Cortisone injections and Peyronie's disease

My doctor wants to put cortisone injections into my Peyronies scar, what do you think of that?

Will steroid injections reduce the inflammation and pain of my Peyronies?

My opinion is that it is risky to use cortisone injections as a Peyronie's treatment.  While a temporary and variable reduction of pain does occur in some cases, but not all, it is not worth the limited benefit that makes future Peyronies surgery more complicated and dangerous should it become necessary.  There is good reason to think twice about using steroid injections for this purpose.  This website has presented an earlier article about a closely related topic, Peyronie's disease treatment via direct drug injection.
It would be good to talk to your doctor about other treatment options or to consider using Alternative Medicine as a way to increase your natural ability to eliminate the Peyronies scar.  The PDI website explains how this can be done without the use of drugs and surgery.
In the 1960’s steroid (cortisone) injections were used as a Peyronie’s treatment under the theory that they would reduce plaque or scar formation because of the inhibitory effect cortisone has on fibroblast cell formation. Since fibroblasts are cells that make fibrin, and fibrin makes collagen in the body, with fewer fibrin cells the ideas was that this would result in less collagen produced during scar formation.
This treatment for Peyronie’s was used rather extensively until the mid-1980s when it became obvious that it did not consistently or greatly reduce collagen at the Peyronie’s plaque. And of equal concern was the observation that these steroid injections were causing penis tissue weakness (atrophy) of blood vessels, nerves, and all connective tissue of the corpora cavernosa and tunica albuginea of the at the site of the injections near the Peyronie’s plaque. These steroid injections resulted in weak and fragile tissue that would easily tear when a surgeon would try to sew it together during surgery, or worse yet would tear after surgery or heal slowly or not at all.

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It took a long time to notice and correlate this problem because virtually all of the studies of using cortisone injections in Peyronie’s disease did not use a placebo control, and they performed with only a small number of patients who reported their improvement subjectively without objective measurement of progress in terms of pain, plaque formation and deformity reduction.
Seldom did the steroid injections actually have a beneficial effect on the eventual Peyronie’s disease outcome, but had an undesirable side effect that made Peyronie’s surgery complicated and less effective. The problem was that the broad tissue destruction caused by the cortisone made the tissue so weak and compromised that a surgeon could not later go into that same area to suture the tissue closed at the site of a surgical incision, or expect the sutures to hold on the weakened tissue. If penis surgery was done it often resulted in frequent bleeding and repeated opening of surgical wounds. Once it was seen that cortisone injections made it difficult to do good surgery later, the practice began to fall out of general use.
In addition, the practice of using cortisone injections for treatment of Peyronie’s disease did not take into account the harmful effect of placing a series of multiple needle punctures into the scar material and the tunica albuginea tissue of the penis. Later clinical observations have shown that these frequent and repeated needle punctures act as additional trauma to tissue that has already shown itself capable of producing excess scar formation to repeated small injury. This has also proven to be the case when a series of multiple injections of other drugs like verapamil and interferon are used as Peyronie’s treatment. The clinical results of these other drug injections have not provided positive or encouraging clinical results that were any better than those of cortisone injections.
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What is my opinion of prescription drug injection?

What is the Dr's opinion on using the prescription Edex injected with a syringe? 

Bryant from Ohio

 

Greetings Bryant, 

You ask for my opinion about Edex injections.  I will not comment on the drug, because that is the decision of your treating doctor.  But I will make a few observations about injections in general and how they could further injure the tunica albuginea.

Anytime you inject ANYTHING – even sterile water – into the penis and directly or indirectly contact the delicate tunica albuginea, you are taking a serious risk of making your Peyronie's disease worse. This could either occur just from the simple act of piercing the tissue of the tunica albuginea, or the placement of a concentrated chemical that is foreign to that tissue, or both.

I have communicated with many, many men whose Peyronie's disease started or was made worse from penile injections of a variety of substances.

If your problem is PD, why are you taking an ED medication? Some MDs prescribe Viagra, Edex, etc to their PD patients in the belief that this increases the local circulation which in turn is beneficial to PD.

