a stretch(I'm stretching almost 2 inches below my erect length), just to get used to the duration, and see if I would even be able to wear the thing for 30-40 hours per week.  So I'll make my decision in the next week or so if I want one or the other or both.  It all depends on what goes on with my pain levels, and my schedule.  I'll be quite honest, both these treatments are a pain in the arse in their on way, but beggars can't be choosers.  I can't sit back and watch myself get worse week after week anymore

also, maybe this isn't the right section to post this, but the injection I had to induce an erection for the ultrasound was really weird.

It did not feel like a regular erection at all.  Some parts of my penis that had indentations or didn't fill out before actually did fill out, so much so that the nurse was asking "ok, where's your deformity?', of course when it came down she could see it.  Also, for some reason, my corpus spongiousum didn't inflate at all!! It was completely flat during the ultrasound and it was scary.  I don't know why this is, perhaps because the drug is injected into the cavernosa and not the spongiousum?  Also when they were doing the ultrasound, size wise the erection was about 75%, but it felt rock hard to the touch, so weird.  I suspect that the drug must have somehow caused the erectile chambers to expand in such a way that pushed out my indentations in the tunica, yet didn't equal my normal erection size.  I just found it so mysterious and thought I'd share.

yeah most people dont get 100% from those shots... i was also 75% or so... and ive had that done a number of times... it's awkward to say the least.

if you were not 100% erect, then yeah the issues with your penis won't be nearly as visible... my curve is less visible if i am not 100%.  you might need something different or stronger.  imho, prostaglandin is stronger than papaverine - but trimix has 3 drugs which should give the best result.

I have only received 2 sessions of the VI, i started at 35% dorsal and am about 15% now. With 10 more to come i am atleast optomistic. RDR

Casey,

Based on my 11 years of obsessive Peyronies Disease study, I would highly recommend you avoid both topical verapamil and VInjections, especially the injections.  Stay on pentox which is much cheaper and actually works, we've had several members say it worked, it worked for me, and studies showing it does as well.  Speaking for the other treatments I can not say the same.  You will make your condition worse by needling it with a drug that has no proven track record to work, avoid it at ALL costs.

Comebackid

CBK- I agree with you on the VI injections had 12 of them after the 8 th I had loss of length & girth. Coinsidence maybe so. IMO it was from the injections. I have never read anywhere that a person had dramatic results from VIs. I do not believe the percentages from the doctors like Levine, if so after all these years we would of heard from at least one guy with great results from the injections.

This is the first time I ve really commented on the VIs. I really didn't want someone new to be steered by my distaste for them. I think it all comes down to an individual discison. I know what my doctor was selling me on the percentages and the injections helping to decrease constant pain were not correct. I felt in the end I got the used car salesman treatment.

Quote from: Woodman on January 24, 2011, 04:09:59 PM
CBK- I agree with you on the VI injections had 12 of them after the 8 th I had loss of length & girth. Coinsidence maybe so. IMO it was from the injections. I have never read anywhere that a person had dramatic results from VIs. I do not believe the percentages from the doctors like Levine, if so after all these years we would of heard from at least one guy with great results from the injections.

This is the first time I ve really commented on the VIs. I really didn't want someone new to be steered by my distaste for them. I think it all comes down to an individual discison. I know what my doctor was selling me on the percentages and the injections helping to decrease constant pain were not correct. I felt in the end I got the used car salesman treatment.

Woodman, I think it's good you commented... the more people that speak up, the better it will be for people here.  Otherwise, we're only getting 1 side from the docs. DR. L probably has seen some results... but it is important to note that I do not recall anyone on this forum posting about any positive results from them.  I had similar results to you...lost size and increased pain.  I know he published a paper on it but it's very common for the actual clinical experiences from doctors to contradict the literature...especially that study which I think had only 14 patients.  Another doctor commented that "there are always small studies coming out without placebo groups trying to claim to be the next big thing...then wait 2 years and nobody is doing it anymore... that's why I don't to verapamil, interferon, or whatever these anecdotal studies claim.  Steroids were a big push 20 years ago and that just made things worse. Vitamin E was a big anecdotal thing for 30 years too and that was proven ineffective."  This was a known doc (discussed here) but I'd rather not say his name since he was contradicting levine (and who knows who reads this).  And a second doc also said he did his own study with a few other docs giving verapamil but they didn't publish it because he had no results...and it's hard to publish a null-result study.  I think the only shots that are likely to work are going to be xiaflex shots... just need a few years left for phase 3 and the FDA approval.

