The use of iontophoresis for Peyronie’s disease has primarily focused on the Physion device from Italy. This is a device which delivers the positively charged energy via a reservoir which is filled with the verapamil with or without the decadron solution. My experience with this device is that 50-60% of treated men have mild improvement of their erect deformity ranging from 5-30 degrees but on average being around 10 degrees. Therefore I typically do not use this approach in men who have more advanced curvature, unless they are also experiencing a good deal of pain. This treatment modality has been shown to accelerate resolution of pain. The experts in the use of iontophoresis have informed me that the penetration of verapamil into the underlying plaque can be enhanced with decadron. Therefore since it appears that one drug does help the other it is best to give them together.
Given that you have lost a lot of size and still appear to have significant Peyronie’s disease, the non-surgical treatment options would include intralesional injection therapy with verapamil or interferon. This may be utilized with vacuum therapy in effort to stretch the scar tissue as well. For men who have strong erections but severe deformity and are not responding to medical treatment surgery is the next option with either a plication or a grafting procedure depending on the severity of the curve. For those men who have a combination of erectile dysfunction and deformity this situation is best treated with placement of an inflatable penile prosthesis where manual modeling is used to straighten the penis.