Use of Intralesional Verapamil to Dissolve Peyronie’s Disease Plaque: A Long-Term Single-Blind Study


      Objectives. Multiple conservative therapies for the treatment of Peyronie’s disease have been offered with variable and poor response rates. Calcium channel blockers have been shown in vitro and in vivo to inhibit secretion and synthesis of extracellular matrix, including collagen, glycosaminoglycans, and fibronectin, as well as causing increased collagenase and anti transforming growth factor-beta activity. Calcium antagonists, including verapamil, are effective in stimulating the remodeling and degradation of extracellular matrix in tissue by altering the metabolic pathways of fibroblasts. Recently, a pilot study (1994) showed preliminary promising results in treating plaque caused by Peyronie’s disease. This randomized single-blind placebo-based study (1994 to 1996) was undertaken to confirm the hypothesis.
      Methods. In this randomized single-blind study, 14 patients completed the study and were divided into two groups: the verapamil treatment group (n = 7) or the control saline group (n = 7). Verapamil or saline was injected directly into the Peyronie’s plaque once a week for 6 months. Patients were evaluated before and after treatment with duplex ultrasound to confirm the extent of the lesion and to measure volume of the plaque, and by interview and mailed questionnaire 3 months after treatment. Patients being treated with oral calcium antagonists were excluded from the study.
      Results. A decreased plaque volume was measured in 57% of the verapamil-treated men versus 28% in the control group (P <0.04). Penile curvature demonstrated an improvement trend of 37.71 ± 9.3° to 29.57 ± 7.3° in the verapamil-treated patients, but the difference was not significant (P <0.07). Plaque softening was noted in all patients treated with verapamil. There was significant objective improvement in plaque-associated penile narrowing in all patients in the verapamil group. Subjective plaque-associated erectile dysfunction (quality of erection) showed improvement in 42.87% of the verapamil group versus none in the control group (P <0.02). There was no local or systemic toxicity except for an occasional ecchymosis/bruise at the injection site. After a positive clinical response, plaque size, penile angulation, and symptoms continued to improve. Decrease in plaque size was noted in each of the responders in the first 3 months.
      Conclusions. This randomized single-blind study suggests that intralesional injection of calcium channel blocker may be a reasonable approach in some selected patients for the treatment of Peyronie’s disease with noncalcified plaque and penile angulation of less than 30°. Patients whose plaque failed to respond to intralesional verapamil therapy within 3 months or whose angulation was greater than 30° at presentation were more likely to benefit from surgery.
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      1. de la Peyronie F: Sur Quelqunes ubstacles qui’s opposent al’ ejaculation naturelle de la semanee. Mem Aca Roy Chur: 425, 1743.

        • Carson CC
        Francois Gigot de la Peyronie (1678–1747).
        Invest Urol. 1981; 19: 62-63
        • Chilton CP
        • Castle WM
        • Westwood CA
        • Pryor JP
        Factors associated in the aetiology of Peyronie’s disease.
        Br J Urol. 1982; 54: 748-750
        • Kaufman JJ
        Scand J Urol Nephrol. 1991; 138: 219
        • Smith BH
        Peyronie’s disease.
        Am J Clin Pathol. 1966; 45: 670-678
        • Nyberg Jr, LM
        • Bias WB
        • Hochberg MC
        • Walsh PC
        Identification of an inherited form of Peyronie’s disease with autosomal dominant inheritance and association with Dupuytren’s contracture and histocompatibility B7 cross-reacting antigens.
        J Urol. 1982; 128: 48-51
        • Willscher MK
        • Cwazka WF
        • Novicki DE
        The association of histocompatibility antigens of the B7 cross-reacting group with Peyronie’s disease.
        J Urol. 1979; 122: 34-35
        • Somers KD
        • Winters BA
        • Dawson DM
        • Leffell MS
        • Wright Jr, GL
        • Devine Jr, CJ
        • Gilbert DA
        • Horton CE
        Chromosome abnormalities in Peyronie’s disease.
        J Urol. 1987; 137: 672-675
        • Bias WB
        • Nyberg Jr, LM
        • Hochberg MC
        • Walsh PC
        Peyronie’s disease.
