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STANDARD
MEDICAL
TREATMENT
oF
PD
Listen
To Your Doctor
PDI wants all Peyronie’s
disease (PD) patients to follow the
sound advice of his personal medical doctor or surgeon. We
suggest only that a man takes the ideas and suggestions for
alternative and complimentary care offered in this website to
that physician for discussion and evaluation.
PDI strongly
recommends that a man with PD listens very closely to the
answers from his doctor, and acts accordingly.
The Pipeline
Considerable space is used on medical websites to explain
standard and customary treatment of PD. From these we learn
there are two methods of medical treatment: drug and non-drug
(surgical). In these discussions even naturally occurring
vitamins and enzymes are often included as drug treatments, as
though any treatment suggested by the medical profession must
be drug related. This underscores that medical care in this
country is heavily influenced by, dependent on, and slanted
toward pharmacological
therapy. The influence of the pharmacology
industry extends so deeply into American medical practice that
the drug companies determine what potential drugs will be
researched, tested and approved for treatment of a disease –
including PD.
No drug is used in medical care that has not
come through the drug industry pipeline, and the drug industry controls
the medical pipeline. The drug industry is not interested in
putting vitamin C, serrapeptase, or other simple treatments
into the pipeline because there is insufficient interest,
based on insufficient profit compared to
the effort and expense of proving their effectiveness. Only
potentially profitable things get into the pipeline. Vitamins,
enzymes and commonly available substances stay out of the
pipeline and continue to be given the terrible sounding label
of being “unproven”. In this way, “unproven” can mean that
many of these basic treatments are simply being ignored by the
drug industry, and does not necessarily mean they are
ineffective.
Drug Options
Concerning drug treatment of PD, the websites all report the
same thing one way or another. Here is a discussion about PD
treatment from the American Academy of Family Physicians. This
is a favorite example because none do it so well with one
grand denial and warning about every treatment available,
except surgery of course:
“Oral agents, particularly those with antioxidant properties,
have been tried
with limited success. Such agents include vitamin E, potassium
aminobenzoate (Potaba), and colchicine. Experimental intralesional
treatments include corticosteroids, parathyroid hormone,
collagenase and
verapamil (Calan). Various modes of energy transfer, including
ultrasound,
radiation, laser therapy, short-wave diathermy and
lithotripsy, have also
been used. However, all current published reports of these
treatments have
been compromised by limited-sample patient populations, lack
of control
populations, poorly characterized outcome parameters,
inadequate follow-up
periods and inconclusive results. It has been difficult,
therefore, to determine
which, if any, of the nonsurgical treatments may be effective.
Caution should
be used when recommending any of these experimental
treatments.”
From the National Institute of Health we learn, “Some
researchers have given vitamin E orally to men with PD in
small-scale studies and have reported improvements. Yet, no
controlled studies have established the effectiveness of
vitamin E therapy. Similar inconclusive success has been
attributed to oral application of para-aminobenzoate, a
substance belonging to the family of B-complex molecules.”(1)
So, this powerful government agency knows of, or at least
suspects, improvement of PD is possible with vitamin E and
para-aminobenzoate. But these findings are not “proven” in a
way necessary for the NIH to officially recommend it. Then why
doesn’t someone just correctly and completely test vitamin E
and para-aminobenzoate, and prove one way or the other if they
are useful in treating PD? Sounds simple; all it takes is an
interest in finding out the truth and the money to get it done
– mostly money. Without this recommendation from the NIH and
other regulating bodies, neither vitamin E nor
para-aminobenzoate will be recommended or used by doctors with
much enthusiasm.
As you go over the medical websites, have you wondered why so
many things are reported to be “unproven” for use in treatment
of PD? They admit that the common and readily available things
reported to be “unproven” are successful “sometimes”, “in some
cases”, “in a small research paper”, “only 60% of the time”,
in treating PD: vitamin E, some basic enzymes and amino acids,
an herb or two, a few drugs, even a by-product from wood pulp
processing. There is little interest in these substances since
they are used in other applications, and do not have much
profit potential. Profit potential? What does profit potential
have to do with scientific research and medical use? Hmm.
Apparently for reasons of profit, these simple treatment
measures are not put in the drug pipeline for full review, and
thus they remain unproven. Since they are unproven, they
receive no support from the scientific community. Without
scientific approval they are not used by the medical community
in treatment; thus, they remain controversial and “unproven” for a
reason. For more on this, click A Honey of an Idea.