I think that was another aspect about the ultrasound at Dr. Levines office that made me wonder about the validity of his studies.

When you get the erection inducing injection, they leave you alone for 5 minutes.  By myself I easily worked up to the best, most rigid type of erection I can get.  When the nurses come in the room to finish the ultrasound and take measurements, it gets really awkward, so the erection goes down a little, but stayed up for me at about 70% just because of the drug.  When they decided to take measurments, I informed the nurse that "hey, I really don't have a full erection."  Even so they took measurements and I measured a lot smaller than I would of, had I measured on my own. 

As far as I can tell from at least the verapamil study that he did (which noted 100% improvement in girth) they used the same type of system to measure. I don't think there's anything unethical going on, but I do think there is a HUGE risk for measurement error in these types of studies.

New to group. Been using the Verapamil ointment for approximately 5 months now with minimal results. Supposedly the ointment can take up to a year to produce noticeable improvement. I can still function sexually and have no pain. Do have approximate 30 degree upward curvature. Urologist has been prescribing frequent masturbation or sexual activity during usage. He has also prescribed Cialis to promote blood flow, but I cannot take right now due to heart arrhythmia.

My urologist is now suggesting Verapamil injections starting in 2 days. Does anybody have any experience with this? Were the results favorable or is this a waste of time and money? I'm up for anything that will help as long as it doesn't cause more damage. I'm about to give him the go-ahead unless I hear something unfavorable here. Then I can also explore other alternative treatments in addition to the injections

I look forward to any helpful replies. Thanks in advance

Didn't do a thing for me  Condition worsened but of course hard to say if it worsened as a RESULT of the injections or despite the injections. 

I don't get the hoopla about Verapamil ointment and injections being touted as a promising treatment for this disease by so many different medical sources. I have yet to hear from anybody who has shown improvement using Verapamil either topical or internal. Should I tell my urologist that I don't feel it's for me or take a shot and be one of the first to be able say that the injections helped?

ek posted recently that he has had very good results from verapamil injections.

I had injections with Verapamil more than ten years ago and it really did have an effect as the hard lumps of plaque disappeared and the angle of the penis was reduced from approximately 45 to 15 degrees. There were several injections (the exact number I can't remember)  The uro was an experienced surgeon and I think he did a good job. I guess clinical experience and practical talent is everything for the outcome of this kind of treatment.
There is however still a lack in elasticity and there is a significant reduction both in length and girth. As I am in the lower part of the normal segment when it comes to penis size the reduction has been problematic to me. Otherwise my penis looks quite normal and it really was a relief to get rid of these hard lumps of plaque.

I have had 5 injections, saw improvement after the first, Have one scheduled this week then new sonogram next week. Could see minor improvement then. Was 35% dorsal now 15% it was worth the try for me
RDR

Thanks for the replies. I was beginning to think that nobody in this forum who got these injections showed any kind of improvement and bring that up to my urologist. Now I'm a little more optimistic and willing to give it a try. However I'm still not comfortable with a nurse administering them and will insist that the doctor do so himself.

I'm really just trying to stop the progression of the disease and perhaps decrease the curvature a bit. As previously mentioned I can still function sexually and even with length loss still measure about 6 1/2" in length with adequate girth size. So if I can at least slow down the process, I'll be happy for now being I'm 48 yo. Any other positive or negative replies are appreciated.

Also if anyone has had these injections coupled with other treatments and had success, I'd be very interesting in hearing about it. Thanks in advance. This is a bitch of a disease for a single unattached guy.

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. 

Disastrous for me.

i've made 12 infusions. I noticed an improvment on erection quality but no benefits for curvature and pain. The progession has not been arrested.

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

You can search the forum and it is 90% negative.

I have nothing but negative things to say about my VI experience.  It was expensive (insurance didn't cover it very well - I spent over 1k in copays), painful, and I only got worse after it... scar tissue seemed to grow and narrowing worsened.  Length is probably similar - but the overall size is embarrassing & the curve is unchanged.

