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The most controversial treatment for Peyronie's Disease (PD) is
the intralesional injection of Verapamil into the plaque. Urologists
who perform this treatment will universally advise patients that
injections must begin during the active phase of the disease,
usually no later than 12-18 months after initial diagnosis. During
this window for treatment, Verapamil a calcium antagonist, plays a
role in the inhibition of - collagen production, inflammation
production and the formation of plaque tissue. After 18 months, the
disease enters the chronic phase and Verapamil injections will no
longer have any beneficial effect. The standard cautionary
statement presented by urologists is that without treatment,
approximately 40% of men will get worse, 40% will stay the same
and 20% will improve. Verapamil is no cure and what you can
expect is that at best these injections will somewhat increase your
odds of improving or not getting any worse.
An original research article appeared in the Journal of the Pakistan
Medical Association, entitled Evaluation of Intralesional Injections
of Verapamil in Treatment of Peyronie's Disease, April 2010. The
research was conducted at the Urology and Nephrology Research
Center, Tehran, Islamic republic of Iran. The inclusion/exclusion
requirements were:
Accepted subjects were given a genital physical examination and
the extent of fibrous plaque was determined through sonography.
For measurement of penile curvature, the curvature was captured
on film by the patient and this was shown to a physician before and
after treatment. Patients received an intralesional injection of
Verapmail every 2 weeks for a total of 6 injections. After treatment,
it was reported there was significant improvement in lesion size,
penile curvature and sexual satisfaction from both the wife and
husband. According to the researchers, injecting a calcium
channel blocker seemed to be effective in the treatment of PD,
“however further investigation must be carried out in this regard.”
Discussion:
Just because an article appears in a medical journal, whether
Pakistani or American, is no reason to consider the findings
authoritative and worthy of acceptance. To their credit, the authors
did say their findings require further investigation, but in my
opinion this study is shot full of holes (no pun intended) and should
essentially be given little weight by anyone considering Verapamil
treatment.
The article states that most PD patients recover by conservative
treatment. Where the author came up with this finding is beyond
my comprehension and I have not seen this 50%+ recovery rate in
any of the medical journals. Patients who had the disease for at
least 6 months were included and then it is reported that patients in
the acute phase of the disease were excluded. It appears the
author is trying to say that the acute phase of PD ends after 6
months. His allegation disagrees with virtually every urologist of
note who believes that the acute phase extends for a period of at
least 12 months through 18 months.
Successful outcomes were demonstrated by a 27% mean decrease
in curvature of the penis and the same percentage decrease in
lesion size. However, upon closer examination, this is much less
impressive than it sounds. Curvature went from 17.18% (I think
they mean degrees) to 12.5%. Given that this was based on a
picture taken by the patient and reviewed by a physician, it is not
very objective. The improvement is less than 5 degrees. Take a
look at this protractor, is it really possible to accurately measure a
5 degree change from a photo?
A sexual satisfaction survey on 10-point scale increased
approximately 1 point for both the man and his wife. This certainly
is subjective and open to the placebo affect. In my opinion the
published findings are of little value and unfortunately, fail to move
forward any conclusion as to whether or not Verapamil injections
are an effective treatment for early stage PD. In defense of these
Iranian and Pakistani medical professionals, I can say their findings
on the use of Verapamil injections are as helpful or not as helpful
as those published in American journals.
Previously, I reviewed an article that appeared in the
Federal Practitioner titled Intralesional Verapmail for Peyronie's
Disease which also presented a positive view of this treatment.
This extremely small study included 13 men. The mean
improvement in curvature was 13.8 degrees, but two men
worsened. The study does not state how many men showed no
change at all. What was most interesting about this study was that
the men in study were beyond the acute phase with a mean
duration time of 21.3 months from initial diagnosis. If this is true,
maybe Verapamil injections should be administered after the
active phase? For further information on this study click on the
icon in the left margin of this page.
