Indurato Penis Plastica (IPP) or Peyronie's Disease
Peyronie's Disease is a baffling disorder and can be difficult to treat successfully. Surgical procedures (there are many) have their drawbacks, systemic medical therapies are unpredictable and localised injections are painful. There have been reports of success with iontophoresis of corticosteroids directly into plaques (1, 2, 3) and also with intralesional injection of verapamil (4). Physion® has developed EMDA® of anti-inflammatory dexamethasone with "anti-collagenic" verapamil to be administered painlessly into plaques. A report of 78 patients so treated demonstrated relief in pain in > 90% of patients, plaque size was reduced in 50% and penile angulation was lessened in 30% of patients (5). Verbal reports from other groups have further confirmed these results and have provided sufficient background for the following recommendations:
- the earlier IPP is treated the better the results; long-standing disease with calcified plaques responds poorly.
- very large plaques, multiple plaques and severe angulation are relative contra-indications; results are poor.
To view a diagrammatic overview of patient preparation for the treatment of IPP with EMDA, click here.
General Overview of Peyronie's Disease
The
first symptom of Peyronie's Disease is generally pain in the penis, particularly
when erect. There is usually also a hardening or a lump in the painful area
and you may notice a curvature or bending of the penis. It is very important
to see your doctor as soon as you notice these symptoms as the condition can
be helped more easily the earlier it is diagnosed.
Peyronie's Disease is a disorder involving lesions along the shaft of the penis. These areas are below the skin and consist of fibrous tissue which may become calcified and are known as plaque. If the symptoms are ignored, progression may result in a curvature of the shaft of the penis eventually making sexual intercourse impossible.
If
the disease is caught in the early stages a non-invasive treatment has been
shown to be effective for most cases. This involves using Electromotive Drug
Administration (EMDA). A small adhesive cup is placed over the area of plaque
on the penis. This is filled with a mixture of the drugs Verapamil and Dexamethasone,
and then a current is passed through the drug mixture which forces it through
the skin to surround the plaque. The current runs for 20 minutes and between
8 and 20 sessions are needed for success, depending on the age of the plaque.
After the first treatment from a medical professional the procedure can be done
at home.
The best chances for success are if there are only one or two plaques and they are no larger than 2.5 cm. Also the curvature of the penis should be no more than 30°. It is therefore very important that medical advice is sought as soon as the symptoms appear.
A clinical investigation on using EMDA on 100 cases of Peyronie's Disease (see note 1) showed 96% of patients with pain resolution, 53% with plaque reduction and 37% with reduction in penile angle.
For patients in this investigation with relatively young disease and with symptoms within the criteria mentioned above, the results were better than for the others. It is very important to treat the condition as soon as possible.
More detail for healthcare professionals
Another treatment for Peyronie's Disease is to inject the area of plaque with anti-inflammatory drugs, which is partially successful. These drugs must be administered under high pressure and can be painful. This procedure also carries a risk of infection.
Surgery may be successful but it is not a simple operation. Just removing the plaque can cause a worse deformity and so delicate and complicated surgery is needed and it is probable that the penis may be shortened.
Notes:
1. Rothfield SH, Murray W. The treatment of Peyronie's disease by iontophoresis
of C21-esterified glucocorticoids. J. Urol 1967; 97:874
2. Fishman IJ, Wong HY, Griffith DP. Case report: Iontophoretic delivery of
steroids in the treatment of Peyronie's disease: case reports of three successful
outcomes. Min Invas Ther 1994; 3:121.
3. Montorsi F, Guazzoni G, Bocciardi A, Barbieri L, Campo B, Rigatti P. Transdermal
electromotive multi-drug administration for Peyronie's disease: a randomized,
double blind, placebo-controlled, partial cross-over study. J Urol. 1995; 153:472
(973A).
4. Rehman J, Benet A, Melman A. Use of intralesional verapamil to dissolve Peyronie's
disease plaque: a long term single-blind study. J Urol 1998; 51:620.
5. "Iontophoresis for Treatment of Peyronie's Disease", C.R. Riedl
et al, Vienna. The Journal of Urology Vol. 163 pp 95-99, January 2000.