What if you could take a drug that would enable you to lift a ton of weight above your head and keep it there for an hour? Nice trick, very impressive, but your body is not built to take that kind of pressure. It would cause great damage to internal organs, your spine, your blood vessels, all major joints, etc. Simply put, “It just ain’t natural.” Same with Viagra, Levitra or Cialis. The increased pressure created by these medications can be very damaging to the delicate tunica albuginea, and can result in or worsen a case of PD. What would happen to your car tires if you happened to over-inflate them with 100 pounds of air pressure, even though they were built to take just 40 pounds of pressure. You would be running the risk of damage to the internal structure of tire, wouldn’t you? Of course.

The same thing can happen if the penis is over-inflated and then given a “rough ride.” This is where the problems start, and this is what I wanted to bring to your attention. It is very likely that the MDs who prescribe these medications to men with PD will not agree with this thinking. MDs tend to favor a chemical “fix” even if it is temporary, so you would tend to expect a prejudice from an MD to use drugs to solve most problems.

A penis that is predisposed to PD in the first place cannot tolerate the kind of stress that these erections drugs create.  If you think independently and logically about what happens when these drugs are used, you should have no trouble understanding how this could work against you.  That is just the way I see it and I feel compelled to share this rationale with you. Use of Viagra and other related meds like it could easily be worsening the very problem you are attempting to heal. Something to think about.  TRH

Channel Blockers and Peyronie’s Disease

Peyronie’s disease and Verapamil

Calcium channel blockers, or calcium antagonists, are a class of medications as well as natural substances (D-glucaric acid) that disrupt calcium ion conduction along what are known as the calcium channels of the body.

While some doctors use calcium channel blockers to treat Peyronie’s disease, there are researchers who have evidence that these very same calcium channel blockers can actually cause Peyronie’s disease.  This shows how strange and up-side-down is the world of Peyronie’s disease treatment.

The most widespread prescription use of calcium channel blockers is to reduce elevated blood pressure in patients with essential hypertension, particularly elderly patients.  Calcium channel blockers are notably effective to reduce large blood vessel stiffness, a common cause of elevated systolic blood pressure in geriatric patients.  They are also used to control and reduce rapid heart rate, prevent spasms of brain blood vessels and reduce chest pain due to angina pectoris.

Calcium channel blockers, or calcium antagonists, also treat a variety of conditions, such as Peyronie’s disease, high blood pressure, subarachnoid hemorrhage, migraines and Raynaud's disease.

All tissue of the body requires oxygen, and the heart muscles in particular need oxygen to pump blood.  The faster and harder the heart pumps blood, the more oxygen it needs. Heart pain occurs when the amount of oxygen available to the heart muscle walls is inadequate for the work load of the heart.  Calcium channel blockers dilate the large arteries that supply blood to the heart muscles, and thereby reduce the pressure within those arteries. This action reduces the stress on the heart muscles and reduces the need for oxygen at the same time, thus reducing angina pain. In similar mechanism, calcium channel blockers reduced elevated blood pressure, and slow the rate at which the heart beats in a condition known as tachycardia.

Peyronie’s treatment with verapamil

One type of calcium channel blocker known as a phenylalkylamine calcium channel blockers, is called Verapamil.  It is used in the treatment of Peyronie’s disease because it is thought to be effective in disrupting the calcium ions found within the Peyronie’s plaque, thus slowing or reversing the development of the offending plaque material that is the cause of the notorious Peyronie’s curved penis.

Peyronie's disease is a complex health condition without a known cause that affects nearly 4-6 percent of the worldwide male population.  It is best characterized by the development of internal fibrous plaque material below the surface of the penile shaft that results in curvature of the penis, as well as pain.  Peyronie’s disease typically on average at age 54, yet men of all ages (from 16 to 80) can and do  develop it for reasons that are not consist or clear.

Some medical doctors prescribe a topical gel of the calcium channel blocker, Verapamil to be applied once or twice daily over the area of the Peyronie’s plaque.  Since it is thought that calcium channel blockers change the way that calcium is bound within the plaque, that it might slow or reverse the development of Peyronie’s disease.  While this form of treatment has not proven especially effective, and has fallen out of general favor, other medical doctors attempt a more direct route of administration by injecting Verapamil directly into the plaque material of the penis.  This can be a rather painful treatment, and is often given in series of 12 to 20 injections over time.  Verapamil injections have not proven to be especially effective, either, yet remain on the list of medical therapies because it offers some avenue of treatment for both patient and doctor who do not have much medical treatment available for this troublesome and persistent problem.