Pain was worse while i was undergoing it... until at least 3 months after I stopped.  This off label crap should be banned.  1 paper by Levine with 20 subjects and no control group is nonsense.  Xiaflex is working and FDA approved... it's just ridiculous why nobody can get that off label when the FDA NEVER APPROVED VERAPAMIL for peyronie's disease either.

It's another vitamin E.  In 20 years, nobody will be doing it.  Many docs already have a very negative opinion of it and will not do it.  It's a big money maker for them though.  VIs are cheap and they can charge a lot.

I agree it VI's should be banned.  Those jackasses at the FDA make it difficult to get drugs that actually work and make the manufacturer of Xiaflex have a placebo group when there is no need for that.  It's total bull.  I can't believe that I even listened to my uro when he said it has no negative side effects.  I guess I was looking for the any answer that could help.  Nothing is worse that having an issue with your dick.

Guys- I had 12 VIs and I had NO results. I noticed after the 8th injection my first signs of decrease in length and girth. I went over with the Doc and PA several times and they laughed and told me if it does get worse it was happening anyhow and that the injections wouldn't make it worse. I already had Peyronies Disease for over two yrs at that point right then my condition progressed. Coincidence maybe......for me with experience and time I say it was not. At the time I was soo desperate to try and reduce the pain also the progression it was non stop from the beginning till that point in time. That was there only suggestion saying it would help with the pain at the very least well gotta call bull on that count too. Like Mike mentioned it was very expensive insurance covered a little less then half and I came out of pocket approx. about 2K plus travel and loss time off work.

I had bruising from the injections for well over a year. I even went and seen Levine about 3 to 4 months afterwards and he seen the bruising and I asked him if it was normal. He said it can happen and seen it once or twice before he told me it could take up to a year to go away. Well it did about 15 months all told.

When I went back for my folllow up after the injections the PA not the doc. told me the obvious that there wasn't any change. I asked him what else I could do. He told me very quickly well we could try another 6 VIs I knew right then and there I had been taken for a ride. I told him I am not interested in that and I haven't even heard or read having that many injections. If 12 didn't work then why? I got no sound ansewer. His second option was to wait six months and see where I was at cause changes can happen up till then. Third he could give me a plication or an implant. I told him I don't want a wired back penis my pain is terrible already also I ve had three penis surgeries before in my life and the condition hasn't stopped. Then I proceeded to ask why would I need an implant when I can function. This part was said kinda sarcastic. I couldn't get a strait ansewer. I am always business when at the doc. polite refined strait forward so I can't see where the ending came from.....but that's ok. I left and made an appointment to Levine 3 months later. He said that I did the right thing not taking the additional 6 injections cause if I was gonna get any milage out of them I would of already seen it.

Sorry for the rant but the VIs IMO are not worth it. I held back my thoughts on it for a long time here so as not to interfere with others decisions who have to decide. Now I have read so many others here on the forum I decided to add my 2 cents for what its worth.

I would like to add my opinion as to verapamil injections.  Had them with Dr. Mulhall and I would recommend - Do not have this treatment!

Quote from: Woodman on May 24, 2011, 03:56:51 AM
Guys- I had 12 VIs and I had NO results. I noticed after the 8th injection my first signs of decrease in length and girth. I went over with the Doc and PA several times and they laughed and told me if it does

Sorry for the rant but the VIs IMO are not worth it. I held back my thoughts on it for a long time here so as not to interfere with others decisions who have to decide. Now I have read so many others here on the forum I decided to add my 2 cents for what its worth.

Glad u posted...and everyone else.   Over a year ago, I was out desperately searching for doctors who would give me the VIs.  I truly believed they were the "cure" based on the Levine research.  I basically called offices and asked if they did VIs and hung up if they did not.  One of my old posts talks about a doctor who wanted me to take Vitamin E and said that verapamil can cause scar tissue to increase due to the needle trauma.  Well, this was over a year ago - and I have to say he was half right.  The vit E does nothing but the plaques certainly got worse after the VIs.

I also sort of gave my opinion "lightly" on the VI issue...saying "well it didn't help but it progressed - and maybe that's due to the disease and not the VIs...etc"  Now, we have a critical mass of unhappy people here who have gone to top docs with VIs.  Maybe levine does something that works better than others in his technique since he published the 1 paper supporting them - but even one of Levine's pts had no results from it who posts here (blanking on the screen name now).  

