Does any Urologist perform a needle aponeurotomy for Peyronies disease?

Needle aponeurotomy for the hand is all I see online. I am a Kaiser Permanente subscriber and even at that, I don't see anywhere online where needle aponeurotomy is performed on a penis…Got any suggestions? Do you know of any Urologist in my medical plan who does needle aponeurotomy for Peyronie?

Sincerely,

Martin Carroll, Jr.

Greetings Martin,

Well, you are certainly an adventurous person. Here you are a layperson and you are thinking outside the box about your Peyronie's treatment, but you are in a risky area. The problem is that this idea of using a needle to tear up the fibrous Peyronie's plaque without having to cut the penis shaft open has already been explored.

As you know, needle aponeurotomy is a type of surgery done on the palm of the hand to surgically reduce the cords that develop in Dupuytren's contracture. It is a less invasive hand surgery performed by inserting a needle under the skin of the palm, and then blindly slashing and tearing at the cords and contracted fascial tissue since the skin is never opened by the surgeon so he/she never actually sees the tissue that is being cut and torn. The purpose of this procedure is an attempt to weaken and reduce the cords that develop under the skin in Dupuytren contracture to the point that the surgeon can eventually break or snap the weakened Dupuytren cords. The recurrence rate of the Dupuytren nodules and cords returning after needle aponeurotomy is fairly high, about a year or two faster than conventional hand surgery. Even though they return after this kind of hand surgery, the real caution and reason many people do not get this surgery is that when the Dupuytrens comes back in that year or two it will come back worse than the first time around. This is common for many of these Dupuytren hand surgeries and a good reason to think long and hard about getting started with the first one.

There are many hand surgeons who are proponents of this technique, and others who are not. No surgical technique is perfect, and they all carry risks. You might want to read more about these drawbacks and apply that thinking to what might happen if that same kind of technique was done for Peyronie's disease.

This same technique in which the tip of a large gauge needle is used as a cutting tool to reduce the Peyronie's plaque while the actual slashing and tearing of the tissue is not directly observed by the doctor who is doing the penis surgery is called the Leriche technique for Peyronie's disease. But it is not called an aponeurotomy because there is no aponeurosis in the shaft of the penis; that is why you were not able to find any information using the terms you were searching. If this surgery for the penis was to be named in a way similar to what is being done in the hand, it might a name like Needle Tunicotomy. This term would be applicable because it is the tunica albuginea of the penis that would be surgically cut by the needle tip and left in place, just as it is the aponeurosis of the palm that is cut with the needle in Dupuytren's contracture. You will not find this term anywhere but here because I coined it. to read more about this procedure, click on “Leriche technique for Peyronie's surgery.”

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There are many more conservative ways of trying to correct your Peyronie's disease than having the internal scar blindly being cut to shreds. I suggest you consider avoiding that kind of risk and look at some of the less risky non-invasive Alternative Medicine options that are on the PDI website. TRH

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If I can't find a scar is it possible I have a condition other than Peyronie's disease?

Hi Dr. Herazy,

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I developed an upward curvature about 10 months ago, and upon recent self examination I cannot find any lumps or scars at all. Is it possible that I have a condition other than Peyronie's disease? Also could I benefit from the treatments available from your website to reduce the curvature since I cannot find the scar and if so which treatment plan do you suggest?

Thanks,

Alan

Greetings Alan,

It is rare for a man to have a recently acquired curved penis and for it to be caused by something other than Peyronie's disease. Even so, you should go to a urologist with some interest and experience with PD for a complete examination and diagnosis of your problem.

It would not be at all unusual for a layperson who has Peyronies to be unable to identify the characteristic Peyronie's plaque or scar that often but not always can be detected as a lump below the surface of the skin. Many times no Peyronie's scar or plaque is found, or found with great difficulty and uncertainty; many times the scar is very flat and thin and is missed simply because the shape and size does not fulfill expectations. TRH


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How should I do penis stretching with two different deformities?

