—Dr. Trost Commentary and Key Take Home Points —
The current study evaluates the combination of traction therapy and oral treatments for Peyronie’s Disease (pentoxifylline and colchicine). Dr. Carrier is a well-known Andrologist with significant experience in Peyronie’s Disease (and is a great person as well). This particular study adds value to the concept of using combination therapies for managing Peyronie’s Disease. There are a few key limitations to highlight. First is that there is not a placebo group, and the study is not performed in a randomized manner. In the absence of a placebo, it is not possible to determine if any of the treatments had any actual efficacy on the overall disease course. In our experience, there is a big tendency to want to show an improvement to patients, and therefore, it is very common for nearly every non-controlled Peyronie’s study ever conducted to show a benefit. However, when more rigorous studies are performed, most therapies are no longer found to be effective.
Specifically, there has been one randomized, controlled trial with colchicine, and it did not show any benefits over placebo (PMID: 14973528). There has also only been one randomized, controlled trial looking at pentoxifylline (PMID: 19863517), which did show some benefits when used in the early phase of disease. However, this article was retracted by the journal for concerns of data manipulation / falsification. No randomized, controlled trials have ever been conducted on Andropenis, and as an aside, the lack of improvement in our patients using Andropenis (PMID: 28347795) was a contributing reason as to why we eventually developed a new traction device, RestoreX, at Mayo (since the concept is viable).
While surgical intervention reportedly has better outcomes in the treatment of Peyronie’s Disease, surgery is not the best option in many cases and more conservative therapies are recommended. Some less invasive therapies include oral medications and penile traction therapy (PTT).
PTT is low risk, low cost and reasonable considering the commonalities between Peyronie’s Disease and Dupuytren’s contracture, a disease causing hand deformation and has gene and pathophysiologic similarities with Peyronie’s Disease. Traction therapy is used to treat Dupuytren’s contracture with success, so it is used for Peyronie’s Disease to reorient the tissues and increase collagen turnover. However, PTT seems to be more effective when coupled with oral medication but studies have not been done to prove that. This study aims to assess the effect of two oral medications, Pentoxifylline and colchicine, on penile curvature and plaque size when coupled with the Andropenis PTT extender.
The study compares baseline and 6-month data of 46 men receiving pentoxifylline and/or colchicine and using the Andropenis PTT extender for a total of 1 hour per day for the 6 months. Measurements taken at baseline and 6 months include size and location of the plaque, degree of curvature, arterial diameter, peak systolic velocity, minimum diastolic velocity, and the pulsatility index. Patients were instructed to use the Andropenis extender for a minimum of 1 hour per day and given either 400 mg of pentoxifylline twice daily (if they had no erectile pain or couldn’t use colchicine) or 0.6 mg of colchicine twice daily (if they had no pain at baseline).
A significant decrease in penile curvature and plaque size was seen after 6 months of this treatment, regardless of whether it was pentoxifylline and/or colchicine that was used. Plaque size decreased from a mean of 5.42 to 2.42 and curvature decreased from a mean of 55.8 degrees to 41.4 degrees.
While more trials are needed, this mix of oral medication with PTT therapy proves to be a convenient, low cost and effective treatment for men with Peyronie’s Disease.
Resources for Article
Ibrahim, Ahmed et al.Sexual Medicine, Volume 0, Issue 0 Article Link: https://www.smoa.jsexmed.org/article/S2050-1161(19)30092-3/fulltext