One other doc says there was a multi-center study of VIs (2-3 docs doing it) that failed, and they called it off  half way thru - never publishing the data on the failure.  Another doc who people like on this board told me the sample sizes are too small in the studies, and he won't do them.

I had heard that it is better to do it earlier, before the plaques form, but when had the series of shots, I developed new plaques, and the plaques I had got harder.  I don't think the "natural progression of the disease" excuse holds up any more.  At best, we  all should've improved.  At worst, we should've had minimal progression of the disease - not significant progression.  With Xiaflex in the pipeline, VIs may soon be a thing of the past.

Okay, I'm going to see uro next Friday and voice my concerns (he has me scheduled to start Verapamil injections). It would seem that the majority here saw no improvement with Verapamil injections although a few did. I am going to have a serious discussion as to the probability of them helping my condition. He had already mentioned that if not, that surgery may be the only other option. However I'm reading that there are many options from fellow sufferers here.

I'm leaning towards not getting the injections. For one, in my uro's office supposedly a nurse administers them and I am not com foratable with that after reading here. However I am willing to give the 6 shot procedure a chance if done properly and in hopes that I may be one of the minority that it does have a positive effect on. As long as there is no possibility of it having an adverse effect and cause my condition to worsen.

My condition is less than a year old and I'm hoping to slow the progression and decrease the upward curvature as it seems to be getting more severe slowly, but surely and now interfering with positions that I can have sex in.

I'd like more info on VEDs if possible and the reality of that being a viable alternative option of treatment. The last thing I want to do is cause more trauma and scarring that will worsen my condition. And what's the realistic possibility of getting these Xia... injections in the near future before further deterioration? I want to start some kind of treatment regimen immediately and need to hear from the experts, fellow patients here who have had success or not, and not doctors who simply treat the condition with the flavor of the month.

I went to Levine. His nurse will do the initial injection for numbing you up. But Levine always did the actual VI's. I would only trust the doctor to do this properly. There definitely is a certain skill and technique for this.

I didn't have the injections but I am glad I read what you wrote.  I was thinking of going to Mulhall since I live in NYC.  Too much trouble going to Chicago.....I have the dents and have lost the spongy part on both sides of my shaft.  I don't know if I will ever get it back and was hoping Mulhall would help.  I had open heart surger at Mt Sinai with the top surgeon there but i don't think I want to see Mulhall. 

YMN

I had 6 VIs and condition worsened plus Muhall had his assistant do all injections.  I must have seen home for a total of five minutes over the course of four months.  Never saw me erect.  I would suggest NO VI's and ESPECIALLY non through Mulhall!!

I had 12 VIs by Dr. Lipshultzs. His PA administered them all and also did the follow up after all the injections were completed. I only seen the doctor maybe 2 out of the 3 times I had a regular appointments. His PA did most of the work. Once the PA took all the info for the appointment then the doctor would come in the room for 2 to 5 mins tops. I had to practically put my foot on his tale to get him to try and ansewer a few of my questions.

I only put up with this kind of service because there isn't another doctor versed in Peyronies in my whole geographical area. This is very ironic too considering I live in Houston where the population in our city is 6 million people now.

When the injections were described to me it was mentioned as more fact then experimentation. Once the injections got underway I noticed and realized I got more steam piped up my stack! When I started getting questions and protocol changing consistently. I remember one day in particular when the PA came in and told me " today the doctor wants me to start modeling after the injections are administered " I asked what modeling meant he explained. I told him I ve been here for 6 months to a year complaining of very bad pain and the injections hurt and bruise so bad that I can't even follow the VED protocol that suppose to go along with the injections. So if the doctor advise to do that for MY case then it makes no sense and I am not comfortable doing it. I can't see the doctor reading my history then prescribing modeling. After some coaxing and telling the PA this he told me " well, its just not for you he is now doing it with all the VI patients but I will not perform it on you since you are having pain issues" I already had the feeling I was being taken for a ride but after that day I knew I was paying them to use me for a pin cushion and a guinea pig.

