Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. The impact of intralesional interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie's disease. Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease. Acute phase Peyronie's disease management with traction device: a nonrandomized prospective controlled trial with ultrasound correlation. Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. Comparison of transdermal electromotive administration of verapamil and dexamethasone versus intra‐lesional injection for Peyronie's disease Nicardipine vs. saline injection as treatment for Peyronie's disease: a prospective, randomized, single-blind trial. Clinical safety and effectiveness of collagenase clostridium histolyticum injection in patients with Peyronie's disease: a phase 3 open-label study. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. The effectiveness of transdermal electromotive administration with verapamil and dexamethasone in the treatment of Peyronie’s disease Intralesional verapamil prevents the progression of Peyronie's disease. Changes in the Effects of Peyronie's Disease After Treatment With Collagenase Clostridium histolyticum: Male Patients and Their Female Partners A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. Clinical Experience With Penile Traction Therapy Among Men Undergoing Collagenase Clostridium histolyticum for Peyronie Disease. Intralesional Injection of Hyaluronic Acid in Patients Affected With Peyronie's Disease: Preliminary Results From a Prospective, Multicenter, Pilot Study Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie's disease. Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study. Intralesional Injections for Early Peyronie Disease: Standardized Assessment and Analysis of Predictive Factors for Treatment Response. Restoration of Penile Function and Patient Satisfaction with Intralesional Collagenase Clostridium Histolyticum Injection for Peyronie's Disease. Treatment of Peyronie's disease with local interferon-alpha 2b. Verapamil versus saline in electromotive drug administration for Peyronie's disease: a double-blind, placebo controlled trial. Effect of intralesional verapamil for treatment of Peyronie’s disease: a randomized single-blind, placebo-controlled study Intralesional verapamil injection for the treatment of Peyronie's disease. A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study Minimally Invasive Therapy Using Intralesional OnabotulinumtoxinA in Peyronie's Disease. Effect of intralesional interferon-alpha 2b combined with oral vitamin E for treatment of early stage Peyronie's disease: a randomized and prospective study. Iontophoresis for treatment of Peyronie's disease. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. Treatment of Peyronie's disease with intralesional verapamil injection. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. Preserved postoperative penile size correlates well with maintained erectile function after bilateral nerve-sparing radical retropubic prostatectomy. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. [Therapeutic choices of penile erectile dysfunction].
CONTEXT Conservative therapies for Peyronie 's disease ( PD ) aim to treat early-stage disease by improving clinical outcomes such as penile curvature , penile length erectile dysfunction , and pain . OBJECTIVE To summarise the available evidence regarding injection and mechanical therapies for PD treatment . EVIDENCE ACQUISITION An extensive search of Medline , Embase , and Scopus data bases retrieved English- language articles up to 15 May 2018 . The systematic review protocol was registered on PROSPERO ( CRD42017077050 ) . Inclusion criteria were as follows : adults with early or chronic PD receiving treatment with injection therapy , penile traction , or a vacuum device .  EVIDENCE SYNTHESIS Fifty-two articles were selected according to the inclusion criteria -17 comparative studies and 35 cohort studies -analysing the effects of calcium channel blockers ( verapamil , nicardipine ) , collagenase Clostridium histolyticum ( CCH ) , interferon α-2b ( IFNα-2b ) , hyaluronic acid ( HA ) , onabotulinum toxin A , thiocolchicine , penile extender devices , and vacuum devices . Qualitative data from these studies suggest a clinical ly significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length . Verapamil and HA performed well in single-arm or case-control studies . Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small , underpowered , nonr and omised studies . Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature , but only in studies of single-arm or case-control design . CONCLUSIONS CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature ; CCH can also improve penile length . However , based on available data , strong conclusions can not be drawn for other treatments , including calcium channel blockers , HA , or mechanical therapies . PATIENT SUMMARY Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie 's disease . No robust evidence is available to support the use of other local treatments including calcium channel blockers , hyaluronic acid , or mechanical therapies INTRODUCTION Penile duplex Doppler ultrasound ( PDDU ) is currently the preferred method for the functional evaluation of penile hemodynamics . PDDU may be used to monitor objective ly changes in penile vascular parameters in men who undergo treatment for Peyronie 's disease ( PD ) , including intralesional interferon alpha-2b ( IFN alpha-2b ) . AIM To investigate the impact of intralesional IFN alpha-2b therapy for PD on penile hemodynamics by using PDDU and to assess the objective role of PDDU in monitoring treatment outcomes . MATERIAL S AND METHODS Thirty-nine patients ( 20 in the placebo and 19 in the IFN alpha-2b treatment arm ) were enrolled in this prospect i ve , placebo-controlled , parallel study . Patients received either 10 mL saline or 5 x 10(6 ) units of IFN alpha-2b intralesional injections every other week for a total of six injections . Patients in each group were evaluated at baseline and after completion of treatment regarding changes in penile hemodynamic parameters , penile curvature , plaque size and density , pain on erection , and erectile function . Specific published criteria were used for PDDU measurements . Outcomes were statistically compared between each group by using Mann-Whitney U and chi-square tests . RESULTS The mean age of the patients and the duration of PD were similar in both groups . The improvement in penile blood flow was significantly greater in IFN alpha-2b-treated patients than those in the placebo group . The number with the nonvascular classification increased significantly in the IFN alpha-2b arm from 31.5 % to 57.8 % . Additionally , improvements in penile curvature , plaque size and density , and pain on erection were better in the IFN alpha-2b group compared with the control . No significant improvement was observed in the erectile function domain in either group . CONCLUSION This study reveals that intralesional IFN alpha-2b injections have a significant benefit on penile hemodynamic parameters . Moreover , intralesional IFN alpha-2b is an effective , minimally invasive treatment for PD , and PDDU is a useful adjunct to monitor objective ly changes in penile vascular parameters . interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie 's disease BACKGROUND Intralesional therapies provide an alternative to surgical treatment of Peyronie 's disease ( PD ) . This study examines the efficacy of intraplaque injections of interferon-alpha-2B ( IFN-alpha-2B ) in the treatment of PD . METHODS Twenty-five patients were enrolled in the study with 21 completing the study . The average age of the study participants was 55.8 years , with 10 of the 21 having diabetes , hypertension , or both . Seven patients received placebo injections using 10 ml saline biweekly for 6 weeks before interferon therapy , and all 21 patients received biweekly injections of 2 x 10(6 ) U IFN-alpha-2B for 6 weeks before reevaluation . Patients were evaluated with  duplex Doppler ultrasonography  to assess penile curvature and blood flow . RESULTS The International Index of Erectile Function question naire was completed by 14 of 21 men to assess severity of erectile dysfunction ( ED ) before and after treatment . Improvements of 20 % or more in penile curvature occurred in 14 ( 67 % ) of 21 men . Penile pain decreased in eight ( 80 % ) of 10 , and plaque size decreased subjectively in 15 ( 71 % ) of 21 participants . The International Index of Erectile Function