Surgical Options
Surgery is presented in the medical websites as the only sure
and proven treatment option for PD. While drug options have
variable success, surgical repair is currently regarded as the
best way to remove the Peyronie’s scar.
Surgery is presented as the back-up choice to be used if PD
leads to extreme pain, distortion and impotency. The American
Academy of Family Physicians states, “Despite numerous
treatment options, there is no generally accepted, standard
non-surgical treatment for Peyronie's disease.” With this
statement they are confirming that there is one accepted
treatment for PD – and it is surgical.
The person who reads this information is comforted by knowing that in the face of this terrible problem
at least there is a surgical treatment to rely upon if all
else fails. Surgery is presented almost as though if you
gambled and lost with the wait-and-see option or with
medication, you can always rely on good ol' surgery to correct
your problem.
In our opinion, while it is fundamentally true that surgery
might be presently the one best standard way to treat an
extreme case of PD, we believe that the cautious and informed
reader needs more information about surgery than is clearly
presented in the average medical website. Our opinion is not
that surgery is bad; no, we agree that surgery is a realistic
option, and maybe the only option for many men with PD. Our
caution is that there is not sufficient information given in
these websites discussing surgical failure upon which a man
can base an informed decision.
As one example, there is a long and detailed discussion about
PD from the Department of Urology, University of California
School of Medicine, San Francisco. In that discussion there is
just this one very brief sentence concerning the outcome of
surgery, “Literature review shows excellent results provided
men have realistic expectations.”(2-5) Read that quote again.
Your eye first picks up, “excellent results”, and you almost
pass over the last part, “provided men have realistic
expectations”. So, PD surgery works out very well so long as
you don’t expect too much. Think about it.
Here are a few questions to ponder a while: What does that
quote about surgical results from the University of California
School of Medicine mean, “…excellent results provided men have
realistic expectations”? If medical websites offer surgery as
the best option for PD, but very little is written about
surgical results and there are no glowing reports of surgical
outcomes, what does that mean? If the average man with PD
develops
a large scar on his penis from of an injury so small that often it
cannot be remembered, what kind of scar formation might occur
from an actual surgical cut to remove the first PD scar? These
questions are posed not to suggest that a man with PD should
not undergo surgery; they are offered to put into perspective
the need and importance of first taking care of the penile
scar with safe conservative measures, so that surgery might
possibly be
avoided. It could be a mistake for someone with PD to have a
casual and unrealistic attitude about surgical correction of
the PD scar. No surgery should ever be taken lightly or for
granted, let alone a man who is thinking about getting cut
in an area that has already demonstrated an excess
tendency for scar formation.
Insufficient details are provided on the internet describing
the end result of PD surgery. It is all too common for an
entire two or three page article to say nothing about actual
outcomes of penile surgery or just one sentence, as in this
Mayo Clinic commentary: “Surgery is generally effective at
restoring normal erections, although each method can cause
unwelcome side effects such as partial loss of erection or
shortening of an erect penis.” Read that sentence again: it
says that PD surgery is generally effective in fixing loss of
erections except when it causes a loss of erection, or a loss
of penis size. Our opinion is that information like this is not helpful
or informative to a degree necessary to create a realistic image
of what happens as a result of penile surgery. If all of the
information upon which a man bases his decision for PD
surgery is a clear and helpful as this information, then he is insufficiently informed.
Perhaps the National Institute of Health is more candid than
most websites by simply explaining, “Peyronie's disease has
been treated surgically with some success.”(1) Perhaps if a
man knew that surgery results in “some success” he might not
think surgery was an easy answer to his problem, and he would
think twice about doing nothing for his ailing penis. Perhaps
if a man knew exactly what “some success” meant, he would know
how to evaluate his options. But that is never
explained.
Explaining surgical methods of repair and removal of penile
scar tissue, the NIH mentions, “The second method, known as
the Nesbit procedure, causes a shortening of the erect penis.”(1)
This article does not mention that the loss is one to two inches of
penis length. This same article reports, “Most types of
surgery produce positive results. But because complications
can occur, and because many of the phenomena associated with
Peyronie's disease (for example, shortening of the penis) are
not corrected by surgery, most doctors prefer to perform
surgery only on the small number of men with curvature so
severe that it prevents sexual intercourse.” In another
commentary the NIH states, “Surgical correction may also lead
to impotence.”(6) Such a limited explanation – no percentages,
rates or comparisons – does not assist in making an informed
decision. With such a partial picture of what happens after
surgery, a man is kept from understanding what really happens
after penile surgery. Perhaps the man with PD should ponder why that information is not offered.