Like I ve said before here, after I had all 12 injections and no results I asked what could we do next and he said right off the hip " well we can try 6 more and see if that works " I told him I am not doing that no thanks. When he told me that and didn't look me in the eye I felt like I got suckered by a sleazy used car salesman. 

An update on my situation. I had a series of six verapamil injections last year, but stopped because I couldn't tell if they had made any difference. The pain was gone, though the plaque kept growing.  I've been on Pentox since then and have used a VED.  Over the last few months the site of the plaques has changed--moved to one near the head and one near the base.  Meanwhile the site of the original plaque has gotten thinned out--I can tell it's a bit harder along the top side of the shaft.

In any case, at my uro's suggestion, I decided on another course of six injections.  It's hard to know if the progress I've made is the result of the pentox or VED (or all the other things I've tried taking like ALC, L-Arginine, PABA).  I tend to think the Pentox has been the most effective, as has re-organizing my life to decrease stress. 

I don't know if this is anyone else's experience, but my plaques seemed to start in one place (about 3/4's the way up the shaft), then turned into two points of inflammation that have traveled in opposite directions.  The site of current inflammations are slightly painful and large (kind of like wads of wax; it feels like a sphere in the head and a oval that wraps around the urethra near the base).  As the inflammation moves it seems to leave a thin track of moderately hardened tissue--sometimes I feel it, sometimes I don't.  The curvature has improved (from almost 90 degrees to 45) as the inflammation moved away from the center.  I've had some shortening, but not too much.  I don't have trouble getting erections and sex is usually fine despite the curvature

Anyway, since it didn't seem to hurt me last time, I'm going to try the Verapamil again.  I had the first shots last week.  I'm a lot more familiar with this area of my body now, so I may be better able to judge when/if it's helping.  Already the pain went away, though the size of the plaques seemed to increase slightly.

I'm sure I'm not the only one who finds the whole injection thing extremely stressful. I get very uptight about it and find it painful and embarrassing.  (Listening to music and especially some relaxation wavelength entrainment effects put out by ambiscience for iphones seems to help.)  I sometimes have swelling afterward--I think this depends on which blood vessels are in the way.  Also, when the doctor is trying to feel the contours of the plaque around the base it sometimes involves a lot of manipulation, which occasionally gives me a partial erection which I find pretty embarrassing. Does that happen to others?  I figure that is normal, but there is very little about this disease or being treated for it that feels normal.

Anyway, I'm just contributing some of my experience since I've appreciated others doing so on this site.

KAC

Thanks for posting this. There is support both for and against VI's. But it seems you are seeing positive results. So in my opinion, it they are helping, then continue the treatment.

KAC

I had 12 VI injections and it made my plaques larger too. I asked the doc and he told me it happens and is temporary. A little while after the injections the palques went back down in size to there normal diameter.

Good luck with your treatments I know they are physically and mentally taxing.

Hi all,

I'm a newbie to Peyronies, started in July '11. On the advice from a Urology specialist in NYC I've started the Verapamil injections. I've had 5 injections so far. I've noticed that it seems to have helped with the overall pain I was experiencing. Daily pain has gone from sharp constant to a dull ache. Even erection pain has limited a bit. Only problem is that the curvature has gotten worse.  :(

During my initial examination the specialist was surprised my curvature wasn't worse due to the extent of the plaque I have. So I'm assuming that it's just caught up with me? But that was the reason I decided to go with Verapamil in the first place - to lessen the curve.

My question to the group - has anyone noticed that Verapamil caused an increase in curvature? If so, did that curvature lessen after the treatments stopped?

I've read on the forum about Pentox and supplements for pain, so I'll take that route as well. Just trying to get a gauge of those that have gone through this whether it's worth it to continue. I'm leaning towards addressing the pain with other measures and discontinuing the shots. But would like to hear other success stories if possible.

Thanks,

Paul

Paul,
My curvature got worse during shots as well--so much so that we quit after a series of 6.  But then after a few months the plaque seemed to diminish from large, hard nodes of inflammation to kind of a painless and not very noticeable rope along the top of the shaft, and the curvature lessened.  I've now returned for another set of 6 shots in hopes that the the two remaining nodes (now one in the head, one at the base) will turn more into the rope-like plaque.  That I can just live with no problem.  The uro did put one shot into the middle rope-like plaque on this last round as an experiment.  It did seem to puff up during the week and resemble more of a node, and now, about 10 days later it's almost back to where it was.  My hope is that over time that will shrink even smaller. If that happens I'll continue with shots--I think that will be evidence that it's actually working.