question naire showed significant improvement of ED in five ( 71 % ) of seven men with baseline moderate to severe ED . Peak systolic blood flow improved in three ( 43 % ) of seven men with baseline hemodynamic impairment , and veno-occlusive disease resolved in three ( 18 % ) of 17 individuals . IFN-alpha-2B injections led to significant improvements in penile pain and curvature caused by PD . CONCLUSION Results of intralesional IFN-alpha-2B injections in improving ED are encouraging . The study findings warrant further investigation of the effectiveness of IFN-alpha-2B injections for treatment of PD INTRODUCTION Outcome data of penile traction therapy ( PTT ) for the acute phase ( AP ) of Peyronie 's disease ( PD ) have not been specifically studied . AIM The aim of this study was to assess the effectiveness of a penile extender device for the treatment of patients with AP of PD . METHODS A total of 55 patients underwent PTT for 6 months and were compared with 41 patients with AP of PD who did not receive active treatment ( " no intervention group " [ NIG ] ) . MAIN OUTCOMES MEASURES Pre- and posttreatment variables included degree of curvature , penile length and girth , pain by 0 - 10 cm visual analog scale ( VAS ) , erectile function ( EF ) domain of the International Index of Erectile Function question naire , Erection Hardness Scale , Sexual Encounter Profile 2 question , and penile sonographic evaluation  ( only patients in the intervention group ) . RESULTS The mean curvature decreased from 33 ° at baseline to 15 ° at 6 months and 13 ° at 9 months with a mean decrease 20 ° ( P < 0.05 ) in the PTT  group . VAS score for pain decreased from 5.5 to 2.5 after 6 months ( P < 0.05 ) . EF and erection hardness also improved significantly . The percentage of patients who were not able to achieve penetration decreased from 62 % to 20 % ( P < 0.03 ) . In the NIG , deformity increased significantly , stretched flaccid penile length decreased , VAS score for pain increased , and EF and erection hardness worsened . PTT was associated with the disappearance of sonographic plaques in 48 % of patients . Furthermore , the need for surgery was reduced in 40 % of patients who would otherwise have been c and i date s for surgery and simplified the complexity of the surgical procedure ( from grafting to plication ) in one out of every three patients . CONCLUSIONS PTT seems an effective treatment for the AP of PD in terms of pain reduction , penile curvature decrease , and improvement in sexual function BACKGROUND Collagenase Clostridium histolyticum ( CCH ) is indicated for the treatment of penile curvature in adult men with Peyronie 's disease ( PD ) with palpable plaque and curvature deformity of at least 30 ° at the start of therapy . AIM To evaluate the efficacy and safety of CCH plus vacuum-pump therapy with and without penile modeling for the management of PD . METHODS Adult men with PD and penile curvature of at least 30 ° were r and omly assigned to receive  CCH  0.58 mg plus vacuum therapy alone ( n = 15 ) or with penile plaque modeling ( n = 15 ) . Patients received no more than four treatment cycles ( cycle = ∼6-week duration ) , each consisting of two intralesional injections of CCH administered 24 to 72 hours apart . Vacuum therapy was applied twice daily from 14 days after the second injection of each cycle until the following cycle . Modeling was performed 24 to 72 hours after the second injection of each cycle . OUTCOMES The primary end point was change in penile curvature from baseline to week 36 ; additional end points included changes in Peyronie 's Disease Question naire ( PDQ ) domain scores , composite response ( ≥20 % decrease in penile curvature and decrease in PDQ bother score ≥ 1 point ) , and global response ( small but important , moderate , or much improvement in the Global Assessment of PD ) . RESULTS At week 36 , improvement in penile curvature from baseline was similar in the two groups ( mean change from baseline = -23.7 ° [ SD = 10.9 ] for CCH + vacuum + modeling and -23.3 ° [ SD = 7.2 ] for CCH + vacuum ; between-group difference = -0.3 ° , 95 % CI = -7.3 to 6.6 ) . Improvements in most PDQ domains , including bother , were observed from baseline to week 36 in the two groups . Most patients were composite ( 66.7 % and 84.6 % with CCH + vacuum + modeling and CCH + vacuum , respectively ) and global ( 86.7 % and 92.3 % , respectively ) responders . The most common adverse events were penile contusion , penile swelling , and penile pain . CLINICAL IMPLICATION S Vacuum-pump therapy administered alone or in combination with modeling after CCH treatment could improve PD symptoms . STRENGTHS AND LIMITATIONS This was a pilot study with a small sample and limited follow-up duration . CONCLUSION CCH and vacuum-pump therapy ( alone or combined with modeling ) could be an appropriate consideration for men with PD and warrants further investigation . Ralph DJ , Abdel Raheem A , Liu G. Treatment of Peyronie 's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy : A R and omized , Open-Label Pilot Study . J Sex Med 2017;14:1430 - 1437 To compare the efficacy of transdermal electromotive administration and intra‐lesional injection of verapamil plus dexamethasone for the treatment of Peyronie 's disease . Patients with Peyronie 's disease of less than 2‐year duration were r and omized into two groups of transdermal electromotive administration and intra‐lesional injection of verapamil plus dexamethasone . During the 6‐week therapy period , a single weekly dose of 10 mg verapamil and 4 mg dexamethasone solution was administered to 30 patients in each group either by transdermal electromotive method or via the conventional injection method by a syringe connected to a 25 G needle . Evaluations of plaque length , width , and volume , penile curvature , erectile dysfunction and penile deviations were carried out before and after 1 and 3 months of the interventions . Erectile pain was reduced in the electromotive group from a mean of 5.1–1.0 in scale of 10 and from 5.4 to 3.6 in the injection group ( p = 0.006 ) . Regarding plaque length , plaque width , penile curvature plaque volume and erectile dysfunction , the electromotive administration group showed better results which , however , were not statistically significant . ( p > 0.05 ) . Transdermal electromotive drug administration yielded comparable results as against current conventional intra‐lesional injection technique and fared better in controlling erectile pain INTRODUCTION Various conservative treatments for Peyronie 's disease ( PD ) have been attempted over the years . Intralesional verapamil injection has been tested in prospect i ve r and omized studies , but the effect of this treatment seems insufficient . Nicardipine is a calcium antagonist alternative to verapamil and is reportedly more effective in vitro . AIM The objective of our study was to evaluate the usefulness of intralesional nicardipine injection as a conservative treatment for PD in the transition period of acute and chronic phase . METHODS Eighty-six patients ( age : 38 - 72 years , mean : 52 ) were enrolled in this study . A total of 74 patients were assigned r and omly to nicardipine group ( 10 mg diluted in 10 mL of distilled water daily , N=37 ) and control group ( 10 mL of saline water , N=37 ) . A total of six injections were administrated biweekly . MEAN OUTCOME MEASURE The subjects were assessed by International Index of Erectile Function (IIEF)-5 and international pain scale . The plaque size was measured by ultrasonography after 20 µg intracavernosal injection of alprostadil ( prostagl and in E1 ) . The penile curvature was also measured by taking a photograph at maximum rigidity . RESULTS A reduction of pain score was seen throughout the course of treatment in both groups with a significant difference between the nicardipine and control groups ( multiple analysis of variance test , P=0.019 ) . A significant improvement of IIEF-5 score occurred only in the nicardipine group at 48 weeks after the initiation of treatment ( P<0.01 ) . The plaque size was significantly reduced at 48 weeks only in the nicardipine group ( 12 points , P=0.0004 by paired t-test ) . The penile curvature was significantly improved in both groups ( P<0.01 ) without significant difference between them ( P=0.14 ) . There were no severe side effects , such as hypotension or other cardiovascular events . CONCLUSION Our findings indicate that intralesional nicardipine injection is clinical ly effective as a conservative treatment for PD in the