I have Peyronie's disease with a downward curvature when erect. I have watched the PDI gentle massage video and it states that you should attack the biggest curvature first, ok. But here is a problem, when the penis is flaccid, ie not erect, I also have an hour-glass deformity figure. The hourglass figure is not there when fully erect at all, but it does make it harder to apply gentle massage technique when flaccid. So should I try to attack the hour-glass figure first or not?

Greetings,

If you are correctly applying the gentle manual PDI penis stretching technique to a flaccid penis that demonstrates a hourglass deformity you should not have any trouble holding or maintaining the correct contact. You are doing something wrong.

In your question you used the word “attack” twice.

In the one-hour video I know I did not use that word once, because the emphasis is always about how light and gentle the contact and minimal the traction is when applying this special penis stretching technique. I hope you are not being too aggressive with this method of treating Peyronie's disease, and that you are carefully applying the specific instructions just as they were carefully presented to you. For you to be having a problem holding a contact for an hourglass deformity tells me you are not doing the work correctly.

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In the video spent a lot time explaining the method will not work if you are too aggressive and heavy-handed when you use it, so please be careful how you apply it. Actually, I encourage you to sit down and watch the CD again to be sure you are doing it correctly.

Regardless how you might be using unnecessary and counter-productive force, I can advise you that you should be applying traction not to correct the hourglass deformity since you report that it is only present when you are flaccid, or non-erect. Your gentle penis traction should be applied to correct the downward bent penis carefully following the instructions given in hour long video for this kind of deformity.

Also, you do not mention doing any other form of Peyronie's treatment, such as vitamin E and C, systemic enzymes, PABA, DMSO, etc. If you are only using the PDI gentle manual penis stretching technique by itself you are making another mistake. Please contact me if you have any questions or need something explained in greater detail. I am concerned how you are working to correct your Peyronie's disease and want to assist you in any way I can. TRH

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How is DMSO applied in a Peyronie's disease treatment plan?

Hi doctor,

I just have a quick question regarding applying DMSO to my curved penis. Will it still be effective to the fibrous plague even my Peyronies disease condition started a long time ago. I had developed a curved penis since i was young and i am now 28. Looking to purchase your BETTER PLAN. How should one apply it? on erect state or not? Thank you and hope for your response.:)

Ollie

Greetings Ollie,

Are you sure you have Peyronie’s disease? Have you been formally diagnosed with PD? Perhaps you were born with a normally curved penis.

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Assuming you do have Peyronie’s disease, the medium plan is by far the most popular. DMSO is an important part of the overall therapy. All instructions you need for using every part of the medium plan are included when you receive your order; you will not have any questions about how to use the DMSO or any other part of the plan.

To answer your question, the DMSO is applied in the non-erect, or flaccid, state.

Let me know if I can help you in any way. TRH

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Is there anything I can do to help my husband recover from Peyronie’s disease?

Any woman can help and support his effort to reduce Peyronies disease in several ways

There obvious and not so obvious, direct and indirect, ways a woman can help the man in her life to deal with his problems of Peyronie’s disease not only on a personal treatment basis, but also by supporting and assisting with those personal matters that threaten their relationship as a social and sexual couple.

It goes without saying that the obvious physical problems of a curved penis, reduced length and girth, and erectile dysfunction that are part of Peyronie’s disease directly affect the man who has this condition.  But the woman in a relationship with such a man is in a critical position because of their personal relationship to help him deal with the many negative aspects of Peyronie’s disease, and so can provide an integral part of any solution he might need.  Her role begins by understanding and accepting that he is going through a strange and stressful event for which no man is ever prepared.  Throughout a woman’s life, even before her teen years, she is talked to and prepared for changes in her reproductive system; she discusses these events that affect her genital area with her mother and perhaps her sisters and girlfriends who also experience these changes; she even goes to a special kind of doctor, a gynecologist, who specializes just in the female reproductive system; each month she is reminded that her pelvic region does unusual things; if she becomes pregnant she soon overcomes her modesty and privacy about this area of her body.  A man does not ever experience anything remotely like that.  His genitals are his prized masculine region, but they are private.  For the most part his reproductive area is uneventful and is not discussed much – except if he develops Peyronie’s disease.

