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MORE ON VERAPAMIL
No issue in the treatment of Peyronies Disease (PD) is more controversial
than the intralesional use of Verapamil. The July 2008 issue of the
Federal Practitioner, A Peer-Reviewed Journal for Health Care
Professionals of the VA, DOD and the PHS (subscription $99 annually)
has a positive article concerning this treatment approach.
Thirteen men with previously untreated PD had been symptomatic from
nine to 36 months. The average mean duration of PD at basepoint was
21.3 months. All were heterosexual and ranged in age from 51-78 years
of age.
Injections were administered every two to four weeks for a total of 12
treatments. Patients were assessed at three intervals: baseline, after the
sixth injection and after the 12th injection (endpoint). Curvature was
determined using a protractor, plaque size was determined through
palpation and plaque volume was assessed with ultrasound. Three
clinicians were present at each assessment; two urologists and a
radiologist. At the endpoint, the mean decrease in curvature was 13.8
degrees and the mean decrease in plaque was 4.6 centimeters. It is
interesting to note that two patients experienced a very slight increase in
curvature of less than 5 degrees despite a decrease in plaque size.
There were also a significant increase in subjective satisfaction. The
researchers concluded that there was a statistically significant decrease
in plaque area and penile curvature. The long term beneficial effect of
this treatment is not known and requires further study.
My Comments:
Although small and not randomized study with a control group, this is an
extremely interesting study. It certainly involved careful measurements
of plaque and curvature.
Virtually every urologist who uses Verapamil injections will tell you that
treatment must begin within 12 months of onset in order to be effective.
This study contradicts this accepted rule as average duration was 21.3
months at baseline. Can it possibly mean that Verapamil injections are
more effective if started after 12 months? Another generally accepted
approach is that patients receive 6 treatments approximately 4-6 weeks
apart. Patients in this study were administered every 2-4 weeks for a
total of 12 treatments. Maybe a total in excess of 6 injections is a
threshold point at which the treatment is more effective? Two men
experienced a slight increase of curvature of less than 5%. This seems
very favorable compared to the experiences of other men with PD. It
would have been helpful to know if any men in the study did not
experience any change. The researchers did not note if any of the men
showed calcification on the ultrasound.
In conclusion, this study has surprising results and would argue for the
use of Verapamil injections.
Charts from the study. Note that a P value of less than .05 is considered
true and important.
No issue in the treatment of Peyronies Disease (PD) is more controversial
than the intralesional use of Verapamil. The July 2008 issue of the
Federal Practitioner, A Peer-Reviewed Journal for Health Care
Professionals of the VA, DOD and the PHS (subscription $99 annually)
has a positive article concerning this treatment approach.
Thirteen men with previously untreated PD had been symptomatic from
nine to 36 months. The average mean duration of PD at basepoint was
21.3 months. All were heterosexual and ranged in age from 51-78 years
of age.
Injections were administered every two to four weeks for a total of 12
treatments. Patients were assessed at three intervals: baseline, after the
sixth injection and after the 12th injection (endpoint). Curvature was
determined using a protractor, plaque size was determined through
palpation and plaque volume was assessed with ultrasound. Three
clinicians were present at each assessment; two urologists and a
radiologist. At the endpoint, the mean decrease in curvature was 13.8
degrees and the mean decrease in plaque was 4.6 centimeters. It is
interesting to note that two patients experienced a very slight increase in
curvature of less than 5 degrees despite a decrease in plaque size.
There were also a significant increase in subjective satisfaction. The
researchers concluded that there was a statistically significant decrease
in plaque area and penile curvature. The long term beneficial effect of
this treatment is not known and requires further study.
My Comments:
Although small and not randomized study with a control group, this is an
extremely interesting study. It certainly involved careful measurements
of plaque and curvature.
Virtually every urologist who uses Verapamil injections will tell you that
treatment must begin within 12 months of onset in order to be effective.
This study contradicts this accepted rule as average duration was 21.3
months at baseline. Can it possibly mean that Verapamil injections are
more effective if started after 12 months? Another generally accepted
approach is that patients receive 6 treatments approximately 4-6 weeks
apart. Patients in this study were administered every 2-4 weeks for a
total of 12 treatments. Maybe a total in excess of 6 injections is a
threshold point at which the treatment is more effective? Two men
experienced a slight increase of curvature of less than 5%. This seems
very favorable compared to the experiences of other men with PD. It
would have been helpful to know if any men in the study did not
experience any change. The researchers did not note if any of the men
showed calcification on the ultrasound.
In conclusion, this study has surprising results and would argue for the
use of Verapamil injections.
Charts from the study. Note that a P value of less than .05 is considered
true and important.