transition period of acute and chronic phase INTRODUCTION Collagenase clostridium histolyticum ( CCH ; Xiaflex , Auxilium Pharmaceuticals , Inc. , Chesterbrook , PA , USA ) is a Food and Drug Administration-approved , intralesional treatment for Peyronie 's disease ( PD ) . AIM The aim of this study was to assess the safety and effectiveness of CCH in the treatment of PD . METHODS This phase 3 , open-label study enrolled subjects who were CCH-naïve , were enrolled in a previous pharmacokinetic study , or had received placebo in an earlier phase 2 CCH study . Each treatment cycle included two intralesional injections of CCH 0.58 mg , approximately 24 - 72 hours apart , and plaque modeling 24 - 72 hours after the second injection of each cycle . The treatment cycle was repeated after 6 weeks for ≤4 treatment cycles . MAIN OUTCOME MEASURES The co- primary end points were the mean percent change in penile curvature deformity and the mean improvement in PD bother score ( range 0 - 16 ) from baseline to week 36 . RESULTS Of the 347 subjects treated with ≥1 injection , 238 had both a penile curvature measurement and a Peyronie 's Disease Question naire response at baseline and ≥1 subsequent time point . Mean baseline penile curvature deformity was 53.0 ° and mean PD symptom bother was 7.3 . Statistically significant mean improvements from baseline to week 36 were observed in both penile curvature deformity ( 34.4 % [ 95 % confidence interval { CI } , 31.2 % , 37.6 % ] ) and PD symptom bother score ( 3.3 [ 95 % CI , 2.8 , 3.7 ] ) . Most adverse events ( AEs ) were mild or moderate in severity and local to the penis . There were three serious treatment-related AEs , two penile hematomas and one corporal rupture ; all resolved with treatment . CONCLUSIONS Potentially clinical ly meaningful and statistically significant improvements in penile curvature deformity and PD symptom bother scores were observed with intralesional injection of CCH compared with baseline in men with PD . CCH was generally well tolerated , with AEs primarily transient and local to injection site . In conjunction with previous studies , the results of this open-label study support the use of CCH in the treatment of PD Introduction . There is no current consensus as to the most effective non-surgical therapy for Peyronie 's disease ( PD ) . Aim . To assess the benefit of penile traction therapy ( PTT ) when added to intralesional verapamil injections ( IVI ) combined with oral L-arginine 1 g bid and pentoxifylline 400 mg tid in men with PD . Methods . 74 men with PD completed 12 IVI . 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 question naires . Stretched penile length ( SPL ) and erect penile curvature ( EPC ) using penile duplex ultrasound ( DU ) were measured . Response to therapy was defined as at least a 10 degree reduction in EPC.Main Outcome Measures . Change in SPL ( cm ) , change in EPC ( degrees ) . Results . 39 patients in the PTT group ( I ) vs. 35 patients in group ( II ) completed the protocol . 54 % of men in group I responded to therapy vs. 46 % in group II ( p = 0.75 ) . Responders had a mean EPC improvement of 26.9 degrees in group I vs. 20.9 in group II ( 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 on 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 ) . Conclusion . 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 [ corrected ] Aim To determine the effectiveness of transdermal electromotive administration ( TEA ) of verapamil and dexamethasone in the treatment of Peyronie ’s disease ( PD ) . Method Totally , 51 patients with PD were prospect ively included in the study . All patients were evaluated by history , subjective score scales , physical examination , photographs , and penile USG , before and after therapy . All patients were treated with TEA of the combination of verapamil and dexamethasone . The treatment plan included a total of 20 sessions ( at 3-day intervals for a period of 2 months ) , each with a duration of 20 min . At the end of the study , improvements in penile plaques , penile deviation , pain on erection , and erectile dysfunction were determined . Results The findings in 41 of the 51 patients were eligible to present . Median patient age was 52 years . Median duration of disease at presentation was 8 months . Remarkable reduction in palpable plaques and in penile angulation was observed in 10 patients ( 24 % ) and 11 ( 26 % ) patients , respectively . There were significant decreases in median plaque volume from 72 mm2 to 45 mm2 ( P < 0.001 ) , and in median penile angulation from 25º to 15º ( P < 0.001 ) . Impaired sexual activity and pain on erection had completely resolved in 11 ( 55 % ) patients and in 16 ( 80 % ) , respectively . Conclusion The results of our study have shown that TEA of the combination of verapamil and dexamethasone is a more effective therapy for improving subjective symptoms rather than objective symptoms . Therefore , we think that this treatment can be individualized according to the clinical features of PD patients OBJECTIVES To define the impact of intralesional verapamil injection therapy on  penile deformity in men with Peyronie 's disease . METHODS Patients underwent a total of 6 intralesional injections of verapamil .  Penile deformity was assessed at baseline and 3 months after the last intralesional injection of verapamil during penile erection after the administration of intracavernosal medication . Measurement was recorded using a goniometer at maximum penile rigidity . Endpoints included change in magnitude of curvature , stretched penile length , penetration ability , and resolution of pain . RESULTS Ninety-four consecutive patients met all inclusion criteria . Mean ( + /- st and ard deviation ) patient age and duration of Peyronie 's disease at time of baseline deformity assessment were 44 + /- 18 years and 5.2 + /- 2.7 months , respectively . At baseline 86 % had dorsal and 14 % lateral curvature . The mean curvature and stretched flaccid length were 50 degrees + /- 28 degrees and 12.6 + /- 3.1 cm , respectively . At the follow-up evaluation , patients were 5.2 + /- 1.8 months after their last ILV injection and were 11.7 + /- 4.2 months after the onset of Peyronie 's disease . Eighteen percent of patients had improvement of curvature , 60 % were unchanged , and 22 % worsened . Pain resolved in 100 % of patients . CONCLUSIONS In response to intralesional verapamil , a minority of men experienced improvement in penile deformity ; however , the majority of patients had stabilization of their deformity . This information may permit clinicians to give realistic expectations to patients considering intralesional verapamil therapy Introduction Collagenase Clostridium histolyticum ( CCH ) intralesional injection was efficacious for the management of Peyronie 's disease ( PD ) in the double-blinded , r and omized , placebo-controlled Investigation for Maximal Peyronie 's Reduction Efficacy and Safety Studies I and II ( IMPRESS I and II ) . Little is known about the consequences of PD or treatment on the sexual partners of affected men . Aim To assess the safety and efficacy of CCH treatment in men who received placebo in the IMPRESS I or II study and to evaluate the men 's PD symptoms and partner bother as reported by female sexual partners . Methods In this phase 3 , open-label study ( NCT01685437 ) , men ( n = 189 ) received up to eight injections of CCH ( 0.58 mg/injection ) . Female sexual partners who provided informed consent at screening ( n = 30 ) participated in the study . Main Outcome Measures Co- primary end points were change or percentage of change in penile curvature deformity and change in PD symptom bother domain score of the Peyronie 's Disease Question naire ( PDQ ) from baseline to week 36 . Participating women completed the PDQ for  female  sexual partners ( PDQ-FSP ) and the Female Sexual Function Index ( FSFI ) . Results Statistically significant mean improvements were observed in penile curvature deformity ( 36.3 % decrease ; 95 % CI = −41.6 to −30.9 ) and PDQ symptom bother score ( 2.4-point decrease ; 95 % CI = −3.0 to −1.8 ) from baseline to week 36 . Most treatment-emergent adverse events were mild or moderate . After CCH treatment of their male partners , female sexual partners reported improvement ( using the PDQ-FSP ) in their male partner 's PD symptoms and female bother regarding their partner 's PD . The percentage of female sexual partners with sexual dysfunction ( FSFI total score ≤ 26.55 ) also decreased after male partner treatment , from 75.0 % at baseline