Peyronies Disease “PD” has been described by experts as a physically and psychologically devastating problem manifested by a fibrous inelastic scar of the fibrous chambers of the penis known as the tunica albuginea. The scarring (known as “peyronies plaques”) can cause pain, bending, narrowing, hinging and shortening of the penis in the erect state. Recent demographic studies have shown that up to 9% of men have this problem and it seems to be even more prevalent after radical prostatectomy surgery. More than half of the cases worsen over time and only 13% resolve spontaneously. Peyronies is also closely associated with erectile dysfunction.
Peyronies Disease and Stromal Vascular Fraction (SVF)
There is no known non-surgical cure for PD and surgery can often result in more scarring, shortening or loss of sensation and adequate erectile function. Cases that involve calcification seem to do the worst with non-surgical treatment. Non-surgical therapies include: Vitamin E, Potaba, colchicine, tamoxifen, carnitine, and Omega-3 fatty acids. Unfortunately, formal studies have shown no benefit of any of these over placebo. Verapamil cream is often used by clinicians but there are no controlled trials proving that the verapamil penetrates into the tunica albuginea. There have been eight studies on intralesional injection of verapamil showing some positive effects in decreasing curvature and deformity improved in 30% to 60% of patients. The usual treatment is 10 mg injected every two weeks a total of twelve times. Injection of interferon alpha 2b has shown very mixed results. There is an ongoing FDA study of a drug (phase 3) called Xiaflex which is made from bacterial collagenase. Early results may be promising with curvature reduction 20% higher than with placebo. There are some ongoing European studies of a penile traction device that stretches the penis and early results seem to indicate a benefit but it involves a rigorous daily application of a device to the penis.
There is evidence that stem cells will actively seek out and attempt to repair a Dupytren’s contracture which is nearly identical to PD but occurs in the hand. Stem cells may be highly effective in inflammatory scarring conditions occurring in other parts of the body. We have developed a protocol for intralesional injection of autologous adipose derived stromal vascular fraction (rich in mesenchymal stem cells and growth factors) directly into Peyronies plaques as a non-surgical option for patients who have not responded to other conservative measures but wish to avoid surgery. Some patients will also be eligible to receive low intensity shock wave therapy in conjunction with SVF deployment in an effort to activate the stem cells to induce revascularization and healing.