Current APDA Questions and Answers
By Dr. Laurence Levine & Dr. John Mulhall

I. General Questions

II. Causes

Are any of the high blood pressure medications responsible for Peyronie’s disease?

 Dr Levine answers: Historically it was felt that men who took beta blockers were at risk for developing Peyronie’s disease. At this time there does not appear to be any evidence that any specific class of drugs, including all the high blood pressure medications, would predispose to the development of Peyronie’s disease. It does appear that many medical conditions appear in men with Peyronie’s, including high blood pressure in up to 44%, diabetes in up to 33%, elevated cholesterol levels in up to 33%, and in two recent reports, low testosterone in up to 70% of men with PD. It is not clear whether the presence of these comorbidities encourage the development of Peyronie’s or whether they may be associated with diminished rigidity, which might predispose to injury, activating the Peyronie’s scarring process.

III. Treatments

 I want to ask: will traction therapy help in patients who have had Peyronie’s disease for more than 10 years? Does age of the patient and weight have an effect upon the outcome of traction therapy?

 

Dr. Levine answers: So far, duration of Peyronie’s disease has not been evaluated to know whether earlier, more acute disease (less than 1 year) responds better or worse than those with a longer duration of Peyronie’s disease. In a comparative trial being conducted at RushUniversity at this time, we are looking at verapamil injections alone vs. verapamil with traction. Early analysis of the data suggests that men who have more long-term chronic disease seem to do better with traction when used as directed at a minimum of 2 hours, but better at 4-6 hours per day, for up to 6 months. The age and weight of the patient does not appear to have any bearing upon outcome. For the man who is overweight or has a good deal of fatty tissue near the base of the penis, these men appear to have difficulty keeping the device in place while standing or walking. This is because the fat pad will tend to push the traction device off the penis.

This question pertains to the use of the traction device for correction of curvature – How hard does one have to stretch? Could more vigorous traction possibly worsen the deformity?

Dr. Levine answers: Experience with the traction device has suggested that wearing the device to provide full penile extension is most likely to benefit the patient. This may cause discomfort initially but should not cause pain. Probably more important than pulling hard on the penis with too much traction is the duration of wearing the device each day. Multiple authors have now recognized that those men who wear the device 4-6 hours or more per day do better than those who wear it only 1-2 hours per day. There does appear to be a dose relationship between the longer you wear the device and the likelihood of deformity improvement. If we liken the penile experience to wearing braces on the teeth, we know that with time the braces will not be pulling on the teeth, as the teeth would have moved due to the traction effect. Therefore the orthodontist must retighten the wires to apply traction to encourage movement of the tooth within the jaw. In a similar fashion, wearing the device on the penis for an adequate period of time is needed to activate the stretch and tissue growth triggered by the traction.

Does it make sense for a patient to use a traction device if he has a thin, long and heavily calcified plaque?

 

Dr. Levine answers: The data so far looking at men with calcification has been limited. In my own experience, I would have thought that men with a calcified plaque would not respond well to traction, but in fact recently a man who had a large, long ventral plaque causing a 70 degree downward curvature did have near complete straightening of the penis after wearing the device for 4-6 hours per day for 4 months. This single case does suggest that with vigorous prolonged use there can be straightening and elongation of the penis, even in those who have a calcified plaque. My suspicion is that this is because there is growth and stretching of tissue around the calcification. I have not seen a change in plaque calcification on imaging analysis as a result of wearing the traction device.

Does it make more sense that vacuum therapy would be better for correction of Peyronie’s disease than traction, as vacuum therapy pulls the tissue in all directions whereas traction pulls tissue only in one direction?

 

Dr. Levine answers: This is a good question that has been recently examined in a small series of patients who were on verapamil injections and a separate comparison group that had verapamil injections with once to twice daily vacuum therapy for 20-30 minutes per session. The results showed that the men who were in the combination group did worse than the verapamil-only group in terms of curvature correction, with no significant change in length in either group. Your thinking is correct that the vacuum is pulling in all directions, but unfortunately the limited duration for safe application of the vacuum appears to compromise the beneficial effects of the stretching caused by the vacuum. In other words, you cannot wear the vacuum long enough to induce the desired stretch without potential internal damage. In addition, studies on other tissues besides the penis have demonstrated that traction on bone for instance will result in multidimensional expansion, so not just parallel to the direction of the traction but also transversely, which might explain why some men with traction may not only gain length, but girth as well.

IV. Surgery

 V. Sex and Masturbation

VI. Stem Cell Research

VII.  Relational issues