Saturday, May 11, 2013

Three years later: Thoughts on the state of Peyronie's Disease treatment and prevention

Three years or so since my last post, I'm still receiving email questions and comments on old posts.

Aside from being 3 years older, and, of course, having the penile fibrosis of "Peyronie's Disease", I'm fine. My hiatus wasn't due to any untoward event -- it's that my life is very full (overflows really) and I didn't have much new to say.

I still follow the research literature from a distance. There hasn't been much change. Among some articles of note:
The story remains fairly grim for men with severe established Peyronie's Disease. The surgeries are not easy things, and the results are not amazing. This isn't too surprising -- the disease damages the tunica albuginea and associated plumbing; these are complex and delicate structures that we are far from being able to restore. I suspect we'll be able to regrow damaged heart muscle well before we can reverse this kind of damage.

Given that we don't yet have the technology to reverse this damage, the clinical efforts need to focus on prevention of severe disease. We need to catch the disorder early, and slow or prevent progression.

That's a bit tricky, since most people present late, there are probably multiple causes of penile fibrosis, and we haven't really shown we can prevent any of them. There's surprisingly little discussion of any of this, it's weird when one of the best references is in an LA Times sex advice column - penile fractures and Peyronie's disease.

Given our lack of knowledge I can't make recommendations. But, if I could go back in time to talk to my younger self, this is what I would have said:
  • You need to minimize further damage.
  • Avoid maneuvers that bend or stress the penis.
  • Use lubricants.
  • Use Viagra and the like to minimize risk of intercourse with a soft penis (likely to induce trauma or bending).
  • If pain occurs avoid reinjury -- allow several weeks of healing.
I have no idea if any of this would work, but it's what I'd tell my younger self. Oh, and I'd tell him not to bother with the Vitamin E -- that was stupid.

It's easier to make recommendations about what urologists should do. They need to come up with a starting guideline on prevention of further injury, then do some case-control studies to see if it makes a difference. (Hard to study this, especially as funds are limited!).

Then urologists and primary care physicians need to educate men on how to respond to painful intercourse or penile injury, and start enrolling men in preventive programs before the disease progresses. It might not work, but it's worth a try.

If I see anything truly remarkable I'll add another post, but given the state of the art, and the fact that I'm past the prevention phase, I probably won't have too many more posts.

Maybe one every 3-4 years...