to 33.3 % . Conclusions These results support the safety and efficacy of CCH in the management of appropriate patients with PD and the potential benefits for patients ' partners . Goldstein I , Knoll LD , Lipshultz LI , et al. Changes in the Effects of Peyronie 's Disease After Treatment With Collagenase Clostridium histolyticum : Male Partners and Their Female Partners . Sex Med 2017;5:e124–e130 Intralesional therapy is a less invasive method for the treatment of Peyronie 's disease . The objective of this study was to evaluate intralesional injections of interferon alpha 2B ( IFN-alpha-2B ) as an effective alternative to the surgical treatment of Peyronie 's disease . Twenty-one patients with Peyronie 's disease were evaluated by use of penile duplex Doppler ultrasonography for cavernosal blood flows , degree of penile curvature , and plaque size . A question naire was given to all patients to assess sexual function . Each patient then received biweekly intralesional injections of 1 x 10(6 ) units of IFN-alpha-2B in 10 ml of normal saline over a period of 6 months . There was no placebo control group in this study . At the conclusion of the study , penile duplex Doppler imaging was repeated . A question naire was completed by all patients to assess changes in sexual function after treatment . Twenty patients completed the study , with all men reporting subjective softening of their plaques . Nine of 10 patients initially reporting penile pain with erection ( 90 % ) had resolution of their phallalgia while on study protocol . Thirteen patients ( 65 % ) had significant improvement in curvature , ranging from 20 to 90 % . Seventeen patients ( 85 % ) demonstrated an objective 10 to 80 % decrease in plaque size . Biweekly intralesional injections of Peyronie 's plaques with IFN-alpha-2B result ed in a significant improvement in penile curvature , diminished pain , and reduced plaque size , and result ed in a subjective improvement in sexual function OBJECTIVE To evaluate the outcomes in men undergoing collagenase Clostridium histolyticum ( CCH ) with concurrent penile traction therapy ( PTT )  for the treatment of Peyronie disease ( PD ) . MATERIAL S AND METHODS We identified patients treated with CCH between March 2014 and July 2016 . Patients were recommended to perform modeling and PTT between injection series . A final curve assessment was performed after patients completed CCH . A prospect i ve data base was maintained , including patient-reported frequency and duration of PTT . Statistical analysis was performed to evaluate outcomes based on use and duration of PTT . RESULTS A total of 51 patients completed CCH and had complete objective data available for analysis . Mean ( st and ard deviation [ SD ] ) baseline curvature was 66.7 ( 25.0 ) degrees , and mean ( SD ) improvement post CCH was 20.9 ( 17.3 ) degrees ( P < .0001 ) . Thirty-five ( 69 % ) men reported daily  PTT  for a mean ( SD ) of 9.8 ( 6.3 ) hours per week . No significant difference was identified in the degree of curve improvement based on frequency or duration of PTT ( P = .40 ) . Similarly , no associations between PTT and functional outcomes including intercourse restoration and surgery prevention were identified . Stretched penile length increased nonsignificantly by a mean ( SD ) of + 0.4 ( 1.5 ) cm in the PTT group , compared with -0.35 ( 1.5 ) in the non-PTT group ( P = .21 ) . CONCLUSION The current series represents a " true-to-life " experience , wherein utilization patterns , attrition , and compliance issues are relevant factors impacting efficacy . PTT use with the And ropenis declined in both frequency and duration with subsequent injection series , and there was no significant difference in curve improvement or stretched penile length with a mean 10 hours of weekly concurrent PTT Introduction Hyaluronic acid has been shown to be efficacious in decreasing scar formation , inflammation , and oxidative stress . Aim To assess the efficacy of intralesional injection of hyaluronic acid in patients affected by Peyronie 's disease . Methods In this prospect i ve , single-arm , self-controlled , interventional , multicenter pilot study , 65 patients underwent a 10-week cycle of weekly intraplaque injections with hyaluronic acid ( 0.8 % highly purified sodium salt hyaluronic acid 16 mg/2 mL ; Sinovial , IBSA , Lodi , Italy ) . Patients were re-evaluated 2 months after the end of therapy . Main Outcome Measures Plaque size ( millimeters ) , penile curvature ( degrees ) , International Index of Erectile Function ( IIEF-5 ) score , visual analog scale ( VAS ) score for sexual satisfaction , and Patient 's Global Impressions of Improvement ( PGI-I ) score . Results Median age was 57 years ( range = 23–70 ) . At baseline , mean plaque size was 10 mm ( range = 3–30 mm ) , mean penile curvature was 30 ° ( range = 0 ° –50 ° ) , and mean IIEF-5 score was 20 ( range = 0–25 ) , with slight to moderate erectile dysfunction ( IIEF score < 21 ) in 36 of 65 patients ( 55 % ) . A median VAS score of 6 ( range = 2–10 ) was found . Mean follow-up was 12 months ( range = 6–24 months ) . Statistically significant post-treatment improvements were detected for plaque size ( before treatment = 10 mm [ 3–30 mm ] , after treatment = 8 mm [ 1–30 mm ] , P < .0001 ) , penile curvature ( before treatment = 30 ° [ 0 ° –50 ° ] , after treatment = 20 ° [ 0 ° –40 ° ] , P < .0001 ) , IIEF-5 score ( before treatment = 20 [ 11–25 ] , after treatment = 21 [ 15–25 ] , P < .0001 ) , and VAS score ( before treatment = 6 [ 2–10 ] , after treatment 8 [ 2–10 ] , P < .0001 ) . After treatment , the rate of patients with an IIEF score lower than 21 decreased from 55 % ( 36 patients ) to 40 % ( 25 patients ) . Overall improvement on the PGI-I question naire was 69 % . Conclusion Intralesional treatment with hyaluronic acid can improve plaque size , penile curvature , and overall sexual satisfaction and seems preferably indicated in the early ( active ) phase of the disease . Furthermore , it is easy to perform and well tolerated PURPOSE We investigated the efficacy and safety of intralesional interferon alpha-2b for the treatment of Peyronie 's disease . MATERIAL S AND METHODS A total of 117 consecutive patients with a mean age of 55.1 years who had Peyronie 's disease were enrolled in a single-blind , multicenter , placebo controlled , parallel study to determine the efficacy and safety of intralesional interferon alpha-2b therapy ( Schering , Kenilworth , New Jersey ) , including 62 who received placebo and 55 who received interferon alpha-2b . Saline ( 10 ml ) in controls and interferon alpha-2b ( 5 x 10(6 ) U ) were administered biweekly for 12 weeks . Each patient was evaluated for penile curvature , plaque size and density , penile pain , erectile function and penile hemodynamics before and after study completion . Improvement in these parameters was statistically compared between the groups . RESULTS A total of 53 patients in the control arm and 50 in the interferon alpha-2b arm completed the study . Improvement in penile curvature , plaque size and density , and pain resolution was significantly greater in patients treated with interferon alpha-2b vs placebo . The increase in mean International Index of Erectile Function scores was not significantly different between the groups . Penile blood flow improvement was observed in interferon alpha-2b treated patients but not in those who received placebo . The decrease in the number of penile vascular pathologies was significantly higher in interferon alpha-2b cases . Side effects , mostly flu-like symptoms , which were frequently noted in patients on interferon alpha-2b , were mild to moderate in degree and of short duration . CONCLUSIONS This single-blind , multicenter , placebo controlled , parallel study demonstrates that intralesional interferon alpha-2b at a dose of 5 x 10(6 ) units biweekly for 12 weeks is effective and safe as minimally invasive therapy for Peyronie 's disease OBJECTIVES Multiple conservative therapies for the treatment of Peyronie 's disease have been offered with variable and poor response rates . Calcium channel blockers have been shown in vitro and in vivo to inhibit secretion and synthesis of extracellular matrix , including collagen , glycosaminoglycans , and fibronectin , as well as causing increased collagenase and anti transforming growth factor-beta activity . Calcium antagonists , including verapamil , are effective in stimulating the remodeling and degradation of extracellular matrix in tissue by altering the metabolic pathways of