How do patients who have curvatures of the penis greater than 30 degrees do when the curvature involves just the distal end of the penis? Can it correct itself without treatment? What about vitamin E? Do we typically see worsening of the disease after a period of 12-18 months?

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Dr. Levine answers: This question addresses many issues in Peyronie’s disease, first that Peyronie’s disease can present with a variety of deformities anywhere along the shaft of the penis and there is nothing particularly unique with respect to treatment response about the curvatures which occur at the base, middle or distal shaft. There is also little evidence that spontaneous correction of a Peyronie’s disease plaque occurs. In fact, the most recent natural history studies show no more than 10% of men will have spontaneous improvement (not complete resolution) and that within the first 6 months to one year after the disease shows itself, 50% of men will get worse if no treatment is offered.

With regard to oral therapy, there is no published controlled trial of oral medications, which has been shown to provide any meaningful benefit with regard to penile deformity. Pentoxyphilline, and L-arginine, as well as the PDE5 inhibitors, have been shown in animal model studies to reduce the production of scar. Reports on these agents have not been published on humans. At this time these penile agents have not shown to reverse scarring other than occasional anecdotal reports.

Previous Hand surgeons for Dupuytren’s contractures have been successfully using an open percutaneous needle fasciotomy procedure instead of an open procedure. Why can’t this closed percutaneous technique be a procedure used by urologists for Peyronie’s patients?
Next I am 45, Peyronie’s for 5 years, stable, curve about 75 degrees. I am able to have sexual intercourse, but I worry about getting worse over time. My urologist suggests I take 2 Pentox a day, Is this OK or should I take 3? I also worry about being on the Pentox for years, if I quit after one year will I experience any worsening? Will using Pentox mess with my Immune system? I suffer from lower than normal testosterone, so I get sick easily. Should vitamin D be taken with Pentox to help in immunity?
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