Combination of Penile Traction, Intralesional Verapamil, and Oral Therapies for Peyronie’s Disease

Abstract

Introduction There is no current consensus as to the most effective nonsurgical therapy for Peyronie’s disease (PD). Aim This study aims to assess the benefit of penile traction therapy (PTT) when added to intralesional verapamil injections (IVIs) combined with oral L-arginine 1 g b.i.d. and pentoxifylline 400 mg t.i.d. in men with PD. Methods Seventy-four men with PD completed 12 IVIs. Patients electing to add PTT were advised to wear the device for 2–8 hours daily and no longer than 2 hours per session. Subjective responses were measured using patient questionnaires. Stretched penile length (SPL) and erect penile curvature (EPC) using penile duplex ultrasound were measured. Response to therapy was defined as at least a 10-degree reduction in EPC. Main Outcome Measures Change in SPL (cm) and change in EPC (degrees). Results Thirty-five patients in group I vs. 39 patients in the PTT group II completed the protocol. Fifty-four percent of men in group II responded to therapy vs. 46% in group I (P = 0.75). Responders in group II had a mean EPC improvement of 26.9 degrees vs. 20.9 degrees in group I (P = 0.22). Mean PTT use was 3.3 hours per day, and men with >3 hours per day use gained 0.6 cm in SPL vs. 0.07 cm using less than or equal to 3 hours per day (P = 0.09), while men in group I lost 0.74 cm of SPL on average. Multivariate analysis revealed that duration of PTT use significantly predicts length gain (0.38 cm gain for every additional hour per day of PTT use, P = 0.007). Conclusions There was a trend toward measured curvature improvement and a significant gain in SPL in men using the combination therapy protocol. Length improvement is related to duration of use of the traction device.

Pentoxifylline Associated with Other Antioxidants (Multimodal Therapy) on Patients with Peyronie's Disease. Results of a Controlled Study

“…Our findings confirm and support that the best approach for treating PD is "multimodal therapy" [41,42,[51][52][53][54][55][56], because it was able to achieve greater results than any single drug alone.…”

Outcomes of Intralesional Interferon-α2B for the Treatment of Peyronie Disease

“…Using a penile stretching device in a combination regimen was previously shown on multivariate analysis to predict a posttreatment length gain with a 0.38 cm increase achieved per hour per day of traction therapy. 26 In our series stratifying patients by treatment received before 2006 (no penile traction therapy) or after 2009 (traction therapy) revealed no difference in curvature change between the groups (p ¼ 0.15).…”

2018 Canadian Urological Association guideline for Peyronie's disease and congenital penile curvature

“…While there exists a dearth of well designed randomized and controlled published studies on penile traction therapy, the existing literature does show some clear benefits. 1,3,60 It appears to have some activity in correcting penile pain, curvature and maintenance of penile length, with recent reports highlighting a potential synergy with intralesional or oral agents. Hellstrom's group has recently reported that routine penile traction therapy during intralesional injection with interferon α-2b for Peyronie's disease may result in a small but subjectively meaningful improvement in stretched penile length, without affecting curvature, if used for at least 3 hours a day.…”