        Am J Med Genet. 1982; 12: 227-235
        • Guerneri S
        • Stioui S
        • Mantovani F
        • Austoni E
        • Simoni G
        Multiple clonal chromosome abnormalities in Peyronie’s disease.
        Cancer Genet Cytogenet. 1991; 52: 181-185
        • Devine Jr, CJ
        • Somers KD
        • Ladaga LE
        Peyronie’s disease.
        Prog Clin Biol Res. 1991; 370: 355-358
        • Hinman Jr, F
        Etiologic factors in Peyronie’s disease.
        Urol Int. 1980; 35: 407-413
        • Rompel R
        • Weidner W
        • Mueller-Eckhardt G
        HLA association of idiopathic Peyronie’s disease.
        Tissue Antigens. 1991; 38: 104-106
        • Novak GI
        • Burdina GV
        • Salomatina LA
        [Activity of free radical processes in Peyronie’s disease].
        Lab Delo. 1983; 11: 42-43
        • Ludwig G
        Evaluation of conservative therapeutic approaches to Peyronie’s disease (fibrotic induration of the penis).
        Urol Int. 1991; 47: 236-239
        • Scardino PL
        • Scott W
        The use of tocopherols in the treatment of Peyronie’s disease.
        Ann NY Acad Sci. 1949; 52: 390-396
        • Scott WW
        • Scardino PL
        A new concept in the treatment of Peyronie disease.
        South Med J. 1948; 41: 173-177
        • Hasche-Klunder R
        Treatment of Peyronie’s disease with para-aminobenzoacidic potassium (POTOBA).
        Urologe [A]. 1978; 17: 224-227
        • Oosterlinck W
        • Renders G
        Treatment of Peyronie’s disease with procarbazine.
        Br J Urol. 1975; 47: 219-220
        • Morgan RJ
        • Pryor JP
        Procarbazine (Natulan) in the treatment of Peyronie’s disease.
        Br J Urol. 1978; 50: 111-113
        • Aboulker P
        • Benassayag E
        Treatment of plastic induration of corpora cavernosa penis with procarbazine.
        J Urol Nephrol. 1970; 76: 499-503
        • Bystrom J
        Induration penis plastica.
        Scand J Urol Nephrol. 1976; 10: 21-25
        • Akkus E
        • Carrier S
        • Rehman J
        • Breza J
        • Kadioglu A
        • Lue TF
        Is colchicine effective in Peyronie’s disease?.
        Urology. 1994; 44: 291-295
        • Ralph DJ
        • Brooks MD
        • Bottazzo GF
        • Pryor JP
        The treatment of Peyronie’s disease with tamoxifen.
        Br J Urol. 1992; 70: 648-651
        • Teasley G
        Peyronie’s disease.
        J Urol. 1954; 71: 611-614
        • Gelbard MK
        • Lindner A
        • Kaufman JJ
        The use of collagenase in the treatment of Peyronie’s disease.
        J Urol. 1985; 134: 280-283
        • Hamilton RG
        • Mintz GR
        • Gelbard MK
        Humoral immune responses in Peyronie’s disease patients receiving clostridial collagenase therapy.
        J Urol. 1986; 135: 641-647
        • Gustafson H
        • Johansson B
        • Edsmyr F
        Peyronie’s disease.
        Eur Urol. 1981; 7: 346-348
        • Verges J
        • Chateau A
        New therapy for Peyronie’s disease.
        Ann Urol. 1988; 22: 143-144
        • Corominas M
        • Bas J
        • Romeu A
        • Valls A
        • Massip E
        • Gonzalez L
        • Mestre M
        • Buendia E
        Hypersensitivity reaction after orgotein (superoxide dismutase) administration.
        Allergol Immunopathol. 1990; 18: 297-299
        • Ianev V
        • Tsvetkov D
        The conservative treatment of Peyronie’s disease with orgotein.
        Khirurgiia. 1989; 42: 57-59
        • Primus G
        Orgotein in the treatment of plastic induration of the penis (Peyronie’s disease).