Danger of Verapamil injections into the Peyronie’s plaque

In addition to the problem of inconclusive results and lack of support within the medical community for the use of Verapamil drug injections as a Peyronie’s disease treatment, there is also the vexing problem of trauma to the delicate tunica albuginea by repeated piercing of these multiple injections.

While there is still debate if calcium channel blockers actually cause Peyronie’s disease in healthy men, as well as if it can be used to treat Peyronie’s disease in those men who have it, the use of verapamil appears to be reducing if only because of discouraging clinical outcomes.

The Peyronie’s Disease Institute has maintained since 2002 that it makes sense to attempt to restore and support the natural healing ability of the body to correct Peyronie’s disease as occurs in about 50 percent of men who develop this condition. Read how you can use many Peyronie’s disease natural treatment options to help your body heal and repair without risk or danger of unnecessary drugs or surgery.

Peyronie’s Disease Treatment Via Direct Drug Injection

Injections can cause Peyronie’s disease

Peyronie’s disease treatment using drug injection into the delicate tunica albuginea of the penis is a medical therapy that is fast loosing favor for treatment of the Peyronie's penis.  One of the reasons is the lack of good results, the other is that it has been shown that injections can cause or aggravate Peyronie’s disease in many cases.

I have personally communicated with hundreds of men whose Peyronies started after a series of penile injections that were undertaken for a variety of reasons.  It appears the drug is not so much the issue that causes injury to the tunica membrane, but the repeated penetration and trauma that causes the scar material that eventually starts a Peyronies problem.   However, it has also been shown that the presence of certain drugs can cause a chemical irritation to the tunica albuginea.  So in this regard, drug injections could easily represent a double threat of injury to the tunica that results in Peyronie’s disease.

Peyronie's treatment – "First, do no harm"

This blog post about Peyronie’s disease treatment using direct drug injections (Verapamil, cortisone, etc.) should hit home for a large number of you.  Many men have undergone painful drug injections into the penis because their medical doctor thought it was worth the effort, and only found themselves with a new problem or worsening of their original Peyronie's disease.

First I will simply copy an article, “Extracorporeal shock-wave therapy in the treatment of Peyronie's disease.”  This research discussion is essentially about Extracorporeal Shock Wave Therapy, ESWT (or ESWLas they call it here).  

What is important to note in our particular discussion is the area I have highlighted for emphasis.  This form of therapy has been fairly well abandoned by a large percent of doctors who used it for many years since these injections seem to cause more problems than it helps. The reason this information about ESWT (or ESWL) is included in this article about penile injections is that these Russian physicians make a very interesting comment while discussing ESWT that underscores the damage created by injections (of any kind) into the tunica albuginea.

[Article in Russian]

Neĭmark AI, Astakhov IuI, Sidor MV.

The authors analyse the results of treatment of 28 patients with Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL) performed on Dornier U15 lithotriptor. A total of 2-6 sessions were made, maximal number–12. The efficacy was controlled by clinical indices and ultrasonic investigation (Doppler mapping of the blood flow). ESWL proved to be efficient in the treatment of Peyronie's disease (PD), primarily, in patients with early disease before appearance of severe fibroplastic alterations. Less plaque vascularization by energetic Doppler mapping due to ESWL is an important diagnostic criterion of PD treatment efficacy. Conservative treatment is not indicated in marked deformities and plaque calcification, erectile dysfunction. Moreover, any injection into the tunica albuginea, especially complicated by hematomas (deep tissue bruising) may be a damaging factor which triggers fibrous inflammation. Such patients should be treated surgically. If the patient is interested in immediate results or is not interested in continuation of sexual life, the treatment is ineffective. Thus, ESWL is an effective, safe method of PD treatment but requires further study and accumulation of clinical experience.

It seems that the problems penile injections can cause is not that necessarily about the drug that is injected into the tunica, but the needle itself that is used to deliver the drug. An injection to deliver any drug, or sterile water, can cause injury to this delicate membrane.  This sets off an inflammatory response that can result in significant Peyronie’s disease plaque or scar tissue formation for men who as so predisposed.   Doing this once can be risky.  Doing this up to a dozen times over a few months, as is often the recommended course of therapy, just multiples the opportunity for injury to mount on top of injury.