But most of this is really to say, who really knows.  I've gone through a lot of stages and finally decided I just have to trust my gut and not be too cautious.  I feel worst when I'm not trying anything.  I do take the pentox as well as ALC and L-Arginine, ubiquinol, and use a VED.  My biggest question for my uro has been whether the verapamil has immediate verses long term effect.  He says he just doesn't know.  If its true effect is immediate, then I think I'm making a mistake; if the true effect is long-term, then I would say it's diminished my curve from 90 to 45 degrees.

I don't really understand the every 2 weeks thing either.  It seemed to me that every shot came just when swelling from the last shot diminished.  Makes me wonder if a little more space--even a month between shots might have been better.

Hope that's helpful in some way.  KAC

I haven't had VI injections but I did notice my plaque seems to over time moved. Mine started out as one peace under the head on the right side of my shaft then over time its been a little over a year it moved to about just above the half way point of my shaft has changed shapes and spit into what at times has felt like 3 peaces. Right now I can only find one and that was after i had the Stem Cell treatment. But I am not free of pain/discomfort and deformaty from the remaining plaque. I never had a curve but a dent which turned into hour glassing as the plaque changed shape and moved.

Had my second round of VI's a week ago. A decent amount of bruising this time, but not really painful after the injections. Still, I did not have sex till six days later (yesterday). One thing I have noticed in the last couple days is that the nodules do seem smaller. However, my penis as a whole seems more firm/dense when flaccid than usual. So I am not sure if the nodules have gotten smaller, or if there is anything going on under the skin (bruising? etc) that might make it harder for me to actually feel the nodules, therefore the impression is that they are smaller? Something has definitely changed since the last shots, it's just too early for me to say definitively if it is improvement or some temporary change that has not actually affected nodule size.

I welcome anyone with any insight or similar experience feedback. Thanks.

It's been some time now since I had my VI's. I also had quite a bit of bruising. And I think I recall the "firmer" feeling when flaccid. After several weeks after the VI's were completed it seems all was back to normal. But I still had the curvature as the VI's did not provide any improvement for me.

I have my fourth round of VI tomorrow.....per my earlier post, the "changes" were not improvement...it was just a different feeling of overall tissue density for a while. But after 6 months of Pentox and 3 rounds of VI, no real improvement. That being said, would my disease be worse if I had not done either of these things or one or the other? Nobody knows, right? Therefore you have to take the medicine and the painful shots....cause it's all you have.....at least in my case (hourglassing). So you are doing treatment without knowing if it does any good or not. There is no other treatment besides this for hourglassing except surgery, and they only do that (appropriately so) if sex is impossible. Thank god I am not there yet.

I try not to get depressed about this....I am in my early 40's, and obviously this is a depressing issue....but I have had friends pass away lately who were my age, and I always think of them and what their families deal with versus my problem to try and keep perspective. It could be worse.....but it still weighs in the back of my mind of course.

I am very interested in hearing back from anyone else who has hourglassing and the treatment they are taking and if it's doing any good or not?

Charlie44
I understand you getting depressed about this...Peyronie's. I was depressed for a long time, but I am not anymore. I make myself busy and yes, thinking about others that they situation is bad than mine, not just with Peyronie's.
People life are affected bad from many diseases and other events so I thank God that is as it is.

Sorry that the VI didn't help you. In any case I suppose you have not expected too much.
Personally after reading on the forum almost everything regarding VI I decided that I will not do.

I do have hourglassing. I don't see yet benefits with VED that I ma doing for 6 months by now but I will continue because I think is helping keeping the penis more healthy with the forced blood flow.
I begin Pentox just two months ago and also just 2*400mg daily, I have benefits not connected to Peyronie's and some Peyronie's benefits like my flaccid state is more full. I read on the forum that should not expect Pentox benefits before 6 months or longer of using it and also higher dosage is more benefitting.
James

James1947, thanks for your post. Regarding Pentox and higher dosage, I was prescribed 400mg three times a day. Good luck moving forward!

charlie44,
I understand what you are saying about the VI's. I too did not see improvement but also wondered if it kept my situation from getting worse. I think it helped me mentally to approach my whole situation in that I felt like I was trying something to try to help myself. I was determined to stay positive and try whatever it took to beat this.