fibroblasts . Recently , a pilot study ( 1994 ) showed preliminary promising results in treating plaque caused by Peyronie 's disease . This r and omized single-blind placebo-based study ( 1994 to 1996 ) was undertaken to confirm the hypothesis . METHODS In this r and omized single-blind study , 14 patients completed the study and were divided into two groups : the verapamil treatment group ( n = 7 ) or the control saline group ( n = 7 ) . Verapamil or saline was injected directly into the Peyronie 's plaque once a week for 6 months . Patients were evaluated before and after treatment with duplex ultrasound to confirm the extent of the lesion and to measure volume of the plaque , and by interview and mailed question naire 3 months after treatment . Patients being treated with oral calcium antagonists were excluded from the study . RESULTS A decreased plaque volume was measured in 57 % of the verapamil-treated men versus 28 % in the control group ( P < 0.04 ) . Penile curvature demonstrated an improvement trend of 37.71 + /- 9.3 degrees to 29.57 + /- 7.3 degrees in the verapamil-treated patients , but the difference was not significant ( P < 0.07 ) . Plaque softening was noted in all patients treated with verapamil . There was significant objective improvement in plaque-associated penile narrowing in all patients in the verapamil group . Subjective plaque-associated erectile dysfunction ( quality of erection ) showed improvement in 42.87 % of the verapamil group versus none in the control group ( P < 0.02 ) . There was no local or systemic toxicity except for an occasional ecchymosis/bruise at the injection site . After a positive clinical response , plaque size , penile angulation , and symptoms continued to improve . Decrease in plaque size was noted in each of the responders in the first 3 months . CONCLUSIONS This r and omized single-blind study suggests that intralesional injection of calcium channel blocker may be a reasonable approach in some selected patients for the treatment of Peyronie 's disease with noncalcified plaque and penile angulation of less than 30 degrees . Patients whose plaque failed to respond to intralesional verapamil therapy within 3 months or whose angulation was greater than 30 degrees at presentation were more likely to benefit from surgery OBJECTIVE To assess the outcomes of a new protocol of intralesional injections of verapamil ( ILIV ) to treat Peyronie disease ( PD ) and to look for predictors of response . METHODS Patients followed up for PD in our center were prospect ively enrolled between 2007 and 2013 . The following data were collected : age , degree of curvature of the penis , Lue score  ( severity score of PD [ 0 - 15 ] ) , and pain  ( analogic Likert scale : 0 - 5 ) . The protocol consisted of 1 verapamil injection per session ( 15 mg in 6 mL ) in the main plaque using a single-puncture approach . Injections were repeated once every 3 weeks , at least 6 times . RESULTS Sixty men were included .  Mean number of injections per patient was 12.6 ( ±8.9 ) . Average Lue scores before and after ILIV were 9.4 ( ±2 ) and 4.5 ( ±2 ; P = .05 ) , respectively . Average penile curvatures during erection before and after ILIV were 37.3 ° ( ±13.3 ) and 21 ° ( ±13 ) , respectively ( P = .02 ) . There were no serious side effects . At the end of follow-up , 47 patients ( 78 % ) considered themselves globally improved . Younger age was the only predictor of response to ILIV in univariate ( odds ratio = 0.91 ; P = .04 ) and multivariate analyses ( odds ratio = 0.87 ; P = .03 ) . CONCLUSION ILIV had a favorable impact reducing PD in 78 % of patients with minimal side effects . Most patients required at least 12 injections to obtain optimal improvement . A protocol consisting of repeated courses of 6 injections using a single-puncture approach appears a valid option . Younger age was the only predictor of success PURPOSE Collagenase clostridium histolyticum is approved for the treatment of Peyronie 's disease . To date , no post-release study to our knowledge has evaluated patient perceived outcomes and satisfaction . Therefore , we evaluated patient perceived experience with collagenase clostridium histolyticum injection for Peyronie 's disease in a clinical practice . MATERIAL S AND METHODS From March 2014 to July 2015 , 69 patients underwent 1 to 4 series of collagenase clostridium histolyticum injections for Peyronie 's disease at our institution . Objective changes in penile curvature as well as patient reported functional outcomes and patient perceived curvature improvements were evaluated . RESULTS By the time of analysis 31 patients ( 45 % ) had completed 4 trials , 47 ( 68 % ) completed 3 trials and 59 ( 86 % ) completed 2 trials . Patient reported improvements ( percentage ) in curvature increased with each series ( trial 1 - 14 % , trial 2 - 28 % , trial 3 - 30 % and trial 4 - 37 % , p < 0.05 ) . Among those completing therapy 57 % reported that collagenase clostridium histolyticum injections negated a need for surgery and 52 % reported restoration of penetration . Overall 81 % of men perceived collagenase clostridium histolyticum treatment as meaningful and 88 % reported subjective improvements after 4 series of injections . Objective measures demonstrated a mean 23-degree curvature improvement ( 38 % , p < 0.0001 ) . Seven patients ( 10 % ) experienced penile hematomas and no patients experienced tunical rupture . CONCLUSIONS Collagenase clostridium histolyticum reduced the need for surgery and restored penetration in the majority of patients completing 4 series of injections . It also significantly reduced the degree of objective ly measured penile curvature . Subjective improvements in curvature increased with each series of collagenase clostridium histolyticum injections as well and the majority of patients considered the therapy worthwhile OBJECTIVE To evaluate the efficacy of subcutaneous interferon-alpha 2b in the treatment of Peyronie 's disease . PATIENTS AND METHODS Twenty-three men ( mean age 53 years , range 27 - 69 ) received interferon-alpha 2b in an unr and omized prospect i ve study . The drug was injected subcutaneously adjacent to the plaque three times a week for 3 weeks at a dose of 2 x 106 IU . The effect of interferon-alpha 2b on the extent of penile deviation , plaque size and erectile pain were investigated , and the drug 's side-effects were documented . The mean ( range ) follow-up was 22 ( 4 - 48 ) months RESULTS All patients had pain relief and 13 of 19 with pain before treatment became pain-free . The penile deviation was reduced in one patient ; the deviation increased despite therapy in one patient and remained stable in the others . Plaque size remained unchanged in all patients . Impaired sexual function was improved in seven ( 30 % ) of the patients . Side-effects ( myalgia , fever ) occurred after only four of 207 injections ( 2 % ) . CONCLUSIONS Subcutaneous interferon-alpha 2b is safe , well tolerated and relieves pain . However , with no objective reduction in penile deviation and plaque size , the outcome of interferon-alpha 2b therapy is generally unconvincing and the drug can not be recommended for the conservative treatment of Peyronie 's disease PURPOSE While surgery remains the gold st and ard of therapy to correct the acquired curvature of Peyronie 's disease , the search for a less invasive therapy continues . Transdermal drug delivery was proposed to be superior to oral or injection therapy because it bypasses hepatic metabolism and minimizes the pain of injection . After electromotive drug administration with verapamil tunica albuginea specimens were demonstrated to contain detectable levels of the drug . Due to varying success with verapamil as injectable therapy for Peyronie 's disease we performed a double-blind , placebo controlled trial to determine the effectiveness of verapamil delivered through electromotive drug administration . MATERIAL S AND METHODS A total of 42 men with Peyronie 's disease volunteered to participate in this study , which was approved by our institutional review board . A genitourinary examination was performed on all patients , including plaque location , stretched penile length , objective measurement of curvature after papaverine injection and duplex ultrasound . Each subject was r and omized to receive 10 mg verapamil in 4 cc saline or 4 cc saline via electromotive drug administration . A Mini-Physionizer ( Physion , Mir and ola , Italy ) device was used at a power of 2.4 mA for 20 minutes . Treatments were performed 2 times weekly for 3 months . After 3 months each patient was reevaluated with physical examination and duplex ultrasound  by a technician blinded to the treatment received . A modified erectile dysfunction index of treatment satisfaction question naire was also completed by each patient . RESULTS A total of 23 patients were r and omized to the verapamil treatment group ( group 1 ) and 19 were r and omized to the saline group ( group 2 ) . There were no significant differences between patient groups with respect to patient age , disease duration or pretreatment curvature . In group 1 , 15 patients ( 65 % ) had measured improvement ( mean 9.1 degrees , range 5 to 30 ) , 5 ( 22 % ) had no change and in 3 ( 13 % ) the condition worsened . In group 2 , 11 patients ( 58 % ) had measured improvement ( mean 7.6 degrees , range 5 to 30 ) , 7 ( 37 % ) showed no change and in 1 ( 5 % ) the condition worsened . To better evaluate effectiveness the total number of patients experiencing significant improvement ( 20 degrees or greater ) was calculated and compared . Seven patients ( 30 % ) in group 1 and 4 ( 21 % ) in group 2 achieved this criterion . Although a greater percent of patients treated with verapamil had improved curvature , the results were not statistically significant . CONCLUSIONS Although a greater percent of patients treated with verapamil in our electromotive drug administration protocol had a measured decrease in curvature , the results were not statistically significant . Further research is necessary to determine whether electric current may have a role in the treatment of Peyronie 's disease as well as if verapamil delivered via electromotive drug administration may have a role as effective treatment . Electromotive drug administration is a treatment option in the patient whose major complaint is pain or in the patient with mild curvature who does not wish to undergo intralesional therapy or surgical correction Purpose We aim ed to assess the effect of intralesional verapamil on the treatment of Peyronie ’s disease . Material s and methods This r and omized study involved 80 patients . First , they were divided into two groups . The first group ( case : 40 patients ) received intralesional verapamil and the second group ( control : 40 patients ) local saline injection . They were followed about 24 weeks and evaluated for the size of plaques , plaque softening , reduction of pain and amelioration of penile deformity and erectile dysfunction ( estimated by the International Index of Erectile Function ) before and after treatment . Results Reduction of plaque size was seen in 17.5 % of the case group and 12.8 % of the control group ( P : 0.755 ) . Pain was reduced in 30 % of the case group and 28.2 % of the control group ( P : 0.99 ) . Curvature was decreased in 17.5 % of the case group and 23.1 % the control group ( P : 0.586 ) . Plaque softening was seen in 30 % of the case group compared with 25.6 % improvement in the control group ( P : 0.803).Also we found 5 % and 2.6 % improvement in sexual dysfunction in the case and control groups , respectively . ( P : 0.985 ) . Conclusion Although in some studies verapamil has been found to be effective in the treatment of Peyronie ’s disease , we did not find any improvement in comparison with the control group . Furthermore , larger scale studies are warranted to assess the effect of this drug on the treatment of Peyronie ’s disease Peyronie 's disease remains a therapeutic dilemma for the practicing urologist . Multiple nonoperative therapies have been offered with variable suboptimal response rates . Calcium channel blockers have been shown to alter the metabolism of fibroblasts , result ing in decreased extracellular matrix secretion of collagen as well as increased collagenase activity . In this nonr and omized dose-escalating format study 14 men received biweekly injections of verapamil into the Peyronie 's plaques for 6 months . Subjectively , there was significant improvement in plaque-associated penile narrowing ( 100 % ) and curvature ( 42 % ) . Objective ly , a decreased plaque volume of greater than 50 % was noted in 30 % of the subjects . Plaque softening was noted in all patients , while 83 % noticed that plaque-related changes in erectile function had arrested or improved . There was no toxicity nor did symptoms recur when improvement was noted . This preliminary study suggests that intralesional calcium antagonist ( verapamil ) therapy offers an economical and sensible nonoperative approach to the treatment of Peyronie 's disease ABSTRACT Objectives : To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie 's disease . Material s and Methods : Prospect i ve , single-blind , r and omized study , selecting patients who have presented Peyronie 's disease for less than 18 months .  Thiocolchicine 4 mg or verapamil 5 mg were given in 7 injections ( once a week ) . Patients who had received any treatment for Peyronie 's disease in the past three months were excluded . The parameters used were the International Index of Erectile Function ( IIEF-5 ) score , analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography . Results : Twenty-five patients were r and omized , 13 received thiocolchicine and 12 were treated with verapamil . Both groups were statistically similar . The mean curvature was 46.7 ° and 36.2 ° before and after thiocolchicine , respectively ( p=0.019 ) and 50.4 ° and 42.08 ° before and after verapamil , respectively ( p=0.012 ) . The curvature improved in 69 % of patients treated with thiocolchicine and in 66 % of those who received verapamil . Regarding sexual function , there was an increase in the IIEF-5 from 16.69 to 20.85 ( p=0.23 ) in the thiocolchicine group . In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 ( p=0.58 ) . In the thiocolchicine group , the plaque was reduced in 61 % of patients . In the verapamil group , 8 % presented decreased plaque size . No adverse event was associated to thiocolchicine . Conclusion : The use of thiocolchicine in Peyronie 's disease demonstrated improvement on penile curvature and reduction in plaque size .  Thiocolchicine presented similar results to verapamil in curvature assessment . No significant side effects were observed with the use of tiocolchicine PURPOSE To determine the effectiveness of intralesional administration of onabotulinumtoxinA in patients with Peyronie ’s disease ( PD ) . MATERIAL S AND METHODS A prospect i ve therapeutic cohort study was undertaken in patients aged ≥ 18 years with stable PD . Intervention included one-time intralesional application of 100 U of onabotulinumtoxinA. We included 22 patients who attended the urology clinic from October 1 , 2011 to June 30 , 2012 . Primary outcome measure was degree of curvature . Secondary outcome measures were thickness of the fibrous plaque , improvement in erectile function and pain . Erectile function was evaluated using the International Index of Erectile Function ( IIEF-5 ) question naire . The Visual Analog Scale ( VAS ) was used to measure pain during an erection . Statistical analyses were performed by Pearson ’s chi-squared test for categorical variables and student ’s t-test for quantitative variables . Any P value < .05 was considered statistically significant . RESULTS The size of the fibrous plaque was reduced from 0.34 ± 0.20 to 0.27 ± 0.13 cm after treatment ( P = .014 ) . The curvature initially averaged 32.95 ± 9.21 ° , and improved to 25 ± 9.38 ° ( P = .025 ) . According to the Kelami classification , the curvature was < 30 ° in 14 cases ( 63.6 % ) and was 30 ° -60 ° in eight cases ( 36.4 % ) . At 16 weeks , the curvature was < 30 ° in 19 cases ( 86.4 % ) and 30 ° -60 ° in three cases ( 13.6 % ) . The IIEF-5 score was 16.18 ± 4.46 before treatment and 18.22 ± 4.55 after treatment ( P = .002 ) . Pain was reduced from 3.36 ± 3.48 before treatment to 1.14 ± 1.58 after treatment ( P = .001 ) . CONCLUSION The administration of onabotulinumtoxinA may improve the clinical manifestations of PD result ing from fibrosis , thus improving sexual function in patients OBJECTIVES To compare the efficacy and safety of intralesional interferon-alpha 2b combined with oral vitamin E or intralesional interferon-alpha 2b alone or oral vitamin E alone for the treatment of Peyronie 's disease . METHODS From January 2000 to March 2002 , a total of 30 consecutive men with Peyronie 's disease were r and omized prospect ively into three different treatment groups . All the patients were assessed objective ly with  penile duplex Doppler ultrasonography  for plaque size , location , and presence