Verapamil for Peyronies Disease Treatment: Topical and Intralesional Uses
Peyronie’s disease is characterised by localized inflammation of tunica albuginea layer of penis which heals with fibrosis. A thick fibrotic plaque can form that consists of collagen and is often palpable as a hard elongated penile nodule. It results in localized changes in penile elasticity and an abnormal curvature causing a difficulty in coitus. Other symptoms include pain during an erection and erectile dysfunction.
Peyronie’s disease not only results in psychological trauma to the affected male, but also affects the quality of life and sexual experience of a female partner.
The exact cause is not known though many factors have been proposed and include repeated microtrauma, vasculitis and connective tissue disorder.
The diagnosis of Peyronie’s disease is based on history and clinical examination. An ultrasonography of penis may be performed for localization of the plaque.
The treatment options are multiple and depend on duration and severity of symptoms. The options include observation for spontaneous resolution, medical therapy and surgery. Observation is usually recommended in cases with mild symptoms and a curvature of penis lesser than 30°. Any curvature less than 30° may allow successful vaginal penetration during coitus. It may take 1 to 2 years for spontaneous resolution of inflammation though about 90% will require some form of therapy.
Drug therapy options include oral, topical and intralesional agents.
One such drug is verapamil which is a calcium channel blocker. The mechanism of action of verapamil is to increase activity of collagenase enzyme which breaks down collagen tissue in the plaque and also reduces collagen production by inhibiting fibroblast metabolism. It also affects fibroblast proliferation.
Verapamil has been used extensively for many years for treatment of Peyronie’s disease.
Intralesional Verapamil Injections
Intralesional verapamil injections have been used extensively based on results of studies that show beneficial effect in animal models and some benefit from mostly retrospective studies in human.
Intralesional injection of verapamil is another modality of treatment with positive backup from research reports. Verapamil is used as first line agent as well as with combination regimens. The intralesional injections are safe as they are performed by trained urologist.
The injection is performed under penile block where Lidocaine is injected around the penis to numb the nerves for penile sensation. Though intralesional injections of other drugs like interferon and collagenase have also been tried, verapamil has been found to be the most effective intralesional drug. It results in improvement in penile curvature, plaque size and penile pain in majority of cases.
Combination therapy involves combined use of multiple modalities like oral pentoxifylline, intralesional verapamil and penile traction. It results in variable degree of success.
Topical Verapamil Cream
Topical verapamil cream has been advocated as an alternative non-invasive treatment for Peyronies disease. A large market has developed around selling various verapamil creams.
Topical therapy with verapamil has been tried by local application of verapamil gel. Though a few studies showed improvement in symptoms after topical verapamil, these results could not be replicated in the studies conducted thereafter. Research has also shown that it does not penetrate into the tunica albuginea. Due to these conflicting reports, at present, topical verapamil is not recommended for the treatment of Peyronie’s disease.
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