1080 INTRALESIONAL VERAPAMIL INJECTION COMBINED WITH PHOSPHODIESTERASE INHIBITORS IMPROVES RESULTS IN THE TREATMENT OF PEYRONIE'S DISEASE

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy I1 Apr 20101080 INTRALESIONAL VERAPAMIL INJECTION COMBINED WITH PHOSPHODIESTERASE INHIBITORS IMPROVES RESULTS IN THE TREATMENT OF PEYRONIE'S DISEASE Desiderio Avila, Paul Gittens, Kathleen Hwang, John Weedin, Daniel Moskovic, Michael Schumacher, Mohit Khera, and Larry Lipshultz Desiderio AvilaDesiderio Avila More articles by this author , Paul GittensPaul Gittens More articles by this author , Kathleen HwangKathleen Hwang More articles by this author , John WeedinJohn Weedin More articles by this author , Daniel MoskovicDaniel Moskovic More articles by this author , Michael SchumacherMichael Schumacher More articles by this author , Mohit KheraMohit Khera More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2239AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is a disorder involving the tunica albuginea of the penis and may present as penile pain, deformity, shortening, and erectile dysfunction (ED). Intralesional injection therapy with verapamil (ILVT) is a treatment option in patients with PD refractory to medical therapy but not advanced enough to undergo surgical intervention. Recent animal in-vivo and human in-vitro studies using chronic phosphodiesterase inhibitor (PDEI) resulted in beneficial effects of fibrotic changes in PD1. Our aim is to identify if the combination of 20mg ILVT and PDEI leads to improved outcomes in PD patients and postpone or prevent surgical intervention. METHODS Patients with PD refractory to therapy with L-arginine, pentoxyphylline, and vitamin E were placed on 20mg ILVT with or without PDEI. Penile deformity was assessed at baseline and 1 month after the final ILVT. Following intracavernosal injection, measurements were obtained at maximal rigidity using a goniometer. Endpoints included a change in magnitude of curvature, plaque size, penetration ability, perceived penile length, and rigidity. Significant improvement in penile curvature was defined as > 10 degrees and/or an improvement in baseline curvature > 20%. Statistical analysis was performed using SPSS. RESULTS 25 patients underwent a mean of 11.5 intralesional injections of 20mg verapamil. 14/25 (56%) patients were also placed on daily PDEI. The overall mean decrease in curvature was 11.6 degrees and the mean improvement from baseline was 32.7%. Significant improvement in curvature occurred in 67% of patients following combined ILVT/PDEI treatment. In contrast, none of the patients on ILVT therapy only had a significant improvement in curvature (p<0.05). There was a trend towards decreased need for surgical correction in patients on combined ILVT/PDEI therapy compared to those not on PDEI (13% versus 26%). There was no significant difference in pretreatment ED, pain, penile length, or change in plaque size between these two groups. CONCLUSIONS PD can be treated effectively with ILVT in a large proportion of patients who have failed medical treatment. The use of 20 mg ILVT combined with PDEI in patients with PD improves treatment outcomes. This is the first report documenting the beneficial effects of combined PDEI and ILVT for the treatment of PD. Larger numbers are needed to confirm our findings. References 1 : Effects of long-term vardenafil treatment on the development of fibrotic plaques in a rat model of PD. BJU Int2006; 97: 625. Google Scholar Houston, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e420-e421 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Desiderio Avila More articles by this author Paul Gittens More articles by this author Kathleen Hwang More articles by this author John Weedin More articles by this author Daniel Moskovic More articles by this author Michael Schumacher More articles by this author Mohit Khera More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...