For these reasons he has been completely unprepared by his past experiences to deal with  suddenly learning that there is a problem he has never heard of before, called Peyronie’s disease, that jeopardizes his ability to engage in sexual intercourse and denies him the act that defines manhood to him.   For a man Peyronie’s disease is perhaps not so much experienced as a health problem in which fibrous plaque material develops internally within the penis, but more so it is felt to be a loss of what makes him a man.  The woman who must deal with her man’s Peyronies problem must see this condition as a great emotional issue for him and be prepared to forgive him if his temperament and mood suffers while he comes to grips with his curved penis that no longer works as it once did.

He will benefit greatly from his mate’s emotional support and patience, and her ability to forgive him while he wrestles with the fears that are connected to Peyronie’s disease. Probably his biggest fear is the losing you because of his reduced sexual ability; no longer being able to provide you the pleasure of sexual intercourse, that you will leave him for someone else. He fears that he will never experience regain the pleasure of traditional sexual satisfaction. He fears that if you do leave him he will never be able to develop a relationship with another woman, and he will be alone in life. He fears being pitied and ridiculed as the man with the deformed and shrunken penis. He fears feeling like less of a man.  It is not really the physical aspects of Peyronie’s disease that drives a man into despair, it is being unprepared for the emotional isolation he feels.  More than ever he needs you but he feels ashamed and embarrassed to be with you, adding to the torment he feels.

From the combination of physical, emotional and sexual problems related to Peyronie’s disease comes a list of common problems and pitfalls that happen to most couples. Since the man with Peyronie’s disease will often shut down emotionally and a state of denial, totally ignoring his problem, the burden to actively learn about and reach out for help will fall to the woman in that relationship. From this reason the Peyronie’s Disease Institute has developed  a special program in which our staff nurse can consult with and advise a woman who needs help dealing with any aspect of Peyronie’s disease.  During a friendly phone call our nurse will answer questions of any sort about Peyronie’s disease (male and female anatomy, sexual difficulties, personal relationship problems, treatment options, or anything else that is on her mind).

Here are a few ideas to consider to help him deal with his penile problems and to protect the bonds of your family:

  1. Continue your usual sex life if at all possible, limiting traditional intercourse only to the extent that his curved penis prevents it.  In case you believe that you cannot any longer engage in intercourse, please know that there are many techniques and ideas that can help you allow entry and increase your ability for traditional sexual intercourse. Few couples are as limited in their ability to engage in intercourse as they assume; usually all they need are some basic ideas and simple instruction. This is such an important topic; please refer to my second book that covers many aspects of this topic at great detail and length, “Peyronie’s Disease and Sex.”
  2. An important aspect of Alternative Medicine treatment of PD is the PDI diet to assist recovery from Peyronies.   This subject is covered in detail in chapter 5 of “Peyronie’s Disease Handbook.”  You can assist his recovery greatly if you can coach him through these dietary ideas, and make it easier to follow if you incorporate these principles into your lifestyle for the time being.
  3. Moral support at this time is crucial.  You will help him, and help yourself as well, if you can offer him encouragement and praise during these rough times.  You will prove your loyalty and earn his admiration and respect when you demonstrate you are not a fair weather friend.  Men commonly refer to their time dealing with Peyronie’s disease as the lowest point of their lives, feeling alone and depressed, offering them all the excuse needed to behave badly.  Just because a man is acting like a jerk does not mean he does not know he is acting like a jerk; he knows his behavior is bad; he just does not care to control his primitive emotions of the moment. This is the time a man needs a friend to offer support and a trusting heart.  Even though he might push you away out of embarrassment and self-consciousness for his reduced physical state, he will soon recognize your acts of steadfast friendship and tolerance as proof you are not going to reject him.  Once he is confident you are not going to run away because of his sexual problems, your man will come around to his old self (and probably better) because you will have proven your love for him to an even greater level than he knew before.  This is how your relationship will grow under the adversity of Peyronie’s disease, by showing your strength and loyalty to him no matter what happens.
  4. Be tolerant and understanding about his reduced sexual interest and flawed sexual ability.  Both of you are afraid of what will happen in the future regarding your sex life together.  The way to make our fears become a reality is to place a lot of pressure on his sexual performance.  Easy does it.  As discussed at length in “Peyronie’s Disease and Sex,” we find that most couples can actually engage in sexual intercourse for a far longer time than they imagine, but stop only because the do not know how to solve get around some of the difficulties of gaining entry with a bent penis; this book explains how to be successful with sex using a curved penis than you could imagine.  In the early stages of Peyronies it is most valuable to continue traditional intercourse for as long as possible.  It is not necessary to stop sexual activity as long as no pain occurs for either partner.  Engaging in sexual activity is good for the physical and emotional health of both partners, as well as beneficial for your personal relationship.  Sex can be the all-important emotional glue that keeps you together, so use sex liberally since PD is really all about sex when you think about it.  If you reduce sexual activity at this time it will only confirm his worse fear that you are no longer interested in him as a sexual person. If traditional sexual intercourse turns out to not be possible due to his curved penis it is necessary to explore, expand and use a greater variety non-intercourse sexual activities and techniques, with the hands, lips and whatever else is mutually agreeable to you as a couple.  Your previous thinking and attitude about sexual activity might have to change to satisfy your unfulfilled physical needs for intimacy.  With an open and honest dialogue you can work these things out.  Again, your helpful and willing approach to sexual problem solving and cooperation only proves your place in his heart as the best possible partner he can have.

Many of the conflicts and stresses a couple goes through when Peyronie’s disease enters their lives are avoidable.  A little understanding, a few suggestions about altered sex techniques, the man having the woman’s side explained to him, the woman having the man’s side explained to her, reading the positive and informative books that are available from the Peyronie’s Disease Institute, and starting an aggressive Alternative Medicine treatment plan to increase his ability to heal and repair the Peyronies plaque can do wonders to reduce stress and misunderstanding between people dealing with Peyronie’s disease.

If the woman would keep in mind that her man with Peyronie’s disease is very much like a scared little boy who is behaving badly because he is scared of losing you, and treat him accordingly, things would improve greatly. With understanding, love and a little compassion you can help that little boy know you are not going to leave him and you will protect your relationship with him.

Is it better to divide or not divide dosage in a Peyronie’s treatment plan?

Dr. H.,

Is it better to take the pills that say 1-2 per day (PABA, Acetyl, Vitamin C and E) 1 in the morning and 1 at night or better to take 2 at one time?

Thanks,

Eli

 

Greetings Eli,

Most people take all dosages in a Peyronie’s treatment plan divided equally throughout the day, so a two/day dosage would be one in AM and PM.

However, taking a two/day dosage all at the same time could be a variation to experiment with to determine if your body responds differently to it than taking the same therapy product in a divided dosage. Experiment.

No matter what you and I think and can rationalize about what to take and how to take it, all aspects of your Peyronies treatment should be evaluated against actual response of your internal scar. No one knows what will work best for you; you must figure it out based on early changes in the size, shape, density and surface features of the Peyronie’s plaque. Even something that many people would take for granted like dividing or not dividing dosages can have an influence on your body’s ability to change the scar structure. I always advise to evaluate every change in your treatment plan by looking for small changes in the scar – after all, that is what your treatment is supposed to do.   TRH

Will items in a Peyronie's treatment plan cause drug interactions?

