What is your opinion on the use of intralesional verapamil for young patients who have had the disease for over three years, but have little or no calcification in the plaque? If it is sensible to try verapamil, would it be better to use iontophoresis? Would traction therapy further enhance the benefits?

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Dr. Levine answers: Intralesional verapamil remains as the most commonly used injection approach for Peyronie’s disease and appears to have fairly consistent results with respect to response. Overall, between 50-60% of men who complete a course of intralesional verapamil will have measured improvement of curvature. “Measured improvement” does not mean a cure, but does indicate a reduction of curvature measured to be at least 10 degrees. Improvement has been measured to be as much as 70 degrees. The current 3-arm approach to non-surgical of Peyronie’s disease is to use pentoxyphilline and L-arginine orally, intralesional verapamil injections every 2 weeks and daily traction therapy (or more daily). This combination has been shown in an ongoing study to result in a more robust and earlier response than with verapamil alone. As to the age of the patient, it is unusual to have men under the age of 40 with Peyronie’s disease, but still 10% of men with Peyronie’s disease are under the age of 40 and appear to respond well to non-surgical therapy as well as surgery. The experience with Iontophoresis is limited and it is my personal opinion that Iontophoresis offers little benefit other than reduction of pain and mild curvature improvement.

Although there have been no studies using iontophoresis with traction, I would certainly recommend this combination approach if iontophoresis is used.

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