What is the best and the most accurate test to evaluate any scarring or scar tissue in the tunica to determine whether it is considered PD? Do you recommend chronic use of small doses of Viagra as an anti-fibrotic regimen? What do you think about using Trental in conjunction with nightly use of Viagra?

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  • What is the best and the most accurate test to evaluate any scarring or scar tissue in the tunica to determine whether it is considered PD? Do you recommend chronic use of small doses of Viagra as an anti-fibrotic regimen? What do you think about using Trental in conjunction with nightly use of Viagra?
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Dr. Levine answers: Probably the best noninvasive test today is to have an evaluation by an urologist who is familiar with Peyronie’s disease to determine whether there is evidence of a palpable plaque or scar in the tunica. To confirm whether this is PD, a surgical biopsy would be necessary, but this is invasive and very rarely indicated unless it is suspected that the lesion is not Peyronie’s disease and could possibly be an unusual type of cancer of the penis known as fibrosarcoma. In my experience with thousands of patients with Peyronie’s disease, I have only seen one case of fibrosarcoma, which did not present like a Peyronie’s plaque.

I have not recommended chronic low doses of Viagra as an anti-fibrotic agent except for men who also have erectile dysfunction. Research in the animal model of Peyronie’s disease has demonstrated that all three of the PDE5 inhibitors (ie, Viagra, Levitra, Cialis) can reduce the scarring process when given to these experimental animals at the time of initiating the Peyronie’s process. But, when the scar is already formed, the use of these agents did not result in significant benefit. Therefore I have been less enthusiastic to use these expensive medications without stronger evidence of benefit for established PD scars. On the other hand, I have used oral Trental and L-arginine for Peyronie’s disease because of their presumed anti-fibrotic effects, relative low cost, and low side-effect profile. There is very little evidence showing any benefit in taking these drugs, but they do make some scientific sense.