Dr. Herazy

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I take metoprolol ( betablocker) , trilipix and simastatin for cholesterol and lansoprazole for reduction of stomache acid. Will taking Nattokinase or serrapeptase, neprinol or any of the other listed treatment plans be a cause for concern for any drug interactions . I also take krill oil.

Greetings,

In over 10 years of doing this work I have never been told about any adverse drug reaction with any of the Peyronie's treatment items that are used. I would suggest, however, that you pose this same question to the doctor who is prescribing all this medication to you. You always want to inform the doctor of your Alternative Medicine intake.

You might also want to discuss with this doctor the very real possibility that the beta blocker and the cholesterol lowering drugs you are taking are the cause of your Peyronie's disease. Taking any one of these carries a risk of starting a drug reaction of its own that can cause Peyronie's disease, but when you take two different drugs that both carry a risk you are creating a very unfavorable situation for yourself. This should have been explained to you when you first started to take these drugs. TRH

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How can I fix my curved penis when I get erect?

Good day,

I have curve to the left and is causing me serious trouble when I got erected.

How do I fix my curved penis?

Regards

Pongo

Greetings Pongo,

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You can spend a little time and effort reading and learning about Alternative Medicine treatment of Peyronie's disease. I suggest you go to “Start Peyronies Treatment” found at the top of the PDI home page and get busy. You can also read any of the hundreds of answers I have already given to this same question that appears in this Question/Answer section. TRH

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After Nesbit Peyronie's surgery the curved penis came back – now what?

Hi Dr Herazy,

I was diagnosed with Peyronie's disease in Oct 2009. the urologist put me on potaba which did nothing. I then tried neprinol that did nothing. I saw the uro again and he put me oh high doses of oral Vitamin E and said I was to start VED therapy. My penis curve did not improve at all and in fact became worse. I was then also put on pentoxifylline which again did nothing. After no improvement and the curve to my penis being 40 degrees upward he told me the only solution was Nesbit surgery which I underwent out of desperation in May last year 2011. All was fine, my penis was very straight but shorter by about an inch but then in Sept.Oct the same year I began to notice my penis curving up again! Now in August 2012 it is really back to where I was in 2009 with an upward curve of 40 degrees. Very depressing as same curve just shorter penis!

What do you suggest in light of my previous drugs and treatment to try and cure this myself as I am beginning to give up on the uro's and certainly do not want more surgery after the first one failing me! What do you think about this if I order: DMSO, Super CD Serum, Vitamin E unique Oil, stretching video, Scar-X and Acetyl-L- Carnitine? I am in the UK. Hello, please help as I am now desperate and depressed.

Gary

Greetings Gary,

I commend you for your tenacity and strength to continue to work to help yourself in view of all that has happened to you.

It appears that you have now spent some time reading a few ideas presented on the PDI website about Alternative Medicine treatment of Peyronie's disease. It sounds like when you earlier used Neprinol by itself you did not receive any good advice and you wasted that opportunity to do something positive and helpful for your curved penis. That is always the problem when buying Neprinol from people who do not know how to use it correctly.

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Please do not evaluate Neprinol based on using it by itself. In my opinion that is not the best way to use Neprinol. It is a great therapy product but it must be combined within a well balanced Peyronies treatment plan that addresses other aspects of this complicated problem. You did the best you knew how to do, but you just did not receive good information. Neprinol cannot do it all by itself, but then again, no other therapy product can either; they all must be combined for greatest effectiveness.