Les

Les...your approach and mindset, and mine is the exact same. I feel I have to do what I can. Maybe it's working, maybe not, but have to stay positive.

Did you ever see any improvement, and if so, what was the reason for it?

I went through a series of  VI's. Didn't get any better but didn't get any worse. During this time I was doing traction (per doctor's recommendation) and using Pentox the whole time. Once I was beyone the 12-18 month acute phase and stable, both the doc and I agreed that there was no improvement and it was time to try something different. This eventually led to surgery which worked out well or me.

Les

What surgery did you have...and I assume it was to correct curvature?

charlie44,
If you click on the "my history" link at the bottom of my post it will provide more details. I eventually had excision and grafting surgery to correct a 70+ degree dorsal curve. The surgery was successful and corrected the curve.

Les

Thanks Les!

Had my first VI injections with doctor Brock in London, went very well no bruising or anything just minor swelling, The injections were at the distal tip under the glands. I have noticed very minor improvements and am going to continue with the injections.



Trevor

I just finished my set of six injections a couple weeks ago. The disease worsened some during the process, so I cannot say that VI has helped at all. But that is like every treatment for Peyronies Disease. Unless you see something dramatic, you hang on to the hope that maybe you are mitigating worse progression than what you currently experience.

Personally I am against sticking a needle or anything else in my dick, but I know from reading the topics related to Verapamil injections that some people see positive results a few months, even six months after they finish the first six VI and decided to go on.

Some on the forum had also very positive results fro VI. :)

I know is very difficult to wait, wait and wait, but with Peyronie's you have to wait to see results from a certain treatmet.
The only thing with Peyronie's not to wait long is to have a bionic dick (implant I mean) and be better than we ever was ;D

James

trevorrr

I have posted my question to you to the wrong person on the wrong topic. Here is my post:

How was the injection? It was painfull?
The doctor injected it in the plaque?
When you are scheduled for the next? How many injections in the plan?
Many questions, sorry, answer when you will feel OK.

Wish you it will work  :)

James

How ya doin James.

They put a numbing agent just inside the skin on the base of penis and under the glands and its fell likes a little be sting which is the worst part after that its fine, Anxiety through the 45 seconds of the injections was my only problem. My uro who is top in canada for peyronies who is currently doing studies with Tom Lue was very accurate with his injections and was going directly into my scars and to be quite honest I enjoyed the sensation it was if I was fighting back against peyronies with this verapmil being injected directly into my scars. I have noticed very minor improvements which are encouraging knock on wood so we are going to continue, no limit on the injections have been discussed. Plus they are free in Canada so as long as its not making my my situation worse I'm going to continue.

Trevor

Hi trevorrr,

I have not understood if you are doing injections in Canada or in London

Can you tell me the name of the doctor? thank you

London Ontario Canada, Dr Gerald Brock.

Good luck with the injections Trevorrr
I believe you are in good hands ( so to speak) with Dr. Brock.
For any members reading this thread , don't forget that Dr. Ethan Grober at Mt. Sinai , in Toronto , is in the same class of expertise as Brock. Handier if you are closer to Toronto area.
Mike

Good luck Trevorrr with the injections.
Keep us updated regarding the results.

James

Comeback....how long were you on Pentox before it improved your condition?

I finished my first six verapamil injections on June 7.  #5 was by a urology fellow, rather than the more experienced PA.  The injections by the fellow were much more unpleasant during and afterwards.  During my ultrasound evaluation this past Monday, the technician said some urologists are trained to repeatedly perforate the plaque with the needle as a way to mechanically break it up.  He said the studies show this technique with verapamil is no more effective than if it was done with saline.  The reason is that the verapamil never gets a chance to "bathe" the plaque and be absorbed, like water on a sponge.  Instead, it shoots through and back out of the holes made by the needle.  I was sore and the plaque felt like it was inflamed for more than a week later.

The forced erection and ultrasound exams were informative.  Because I did not have a baseline measurement, he could not quantify a plaque volume reduction.  Subjectively, I can feel that it has slightly changed in shape and volume.  The plaque has compressed the main artery, which reduced blood flow in.  During the 2+ years I have been on pentox, nightly 25 mg viagra, and L-arginine, collateral circulation has improved, resulting in erections of near normal volume and firmness.