This treatment remains controversial. Based on my experience
with this treatment, it is not effective and should be avoided.
the intralesional injection of Verapamil into the plaque. Urologists
who perform this treatment will universally advise patients that
injections must begin during the active phase of the disease,
usually no later than 12-18 months after initial diagnosis. During
this window for treatment, Verapamil a calcium antagonist, plays a
role in the inhibition of - collagen production, inflammation
production and the formation of plaque tissue. After 18 months, the
disease enters the chronic phase and Verapamil injections will no
longer have any beneficial effect. The standard cautionary
statement presented by urologists is that without treatment,
approximately 40% of men will get worse, 40% will stay the same
and 20% will improve. Verapamil is no cure and what you can
expect is that at best these injections will somewhat increase your
odds of improving or not getting any worse.
An original research article appeared in the Journal of the Pakistan
Medical Association, entitled Evaluation of Intralesional Injections
of Verapamil in Treatment of Peyronie's Disease, April 2010. The
research was conducted at the Urology and Nephrology Research
Center, Tehran, Islamic republic of Iran. The inclusion/exclusion
requirements were:
- Referral from a urology clinic to this clinical trial
- Patients had to have been diagnosed with PD for at least 6
months - Patients in the acute phase were excluded
- Most of the patients were men between the ages of 50-56 years
- Patients with certain co-morbidities such as diabetes were
excluded - A total of sixteen patients who could meet all the inclusion
criteria were admitted into the study
Accepted subjects were given a genital physical examination and
the extent of fibrous plaque was determined through sonography.
For measurement of penile curvature, the curvature was captured
on film by the patient and this was shown to a physician before and
after treatment. Patients received an intralesional injection of
Verapmail every 2 weeks for a total of 6 injections. After treatment,
it was reported there was significant improvement in lesion size,
penile curvature and sexual satisfaction from both the wife and
husband. According to the researchers, injecting a calcium
channel blocker seemed to be effective in the treatment of PD,
“however further investigation must be carried out in this regard.”
Discussion:
Just because an article appears in a medical journal, whether
Pakistani or American, is no reason to consider the findings
authoritative and worthy of acceptance. To their credit, the authors
did say their findings require further investigation, but in my
opinion this study is shot full of holes (no pun intended) and should
essentially be given little weight by anyone considering Verapamil
treatment.
The article states that most PD patients recover by conservative
treatment. Where the author came up with this finding is beyond
my comprehension and I have not seen this 50%+ recovery rate in
any of the medical journals. Patients who had the disease for at
least 6 months were included and then it is reported that patients in
the acute phase of the disease were excluded. It appears the
author is trying to say that the acute phase of PD ends after 6
months. His allegation disagrees with virtually every urologist of
note who believes that the acute phase extends for a period of at
least 12 months through 18 months.
Successful outcomes were demonstrated by a 27% mean decrease
in curvature of the penis and the same percentage decrease in
lesion size. However, upon closer examination, this is much less
impressive than it sounds. Curvature went from 17.18% (I think
they mean degrees) to 12.5%. Given that this was based on a
picture taken by the patient and reviewed by a physician, it is not
very objective. The improvement is less than 5 degrees. Take a
look at this protractor, is it really possible to accurately measure a
5 degree change from a photo?
A sexual satisfaction survey on 10-point scale increased
approximately 1 point for both the man and his wife. This certainly
is subjective and open to the placebo affect. In my opinion the
published findings are of little value and unfortunately, fail to move
forward any conclusion as to whether or not Verapamil injections
are an effective treatment for early stage PD. In defense of these
Iranian and Pakistani medical professionals, I can say their findings
on the use of Verapamil injections are as helpful or not as helpful
as those published in American journals.
Previously, I reviewed an article that appeared in the
Federal Practitioner titled Intralesional Verapmail for Peyronie's
Disease which also presented a positive view of this treatment.
This extremely small study included 13 men. The mean
improvement in curvature was 13.8 degrees, but two men
worsened. The study does not state how many men showed no
change at all. What was most interesting about this study was that
the men in study were beyond the acute phase with a mean
duration time of 21.3 months from initial diagnosis. If this is true,
maybe Verapamil injections should be administered after the
active phase? For further information on this study click on the
icon in the left margin of this page.
This treatment remains controversial. Based on my experience
with this treatment, it is not effective and should be avoided.
| Verapamil - The Never Ending Controversy |
