Treatment Protocol for Peyronie's Disease
By Joseph Kahn, PhD, PT
The telephone rings. "Is this Dr. Kahn?" says the voice at the other end..."I've been referred to you by Dr. Wilson for..." I know the rest of the conversation. Dr. Wilson is a prominent urologist who periodically refers patients to me who have Peyronie's disease.
Most patients with Peyronie's disease think they have a rare, unusual condition and treat the diagnosis as top secret. They are surprised 1) at being sent to a physical therapist for treatment; 2) that I know enough about the condition to answer their many questions; and 3) at the knowledge that Peyronie's disease is not really a disease in the sense of other more dire conditions.
MEN ARE NOT prone to discuss this malady among the boys in the locker room, so it becomes a closely guarded and mysterious secret, causing fear and anxiety for the patient. I provide educational material and offer a short, but factual lecture on the subject while patients are receiving treatment. In many instances, the conversation is almost as important as the treatment itself.
The etiology of this fibrotic plaque development is unknown. The onset is usually insidious, but has been reported to have developed in a relatively short time (weeks). Pain is occasionally reported in the first week or two as the tissues are stretched with erections. However, the pain usually disappears shortly. The angulation of the penis when erect is the prominent symptom, preventing intercourse, and requiring treatment. The average angle of deviation is from 30 to 45 degrees, usually found at the mid-shaft/distal third of the penis, most often to the left and upward.
Measurement of the angle of deviation is often a question of talent. The most common deviation is to the left of center, as measured from the 180-degree straight alignment of the erect penis. This is sometimes augmented by an upward angulation, causing a complex angle to be measured. The patient can estimate an angle of from 30 to 60 degrees with no formal training or mechanical instrumentation. Those more dedicated to exactness may use a protractor to accurately evaluate the angulation, which usually is at the mid-to-distal third of the erect penile shaft. The best method is to ask the patient to provide a Polaroid photo to record this phenomenon, with the camera held above the lower abdomen and pubic area.
The plaque is sometimes palpable. Oral medications have not proved to be effective, nor is surgery a popular approach to date.
Effective PT treatment is geared to reduction of the deviation in increments of several degrees over a period of several weeks. When the angle is reduced to about 10 to 15 degrees, most patients will discontinue formal treatment, since near-to-normal function is obtained. Ten to 12 treatments usually are required to provide visible and functional progress, although in some cases, the results are evident much sooner.
THE TREATMENT includes cold laser radiation to the fibrotic area, microamperage stimulation with probes, negative square wave for sclerolytic effect and phonophoresis with 1 percent hydrocortisone ointment.
Patients are scheduled for twice weekly visits. Most important, however, is the recommendation to the patient for patience, since this condition is not readily corrected. The longer the fibrotic plaque has been in place, the more difficult it is to soften and relax its hold on the normally elastic fibers of the penile shaft, corpus cavernosum, etc.
* About the author: Dr. Kahn is clinical assistant professor at SUNY, Stony Brook, and has a private practice in Syosset, NY.