of calcification before and after treatment . Subjective data were obtained by querying about the improvement in penile pain and by using the " global efficacy question " for the assessment of the quality of sexual intercourse at the end of the study . A total of 5.0 x 10(6 ) U of interferon-alpha 2b was given once per week directly into the plaque for a period of 12 weeks . Patients received 400 IU of vitamin E orally twice daily for 6 months . RESULTS At the 6-month follow-up visit , we did not find any statistically significant changes in the objective parameters when compared with the initial findings in each group or among the three groups ( P > 0.05 ) . We did not observe any clinical ly significant improvement in the subjective parameters among the three groups ( P > 0.05 ) . However , all patients who were treated with interferon-alpha 2b experienced brief flu-like side effects . CONCLUSIONS Our findings indicate that 5 million units of intralesional interferon-alpha 2b injection therapy either alone or in combination with vitamin E does not appear to be clinical ly effective in the management of early stage Peyronie 's disease compared with only oral vitamin PURPOSE We evaluate the efficacy of iontophoresis of dexamethasone , lidocaine and verapamil to treat Peyronie 's disease . MATERIAL S AND METHODS In an uncontrolled prospect i ve study 100 unselected patients with Peyronie 's disease were treated with 3 weekly courses of iontophoresis . The drug mixture was administered by an electrical current of 5 mA. and a self-adhesive receptacle fixed to the penile skin overlying the plaque . RESULTS Resolution of pain was observed in 96 % of patients , plaque diminution in 53 % and improvement of penile deviation in 37 % . Impaired sexual function was improved in 19 of 43 patients ( 44 % ) . The benefit of iontophoresis therapy was more pronounced in patients with a short history of disease . Because of lack of side effects and painless administration iontophoresis was well tolerated and accepted by all patients . CONCLUSIONS Iontophoresis of dexamethasone , lidocaine and verapamil may be regarded as first line nonsurgical treatment for Peyronie 's disease The purpose of this study was to clarify the actual therapeutic potential of a new transdermal drug delivery system ( electromotive drug administration ; EMDA ) for selected patients with Peyronie 's disease . Forty patients with Peyronie 's disease were treated by electromotive administration of the 3-drug association orgotein-dexamethasone-lidocaine in a double-blind , placebo-controlled , partial crossover study ( study 1 ) . Another 25 patients were treated by EMDA with a combination of verapamil-dexamethasone in an uncontrolled study ( study 2 ) . Treatment sessions lasted 20 minutes each and took place 3 times a week for 3 weeks with a current of 3 mA. Patients were assessed before treatment and at 1- and 3-month follow-up examinations . Assessment s were based on sexual history , physical examination , and dynamic color Doppler ultrasonographic results . Adverse effects of EMDA were not reported . In study 1 , the clinical results observed after treatment proved to be significantly better than those of the placebo .  Penile pain disappeared in all patients in both studies . Penile lesion ( nodule or plaque ) either disappeared or significantly improved in 79 % and 90 % of patients treated by the 3- and 2-drug association , respectively . The improvement of penile deformity also was notable although it did not match the effect observed on penile nodules or plaque ( 62 % and 88 % , in studies 1 and 2 , respectively ) . In both studies , more than 80 % of patients reported a definite amelioration of penile rigidity , which paralleled the improvement of penile dynamic color Doppler ultrasonographic parameters . Overall , the combination of verapamil-dexamethasone achieved better clinical results than the 3-drug combination . Electromotive drug administration is a novel technique capable of safely achieving satisfactory results in selected patients with Peyronie 's disease not only in terms of improvement of patient 's symptoms but also due to the reduced need for penile surgery PURPOSE In a previous study , 83 % of 14 patients noted that their symptoms of Peyronie 's disease had arrested or improved after intralesional injection of verapamil . This nonr and omized , prospect i ve study further investigates the use of verapamil in a larger , thoroughly characterized patient population . MATERIAL S AND METHODS Forty-six men began treatment ; 38 completed the study . Using a multiple puncture technique , 10 mg . of verapamil diluted to 10 cc were distributed throughout the plaque every 2 weeks for a total of 12 injections . Response to treatment was evaluated through subjective and objective measurements of pain , plaque size , deformity , duration of disease and sexual function , and with the Kelami classification system based on plaque size and curvature . RESULTS Pain resolved in 97 % of the patients who presented with pain after a mean of 2.5 injections . After therapy , 76 % reported a subjective decrease in curvature , 9.5 % noted an increase and 14.5 % remained unchanged . Of the treated patients 72 % reported an improvement in the ability to engage in coitus . Objective measurements demonstrated that curvature was decreased in 54 % of the patients , increased in 11 % and remained unchanged in 34 % . There were no substantial differences in response to treatment based on duration of disease or within the 3 Kelami classification groups . Other than transient post-injection ecchymosis , there were no significant acute or chronic side effects . CONCLUSIONS Verapamil injection therapy result ed in a reduction of pain in 97 % of the patients , an improvement in sexual function in 72 % , a reduction of deformity in 86 % , an improvement in distal rigidity in 93 % and an objective reduction of curvature in 54 % . Further studies are required to determine the effectiveness of this nontoxic , inexpensive , nonsurgical approach to Peyronie 's disease BACKGROUND Erectile dysfunction is a common medical problem affecting many men . Although several intracavernosal therapies are available , their efficacy and safety have not been studied systematic ally . METHODS We investigated the efficacy and safety of alprostadil formulated for intracavernosal treatment in three separate multi-institutional , prospect i ve studies in men with erectile dysfunction of vasculogenic , neurogenic , psychogenic , and mixed causes . Clinical and laboratory evaluations of erection and the feasibility of satisfactoriness of sexual activity as assessed both by the men and by their partners were the primary measures of efficacy . RESULTS In a dose-response study of 296 men , all doses of alprostadil were superior to placebo and there was a significant dose-response relation ( P < / = 0.001 ) , result ing in higher response rates with increasing doses of alprostadil ( from 2.5 to 20 microg ) . In a dose-finding study of 201 men , the minimal effective dose was < / = 2 microg in 23 , 20 , 38 and 23 percent of men with erectile dysfunction of neurogenic , vasculogenic , psychogenic , or mixed causes , respectively . In a six-month self-injection study in 683 men , the participants reported being able to have sexual activity after 94 percent of the injections . The men and their partners rated the sexual activity as satisfactory after 87 and 86 percent of the injections , respectively . Penile pain , usually mild , occurred in 50 percent of the men at some time but after only 11 percent of the injections . Prolonged erections occurred in 5 percent of the men , priapism in 1 percent , penile fibrotic complications in 2 percent , and hematoma or ecchymosis in 8 percent . CONCLUSIONS In men with erectile dysfunction , intracavernosal injection of alprostadil is an effective therapy with tolerable side effects OBJECTIVES Controversial data on penile length after  radical retropubic prostatectomy  are available . We hypothesised that postoperative penile size correlates to erectile function following bilateral nerve-sparing radical retropubic prostatectomy  ( BNSRRP ) . METHODS Thirty-three consecutive patients with a preoperative erectile function domain of the International Index of Erectile Function ( IIEF-EF ) score indicating full potency ( > or = 26 ) were prospect ively enrolled . All patients underwent BNSRRP performed by one high-volume surgeon . All patients were preoperatively evaluated by IIEF-EF ,  analysis of comorbidities , physical examination  , and  penile power colour Doppler ultrasound using intracavernosal injection of prostagl and in E(1 ) ( PGE(1 ) ) 20 microg plus audiovisual and manual genital stimulation .  