So far, there has not been any noticeable improvement in my curve.  This has now officially been measured and entered into my medical record as 90 degrees.  Sigh.  Penetration attempts after injection #6, both without and using the VED and band, were not successful.

I have another round of six injections scheduled early July to mid-September.  Unless these (by the PA!) result in a curve reduction of at least 30 degrees (I think I could live with a 60 degree curve), there probably won't be any more injections for me.

I have not found time in my day to regularly wear the Fastsize extender the recommended 3+ hours.

If the first 6 didn't see any improvement, I question why they think 6 more will do anything.

BrooksBro

As lwillisjr has said, why your uro think that additional Verapamil injections will help if the fist six don't helped?
Interesting to know his answer.

Even that the oral medications not straitened your curve, is encouraging that your erections are

Quotenear normal volume and firmness

I will be happy to achieve that also!
What is the daily dosage of the Pentox and L-Arginine?

James

The normal dosage of Pentox is 400 mg tablet 3x daily, with food.  I take 2g (2,000 mg) L-Arginine, usually in the evening at the same time as my nightly 25 mg viagra, on an empty stomach.

The PA (not the urologist) said their patients getting VI fall into three broad categories.  Those for whom the first six did nothing, those for whom there was some improvement, and those for whom there was significant improvement.  I am in the second category.  After six, I can feel my plaque is a slightly different shape than it was before the first injection.  Does reduction in the plaque shape or volume translate to a reduction in curve?  In my experience, not yet.

The best description I recently read about the plaque is that it is a change in the structure of the tunica albuginea itself.  The analogy being to replace a section of a latex balloon with a piece of non-expanding plastic.

With this condition, I have not found any "good" solutions.  I tried oral therapy.  I tried traction therapy.  I tried VED therapy.  I am now trying verapamil injection therapy.  Should the next six injections not reduce the curve to where I can penetrate my wife, with a 90 degree curve, the only practical solution left is an implant.  Nesbit plication is not an option for a curve that severe.  I think I can endure 12 more shots (6 to numb, and 6 of verapamil).

BrooksBro

Thank you for the answer. I am taking the L-Arginine 1g one in the morning one in the evening with 4mg Cialis after meal.
I will change to 2g L-Arginine in the evening together with the 4mg Cialis on empty stomach. Hope will help something.

Maybe if as you say your erections are firm a incision with grafting surgery will be enough.
I think implant is mainly to solve ED problems and to gain back some length and girth lost to the Peyronies.
Just thinking, not trying to advise in the subject.

James

Thanks for the thought.  Most of what I have read about grafting is that the long term (over 5 years) satisfaction is low, even when there was the best possible procedure.  My erections are firm, with medication or VED assistance.  Venous leakage is still present, even though the collateral circulation has partially overcome the arterial blockage from the plaque.  Achieving an erection is not the same as sustaining it long enough.

Quote from: james1947 on June 22, 2012, 08:16:27 PM
Maybe if as you say your erections are firm a incision with grafting surgery will be enough.
I think implant is mainly to solve ED problems and to gain back some length and girth lost to the Peyronies.

I had excision and grafting 4 years ago next month. And it is equally as good today as it was post surgery.

I suppose from reading this forum and other information that lwillisjr is not the only one that can say:

QuoteI had excision and grafting 4 years ago next month. And it is equally as good today as it was post surgery.

BrooksBro you are right that:

QuoteAchieving an erection is not the same as sustaining it long enough.

This can be fixed with an implant if all the other treatments don't help anymore.

James

Very good results from Verapamil Injections in combination with using VED and Traction Device.
Quote from DO post:

QuoteI 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

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.

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.

BrooksBro

  ;D :) :(

James

You @old man make me. Ridiculously suicidal. Destroying every hope I have and had

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

I have an appointment tomorrow. It's not like I'm doing nothing. Sorry for being off topic

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

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

Quote from: peyrosucks on May 17, 2011, 05:23:43 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

Quote from: ComeBacKid on May 21, 2011, 01:24:42 AM
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

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.

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

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: ude.fscu@euL.moT.
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