Use of Traction Devices for Peyronie’s disease

Peyronie’s disease (PD) is characterized by formation of fibrous plaque involving the tunica albuginea of penis. These plaques are felt as hard nodules over upper or under surface of penile shaft. These plaques consist of collagen and reduce the elasticity of penis. This produces abnormal curvature of penis and restricts satisfactory coitus. PD is associated with various penile deformities, including penile shortening, narrowing, pain, erectile dysfunction and sexual dysfunction.

Penile traction therapy appears to be safe and well tolerated but requires a great amount of patient compliance. Stretching of fibrosis related disabilities have been tried in many fields in orthopaedics like bone remodelling and also in joint contractures that are released by mobilization under anaesthesia.

Mechanical stress may reorient and modulate fibroblast function. Histological studies have shown that the collagen fibers reorient parallel to the axis of stress. It also reduces extent of fibrosis by upregulation of antifibrotic genes.

The device used to deliver this therapy is called penile extender or penile traction device. Many such devices are available commercially like Andropenis, Golden erect extender device, Size genetics, Vimax extender and Pro extender.

The basic structure of this device consists of a plastic support ring which holds against the pubis, a silicone band that fits just under the glans and two dynamic rods used to apply distraction. A gentle and progressive traction is applied on the penis which is increased every few weeks so as to achieve straightening of penis.

When used correctly, it results in decreased curvature and an increase in length. The extender is recommended to be applied for 2 to 8 hours every day as tolerated, for 6 months. Up to 2.5 cm of length gain has been reported in men with penile shortening due to Peyronies.  These results are not based on randomized studies so the effectiveness is not clear. It does not affect penile sensation and also does not cause new erectile dysfunction.

The major disadvantage with these devices is that it is difficult to control the amount of traction placed on the penis. Therefore it is likely that many times this device is underutilized or over utilized.  This may thus compromise any potential benefits.

Penile traction therapy is also useful in patients with Peyronie’s disease in whom penile implant is removed due to infection. This is followed by severe corporal fibrosis and shortening of penis which can be minimized by the use of a penile extender.

The penile traction device is well tolerated by majority of cases with Peyronie’s disease. Though the satisfaction levels are good, more research is required to determination optimal duration of therapy and degree of traction. The efficacy of multiple devices available also needs to be compared before penile traction therapy is accepted as standard of care in men with Peyronie’s disease.

References:

1. Levine LA, Newell MM. FastSize Medical Extender for the treatment of Peyronie’s disease. Expert Rev Med Devices 2008;5(3):305–10.

2. Gontero P, Di Marco M, Giubilei G, et al. Use of penile extender device in the treatment of penile curvature as a result of Peyronie’s disease. Results of a phase II prospective study. J Sex Med 2009;6(2):558–66.

3. Greenfield JM. Penile traction therapy in Peyronie’s disease. F1000 Med Rep 2009;1(pii):37.

Last modified on November 30, 2013