Many of the website discussions about surgical outcomes contain
partial answers and twisted information. A man reading these
discussions could assume surgery was a better and easier
answer than it actually is. He could believe that the best
treatment choice early in his PD was to do nothing –
wait-and-see what happens – because he could always see the
surgeon and get fixed up as good as new. Careful reading shows
this is not the case.
Since our caution to the reader suggests that surgery is not
without its own considerable risks, our opinion is that it is
wise and prudent to do all that you can to avoid being put in
a position where surgery is your only option.
Standard Medical Care
Many doctors suggest doing no treatment in the early stage of
PD, for two reasons. First, there is no drug treatment that is
proven successful in helping PD. Second, since 5-50% of the
cases get well on their own with no treatment, they prefer a
wait-and-see approach to see if the PD gets bad enough to
require surgery. Many doctors appear to be content – even satisfied with the
wait-and-see approach – when their patient develops only a
slight bend in the penis or develops only a moderate impotency
problem. From the medical discussions in many websites, these
slightly disabling outcomes are considered to be an acceptable
medical outcome. Read the medical website reports and
discussions to understand where the medical thinking is coming
from. The attitude that is so prevalent is this: PD is only a
serious problem if it is bad enough to require surgery; if it
doesn’t need surgery, it’s just an inconvenience. With that
attitude, it is no wonder not much progress has made in
finding a cure for PD, or that there is not more effort made
to extend help to a man with this problem.
PDI does not consider peeing on your foot the rest of your
life because your penis is bent like a cane as a satisfactory outcome or
an inconvenience; it’s a tragedy. Even if there is no perfect
answer, and only spotty research to support a cure,
PDI’s
opinion is to use the best of what is available while the jury
is out looking for the truth about PD. If what you do makes a
difference in your health, look what you have gained; if it
does not help, at least you did your best, and you cannot feel
bad about trying. For more discussion along this line, please
click on Russian Roulette.
So,
What Do You Do?
All of the above is not presented to say PD surgery is bad, or
to scare men away from it. The intent is to put things into
perspective. It is the opinion of the doctors of
PDI that to
play a “wait-and-see game” while there are many viable and
potentially beneficial ways to assist your tissue repair, just
because surgery is an option, sounds ludicrous. It seems as
though most websites whitewash the whole surgery option,
downplaying what really happens post-surgically. Because there
are no easy answers to PD – especially surgical –
PDI
encourages any man with PD to do all he can to make the
surgical option unnecessary.
The current situation leaves the man with PD with a few
options:
1. Wait on the sidelines while the drug companies research,
discover and patent a wonder drug.
2. Wait on the sidelines while the scientists figure out how
to conduct a valid study to verify the substances they think
might be helpful, but currently are “unproven”. Isn’t it
strange they can perform these studies very well when a new
wonder drug is involved, but can’t do the tests correctly for
vitamin E?
3. Wait on the sidelines until you need surgery, then hope
for the best.
4. Use several of the many safe and researched vitamins,
enzymes, herbs, and other substances that receive reports of
variable success for PD from around the world for PD, or for problems
similar to PD. Take advantage of the power of synergy to do
all that you can to increase your healing capacity to correct
your PD.
The latter choice, using a few of the alternative methods of
complimentary medicine that are not mainstream, is really not
such a strange gamble as some may think. Go to our section,
PDI Treatment Plan, to read about the many alternative and
complimentary PD treatment methods suggested by the doctors of
PDI. You might find a few things to consider doing for
yourself that will make sense to you and will empower you.
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1. NIH Publication
No. 04-3902 – December 2003
2. Carson CC: Penile prosthesis implantation in the treatment
of Peyronie’s disease. Int J Impot Res, 10: 125-128, 1998.
3. Pryor J: The Management of Peyronie’s Disease. In: Porst H
(ed.). Penile Disorders. Berlin, Springer-Verlang, pp. 35-56,
1997.
4. Eigner EB, Kabalin JN, Kessler R: Penile implants in the
treatment of Peyronie’s disease. J Urol, 145: 69-71, 1991.
5. Montague DK, Angermeier KW, Lakin MM, Ingleright BJ: AMS
3-piece inflatable penile prosthesis implantation in men with
Peyronie’s disease: comparison of CX and Ultrex cylinders. J
Urol, 156: 1633-1635, 1996.
6. U.S. National Library of Medicine, National Institute of
Health Updated by: Young Kang, M.D., Department of Urology,
Columbia University College of Physicians and Surgeons, New
York, NY. – 5-25-02
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