        Int Urol Nephrol. 1993; 25: 169-172
        • Morales A
        • Bruce AW
        The treatment of Peyronie’s disease with parathyroid hormone.
        J Urol. 1975; 114: 901-902
        • Duncan MR
        • Berman B
        • Nseyo UO
        Regulation of the proliferation and biosynthetic activities of cultured human Peyronie’s disease fibroblasts by interferons-alpha, -beta and -gamma.
        Scand J Urol Nephrol. 1991; 25: 89-94
        • Kierkegaard E
        • Nielsen B
        Peyronie’s disease treated with K-para-aminobenzoate and vitamin E.
        Ugeskr Laeg. 1979; 141: 2052-2053
        • Miller HC
        • Ardizzone J
        Peyronie disease treated with ultrasound and hydrocortisone.
        Urology. 1983; 21: 584-585
        • Levine LA
        • Merrick PF
        • Lee RC
        Intralesional verapamil injection for the treatment of Peyronie’s disease.
        J Urol. 1994; 151: 1522-1524
        • Pierce GF
        • Van de Berg J
        • Rudolph R
        • Tarpley J
        • Mustoe TA
        Platelet-derived growth factor-BB and transforming growth factor beta 1 selectively modulate glycosaminoglycans, collagen, and myofibroblasts in excisional wounds.
        Am J Pathol. 1991; 138: 629-646
        • Anafarta K
        • Beduk Y
        • Uluoglu O
        • Aydos K
        • Baltaci S
        The significance of histopathological changes of the normal tunica albuginea in Peyronie’s disease.
        Int Urol Nephrol. 1994; 26: 71-77
        • Diegelmann RF
        • Peterkofsky B
        Inhibition of collagen secretion from bone and cultured fibroblast by microtubular disruptive drugs.
        Proc Natl Acad Sci U S A. 1972; 69: 892-896
        • Ehrlich HP
        • Ross R
        • Bornstein P
        Effects of antimicrotubular agents on the secretion of collagen.
        J Cell Biol. 1974; 62: 390-405
        • Dietrich JW
        • Duffield R
        Effect of calcium antagonist verapamil on in vitro synthesis of skeleton collagen and non collagen proteins.
        Endocrinology. 1979; 105: 1168-1172
        • Aggeler J
        • Frisch SM
        • Werb Z
        Changes in cell shape correlate with collagenase gene expression in rabbit synovial fibroblasts.
        J Cell Biol. 1984; 98: 1662-1671
        • Kelly RB
        Pathways of protein secretion in eukaryotes.
        Science. 1985; 230: 25-32
        • Askey DB
        • Miller EA
        • Holguin MA
        • Lee RC
        The effect of weak electric field and verapamil on exocytosis in human fibroblast (abstract).
        J Cell Biol. 1988; 107: 336A
        • Lee RC
        • Ping JA
        Calcium antagonists retard extracellular matrix production in connective tissue equivalent.
        J Surg Res. 1990; 49: 463-466
        • Fitscha P
        • Keiler A
        • Rauscha F
        • O’Grady J
        • Sinzinger H
        The diminished extracellular matrix production induced by isradipine, a calcium channel blocker, is completely abolished by cyclooxygenase inhibition.
        Prostaglandins Leukotrienes Essential Fatty Acids. 1992; 45: 289-291
      2. Steinleitner A, Kazensky BS, and Lambert H: Calcium channel blockade prevents post surgical reformation of adenexal adhesions in rabbits. Obstet Gynecol 74: 796–788, 1989.

        • Kappas AM
        • Barsoum GH
        • Ortiz JB
        • Keighley MR
        Prevention of peritoneal adhesions in rats with verapamil, hydrocortisone sodium succinate, and phosphatidylcholine.
        Eur J Surg. 1992; 158: 33-35
        • Johnson Jr, H
        • Parham M
        • Davis E
        • Wise L
        Preliminary study of the protective effect of the calcium channel blocker, nifedipine, on adriamycin-induced tissue injury.
        J Invest Surg. 1991; 4: 313-322
        • Lee RC
        • Doong H
        • Jellema AF
        The response of burn scars to intralesional verapamil.
        Arch Surg. 1994; 129: 107-111