This Russian research team offers the opinion that the effects of such injection into the penile shaft causes such significant plaque development, that surgery is the best treatment option for the damage that it can cause.   Obviously, I do not agree with that, since surgery can also cause more scar development. Their conclusion is that they find men who receive these injections often eventually are rewarded with a disturbed and discontinued sexual life.

Growing concern about injections for Peyronie's disease treatment

This idea is brought to your attention to demonstrate there are many in the medical community who agree with the same position that I have taken for many years now.  These doctors and I contend it is inherently risky, in fact, dangerous, to stick needles repeatedly into the penis for Peyronie’s disease treatment. Their  logic concludes that any treatment that can start or aggravate the very problem it is attempting to treat, is not much of a treatment.

It is unfortunate that the medical community turns a blind eye to the direct observation of poor results, serious irritation of the tunica, and the solid logic that reputes injections as a form of Peyronie’s cure.  Those who continue to inject their Peyronie’s disease patients, and bring these men farther down the road toward greater plaque development, must be desperate to look useful or just ignorant of how Peyronie’s disease often develops.  It is so common for medical doctors to think only in terms of medicine and surgery, notwithstanding the tragedy that can often result from their limited thinking.

The Peyronie's treatment concept of using non-invasive methods to increase the healing response of the body is a safer and more trustworthy Peyronie’s disease treatment than some of the aggressive medial schemes being promoted today.

Peyronie's disease treatment with Xiaflex

Peyronie's treatment with experimental drug, Xiaflex

Peyronie’s disease is best known for the plaque, scar or hard lump that causes a curved penis to develop. Peyronies begins as a localized inflammation, usually as a result of injury of some type. It is currently believed that Peyronie’s disease is caused by vascular trauma or injury to the deeper penis anatomy. Peyronie’s disease is most common in men over 50 years, and the incidence increases with age. This inflammation often progresses to a hardened plaque or scar that reduces flexibility of the tissue of the penis, and results in a bend or distortion during erection due to incomplete filling or restriction of the tissue. Often, this causes constant pain or pain during erection, and for some men these can prevent sexual intercourse due t physical incompatibility or erectile dysfunction.

Aside from the physical changes, depression and reduced self-esteem are commonly experienced by men with Peyronie’s disease.

Peyronie’s disease is most often treated by urologists, even though there are no approved drug therapies for Peyronie’s disease. Peyronie's surgery may be an option for some patients although complications such as worsening of the PD distortion can develop, as well as loss of penile length can occur. Xiaflex, a type of collagen reducing enzyme, or collagenase, has been experimentally injected into the Peyronie’s disease scar or plaque as an in-office procedure. The purpose of injecting Xiaflex into the Peyronie's disease scar is to soften the scar tissue and improve or reduce the curvature of the penis. Further, this is hoped to improve sexual function and eliminate the distressing negative psychosocial aspects of Peyronie’s disease.

Peyronies Xiaflex trial results

Sponsored and monitored by BioSpecifics Technologies Corp., licensor of Xiaflex, the 12 month phase II open-label trials of Xiaflex showed limited but promising results. These research tests were conducted to evaluate the ability of Xiaflex to successfully treat Peyronie's disease, as well as its compatibility and side effect potential. In this process clinical success was defined as a baseline change of penile angulation of at least 25 percent.

Each of the study participants received three injections of Xiaflex, administered on a separate day, and given over seven to ten day period. Twelve weeks later, each man received a second series of three injections. Research subjects were evaluated at three, six, and nine months after the Xiaflex injection series.

The average baseline angulation was 52.8 degrees. In this study clinical success was achieved at three and six months with 58 percent and 53 percent of patients, respectively. This would suggest that early success might not last very long or that the improvement to the Peyronie’s disease distortion was temporary.

In this study there were adverse reactions with Xiaflex that were not described in the general media. The most common adverse reaction was only reported as a problem at the local administration site that was mild or moderate in severity, non-serious, and resolved in time without medical attention. No comment was made about worsening of the Peyronie’s disease after the nine month time frame as a direct result of repeated injury to the delicate tunica albuginea tissue from the multiple needle injections of the needle used to deliver the Xiaflex.

It is the opinion of PDI that for some men these repeated injections could make their Peyronie's disease condition worse over time. It might be prudent for the average man to wait until more clinical treatment results are collected and interpreted before considering this treatment approach.

