Penile Traction Therapy for Peyronie's Disease

What's the Evidence?

Mustafa Faruk Usta; Tumay Ipekci

Disclosures

Transl Androl Urol. 2016;5(3):303-309. 

In This Article

Abstract and Introduction

Abstract

Penile traction therapy (PTT) is a new therapeutic option for men with Peyronie's disease (PD). However, it has a long history of use in other fields of medicine including bone, skin, skeletal muscle, and Dupuytren's. Mechanotransduction, or gradual expansion of tissue by traction, leads to the formation of new collagen tissue by cellular proliferation. As a molecular result, continuous extension of the fibrous plaque causes significant increases in collagenase and metalloproteinases, and, ultimately, to fibrous plaque softening and extension. This hypothetical knowledge has been supported by recent well designed experimental studies. Furthermore, several clinical papers have provided promising results on the use of PTT in PD patients. It has been shown in some series that the use of PTT significantly increases flaccid and stretched penile lengths and results in significant penile curvature improvement when compared to baseline. Furthermore, the use of PTT concomitantly with either verapamil or interferon α-2b has also been shown to be an effective therapy. Additionally, the beneficial effect of PTT on penile length before or after penile surgery in men with corporal fibrosis has been described. Finally, as a minimally invasive alternative treatment option to penile augmentation surgery in men with dysmorphophobia, PTT use has shown promising results by several experts. Studies have shown that PTT provides an acceptable, minimally invasive method that can produce effective and durable lengthening of the penis in men complaining of a small/short penis. There are, however, several criticisms related to the designs of the reported studies, such as small sample size and selection bias. Well-designed studies with larger numbers of patients and longer follow-up periods are, however, needed to establish the true benefits of PTT.

Introduction

Peyronie's Disease (PD) is manifested by the development of a fibrous inelastic scar within the tunica albuginea, which can lead to penile deformity, penile curvature, shrinkage, narrowing, hinging, shortening, and painful erections. These symptoms subsequently cause painful and/or unsatisfying sexual intercourse.[1–7]

Treatment options range from reassurance to medical, mechanical, and surgical options.[1] Medical treatment options for PD are used to treat patients in the early/acute phase of the disease. Although several reports in the literature exist of penile curvature stabilization and/or improvement in other clinical symptoms, recent guidelines describe that the available evidence reveals no significant benefit from common medical treatment options, especially for reducing penile curvature.[3] On the other hand, according to the recent therapy guidelines, medical treatment options including either oral or intralesional injection therapy have been widely accepted as the standard of care at the first presentation of men with PD.[8] In addition to oral and intralesional injection therapy, several authors have also used other non-surgical treatment modalities to treat patients with PD, including topical therapy, extracorporeal shockwave therapy, iontophoresis, and penile traction therapy (PTT).[1–4] PTT, which produces gradual mechanical traction to the penis, has been described as an efficient, nonsurgical treatment option for men with PD. It has been suggested that application of PTT results in an enhancement in the length of the penis in both erect and flaccid forms.[6,7]

In this article, we aim to review the current literature regarding the use of PTT in men with PD, and, additionally, its use in specific patient subgroups, including men with shortened penis prior to penile prosthesis placement.

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