If you read about the Nesbit Peyronie's surgery procedure and outcomes on the PDI website you will learn that it is not uncommon for Peyronie's disease to return within a few years; sometimes sooner and sometime later, but it will always return. The surgeons do not like to discuss this aspect of their work because it does not do a lot for their business prospects. In this regard I strongly suggest that you consider putting yourself on an aggressive support plan to minimize the potential of fibrous tissue return. The outline that you suggest is not a bad one and could be helpful in your situation. If it makes sense to you, as apparently it does, I suggest you put yourself of this plan you designed and try it for a month to see if it makes a difference in the size, shape, density and surface features of your scars – no plan can be evaluated on paper; it is only by applying it and evaluating how it affects your PD scars will you know if it is actually effective for you.

Please let me know if I can be of help to your effort. TRH

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What do you think is the best route for Peyronie's treatment?

I am a 39 year old male that developed peyronie's about 1 year ago. Much of the curvature has gone away, but my erection still bends slightly down (compared to having a natural upward curve previously), and it has a dimple on the underside of the shaft. Most of the pain has gone away. At the recommendation of my urologist, I was taking oral Vitamin E of about 400 IU daily, and added Wobezym (6 pills daily), Serrapeptase (120,000 IU/2 daily), and bromelain (1000mg daily of 2,000 GDU/g).

I was considering ordering the medium plan along with the stretching DVD. Do you think this would be the best route to go? How long do you think it would take to see results?

Thanks.

Tony

Greetings Tony,

Judging your progress simply by noting good or bad changes in the penis curvature is not a good strategy.  Naturally it is the bent penis that gets your attention and it is what you most want to see improved, but it is a poor way to evaluate what is going on with the Peyronie's disease treatment you are doing.

The fact is that the curved penis is not the primary problem of Peyronie's disease; the primary problem of Peyronie's disease is the internal scar or Peyronie's plaque that causes the penile distortion.  The size, shape, density and surface features of the internal Peyronie's plaque this is what you need to measure and evaluate to determine if your effort is being truly successful or not.

Another fact is that your Peyronie's plaque can be worsening and your curved penis can become straighter at the same time this is happening.  This happens when the growing PD scar tissue balances out the internal stresses and tissue pulling that takes place because of scar material.  This is not a good thing.  I f you have a large and complex interplay of PD scar material that is so arranged that your penis is straight, is this really desirable? Is it a good thing? If you say, “What do I care if the scars are getting worse?  Just as long as the curve is getting better and I can continue to have sex.”    The answer to that attitude is to understand that Peyronie's disease is not a static problem and over time it will worsen.  You might eventually have the currently balanced scars become imbalanced and they can begin to pull the penis in a weird and abnormal way resulting in a worse curve than you had at the beginning of your problem. 

Of course, I have no way to know the condition of your internal scar tissue.  But then again, neither do you unless you understand this concept and are paying attention to what is really important.  Your internal scar material could be totally reversed, it is possible, but you will never know and will remain at a distinct disadvantage for as long as you ignore what is going on inside. 

Only you will know the best treatment route to take by noting the response of your scar in terms of changes of the size, shape, density and surface features of your internal Peyronie's plaque.  The medium plan is a good one to work with.  Take it as you are given suggestions when you receive your order and every 7-10 days evaluate your shaft for changes in the scar size, shape, density and surface features.  Increase the dosage of your plan until you see definite and clear reduction of the size, shape, density and surface features of the plaque material.   This is the very best way to know you are following the best plan of action for your recovery. 

When a man follows a very aggressive Peyronies plan and does so faithfully, and finally reaches the correct dosage by slow incremental increase of dosage while evaluating the size, shape, density and surface features of his fibrous Peyronie's plaque, he can expect to see changes as quickly as 7-10 days after he has reached his correct dosage level.  Notice, I did not say his PD would be gone, just that his scar would begin to be reabsorbed and start to get smaller as determined by these various measures.   After that point it is usually 2-6 months of care to have all the tissue changes occur that will take place. 

By the way, you might be getting better results with Neprinol.  I also recommend that a good treatment strategy includes a variety of Peyronies disease exercises along with using vitamins, minerals, enzymes and herbs to support your natural recovery. TRH

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