WRITINGNARRATIVEESSAY.COM
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Peyronie’s disease treatment via direct drug injection

Injections can injure delicate tunica albuginea, leading to Peyronie's disease

This blog post about Peyronie’s disease treatment using direct drug injections (Verapamil, cortisone, etc.) should hit home for a large number of you. Many men have undergone painful drug injections into the penis because their medical doctor thought it was worth the effort, and only found themselves worse for their effort.

First I will simply copy an article, “Extracorporeal shock-wave therapy in the treatment of Peyronie's disease.” This research discussion is essentially about Extracorporeal Shock Wave Therapy, ESWT (or ESWL as they call it here). This article comes from www.pubmed.gov under the reference number PMID: 15114750 [PubMed – indexed for MEDLINE].

What is important to note in our particular discussion is the area I have highlighted for emphasis. You will note from an earlier post about ESWT in Peyronie’s Disease Treatment Forum blog, this form of therapy has been fairly well abandoned by a large percent of doctors who used it for many years since these injections seem to cause more problems than it helps. The reason this information about ESWT (or ESWL) is included in this article about penile injections is that these Russian physicians make a very interesting comment while discussing ESWT that underscores the damage created by injections (of any kind) into the tunica albuginea.

[Article in Russian]

Neĭmark AI, Astakhov IuI, Sidor MV.

The authors analyze the results of treatment of 28 patients with Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL) performed on Dornier U15 lithotriptor. A total of 2-6 sessions were made, maximal number–12. The efficacy was controlled by clinical indices and ultrasonic investigation (Doppler mapping of the blood flow). ESWL proved to be efficient in the treatment of Peyronie's disease (PD), primarily, in patients with early disease before appearance of severe fibroplastic alterations. Less plaque vascularization by energetic Doppler mapping due to ESWL is an important diagnostic criterion of PD treatment efficacy. Conservative treatment is not indicated in marked deformities and plaque calcification, erectile dysfunction. Moreover, any injection into the tunica albuginea, especially complicated by hematomas (deep tissue bruising) may be a damaging factor which triggers fibrous inflammation. Such patients should be treated surgically. If the patient is interested in immediate results or is not interested in continuation of sexual life, the treatment is ineffective. Thus, ESWL is an effective, safe method of PD treatment but requires further study and accumulation of clinical experience.

It seems that the problem penile injections can cause is not necessarily about the drug that is injected into the tunica, but the needle itself that is used to deliver the drug. An injection to deliver any drug – or sterile water – can cause injury to this delicate membrane. This sets off an inflammatory response that can result in significant Peyronie’s disease plaque or scar tissue formation for men who as so predisposed. Doing this once can be risky. Doing this up to a dozen times over a few months, as is often the recommended course of therapy, just multiples the opportunity for injury to mount on top of injury.

This Russian research team offers the opinion that the effects of such injection into the penile shaft causes such significant Peyronie's plaque development, that surgery is the best treatment option for the damage that it can cause. Obviously, I do not agree with that, since Peyronie's surgery can also cause more scar development. Their conclusion is that they find men who receive these injections often eventually are rewarded with a disturbed and discontinued sexual life.

This idea is brought to your attention to demonstrate there are many in the medical community who agree with the same position that I have taken for many years now. These doctors and I contend it is inherently risky, in fact, dangerous, to stick needles repeatedly into the penis for Peyronie’s disease treatment. Their logic concludes that any treatment that can start or aggravate the very problem it is attempting to treat, is not much of a treatment.

It is unfortunate that the medical community turns a blind eye to the direct observation of poor results, serious irritation of the tunica, and the solid logic that reputes injections as a form of Peyronie’s treatment. Those who continue to inject their Peyronie’s disease patients, and bring these men farther down the road toward greater plaque development, must be desperate to look useful or just ignorant of how Peyronie’s disease often develops. It is so common for medical doctors to think only in terms of medicine and surgery, notwithstanding the tragedy that can often result from their limited thinking.

The PDI concept of using non-invasive methods to increase the healing response of the body is a safer and more trustworthy Peyronie’s disease treatment than some of the aggressive medial schemes being promoted today. For more information about the Alternative Medicine treatment philosophy for care of PD, please go to the PDI website.

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