Penile length and circumference were measured in flaccidity and at maximum erection . Six months postoperative , patients were assessed with the same protocol plus general assessment questions investigating penile structure and function . Statistical analysis was performed with an independent sample t test . RESULTS Mean patient age was 56.5 yr . We found no difference between the preoperative and the 6-mo postoperative mean IIEF-EF domain score ( 27.2 vs , 26.7 , respectively ; p = 0.35 ) . No difference was found in penile colour Doppler evaluation between the preoperative and postoperative periods ( all p values > or = 0.3 ) . We found no differences in penile length and circumference between the preoperative and postoperative evaluation either in the flaccid or in the erect state . Mean flaccid penile length ( cm ; preop vs. postop ) : 13.2 vs. 13 ( p = 0.6 ) . Mean flaccid penile circumference ( cm ; preop vs. postop ) : 11.1 vs. 11 ( p = 0.7 ) . Mean erect penile length ( cm ; preop vs. postop ) : 16.8 vs. 16.5 ( p = 0.08 ) . Mean erect penile circumference ( cm ; preop vs. postop ) : 15.6 vs. 15.3 ( p = 0.2 ) . CONCLUSIONS This is the first report on penile changes in flaccidity and at maximum erection after BNSRRP in patients treated by one high-volume surgeon . The postoperative preservation of erectile function positively correlated with the maintenance of penile length following surgery . We found no change in penile size after surgery PURPOSE This study was aim ed at assessing prospect ively the effect of postoperative intracavernous injections of alprostadil on the recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy . MATERIAL S AND METHODS A total of 30 potent patients with clinical ly localized prostate cancer ( clinical stage B1 or B2 , Gleason sum 7 or greater , prostatic specific antigen less than 20 ng./ml . ) underwent nerve-sparing radical retropubic prostatectomy  and was subsequently r and omized to alprostadil injections 3 times per week for 12 weeks ( group 1 , 15 patients ) or  observation without any erectogenic treatment ( group 2 , 15 patients ) . Patients were assessed at the 6-month followup by sexual history , physical examination , color Doppler sonography of the cavernous arteries and polisomnographic recording of nocturnal erections . RESULTS In group 1 , 12 patients ( 80 % ) completed the entire treatment schedule and were evaluated at the long-term followup . Eight patients in this group ( 67 % ) reported the recovery of spontaneous erection sufficient for satisfactory sexual intercourse , compared with 3 patients ( 20 % ) in group 2 . The difference between the 2 groups was statistically significant ( p < 0.01 ) . In group 1 , all but 1 patient reporting normal postoperative erections also showed normal erections at nocturnal testing , whereas color Doppler sonography demonstrated normal penile hemodynamics in all of them . In these patients , failures were the result of cavernous veno-occlusive dysfunction ( 2 cases , 17 % ) and cavernous nerve injury ( 2 cases , 17 % ) . In group 2 , patients with normal erections showed both normal nocturnal testing and penile hemodynamics , whereas failures were the result of cavernous veno-occlusive dysfunction ( 8 cases , 53 % ) , cavernous arterial insufficiency ( 2 cases , 13 % ) or cavernous nerve injury ( 3 cases , 20 % ) . Complications in patients treated with alprostadil injections accounted for 2 cases ( 13 % ) of a penile nodule and 1 further case ( 6 % ) of prolonged penile erection . Complications were not seen in group 2 patients . CONCLUSIONS Early postoperative administration of alprostadil injections significantly increases the recovery rate of spontaneous erections after nerve-sparing radical retropubic prostatectomy . It is our belief that programmed vasoactive injections improve cavernous oxygenation , thereby limiting the development of hypoxia-induced tissue damage . The potential complications related to the use of intracavernous injections must be clearly explained to patients BACKGROUND Erectile dysfunction in men is common . We evaluated a system by which alprostadil ( prostagl and in E1 ) is delivered transurethrally to treat this disorder . METHODS Alprostadil was delivered transurethrally in a double-blind , placebo-controlled study of 1511 men , 27 to 88 years of age , who had chronic erectile dysfunction from various organic causes . The men were first tested in the clinic with up to four doses of the drug ( 125 , 250 , 500 , and 1000 microg ) ; those who had sufficient responses were r and omly assigned to treatment with either the effective dose of alprostadil or placebo for three months at home . RESULTS During in-clinic testing , 996 men ( 65.9 percent ) had erections sufficient for intercourse . Of these men , 961 reported the results of at least one home treatment ; 299 of the 461 treated with alprostadil ( 64.9 percent ) had intercourse successfully at least once , as compared with 93 of the 500 who received placebo ( 18.6 percent , P<0.001 ) . On average , 7 of 10 alprostadil administrations were followed by intercourse in men responsive to treatment . The efficacy of alprostadil was similar regardless of age or the cause of erectile dysfunction , including vascular disease , diabetes , surgery , and trauma ( P<0.001 for all comparisons with placebo ) . The most common side effect was mild penile pain , which occurred after 10.8 percent of alprostadil treatments , but the pain rarely result ed in refusal to continue in the study . Hypotension occurred in the clinic in 3.3 percent of men receiving alprostadil .  Hypotension-related symptoms were uncommon at home . No men had priapism or penile fibrosis . CONCLUSIONS In men with erectile dysfunction , transurethral alprostadil therapy result ed in erections in the clinic and in intercourse at home OBJECTIVES To discuss the therapeutic choices of erectile dysfunction ( ED ) and to improve the therapeutic efficacy for different ED cases . METHODS Two hundred and twenty-seven patients with ED were treated repectively with psychological treatment(31 cases ) , oral testosterone(30 cases ) , Viagra(121 cases ) , psychological treatment + Viagra ( 16 cases ) , intraurethral PGE1 ( 8 cases ) and intracavemous injection(21 cases ) . RESULTS Among those ED patients , 142 ( 62.6 % ) cases reported improved erections after they had undergone above-mentioned therapies . The improved patients include 12 cases(38.7 % ) with psychological treatment , 9 cases ( 30.0 % ) with oral testosterone , 91 cases ( 75.2 % ) with Viagra , 13 cases ( 81.3 % ) with psychological and Viagar , 2 cases ( 25.0 % ) with intraurethral PGE1 and 21 cases ( 71.4 % ) with intracavemous injection . CONCLUSIONS ED is a highly individualized disease , therapeutic choices of ED based on patient 's situation can benefit those patients
Qualitative data from these studies suggest a clinical ly significant effect of CCH and IFNα-2b injection therapy to decrease penile curvature and conserve penile length .
Verapamil and HA performed well in single-arm or case-control studies .
Studies of penile traction and vacuum devices in patients with PD demonstrated some benefits in terms of curvature and penile length but only in small , underpowered , nonr and omised studies .
Studies of onabotulinum toxin A injections or thiocolchicine showed significant improvements in penile curvature , but only in studies of single-arm or case-control design .
CONCLUSIONS CCH and IFNα-2b injected into stable PD plaques can decrease penile curvature ; CCH can also improve penile length .
However , based on available data , strong conclusions can not be drawn for other treatments , including calcium channel blockers , HA , or mechanical therapies .
PATIENT SUMMARY Our systematic review of injection therapies provides evidence for improvements in penile curvature for patients with Peyronie 's disease .
No robust evidence is available to support the use of other local treatments including calcium channel blockers , hyaluronic acid , or mechanical therapies
CONTEXT Conservative therapies for Peyronie 's disease ( PD ) aim to treat early-stage disease by improving clinical outcomes such as penile curvature , penile length erectile dysfunction , and pain .
OBJECTIVE To summarise the available evidence regarding injection and mechanical therapies for PD treatment .