COMPARATIVE STUDY OF ORAL AND INTRALESIONAL VERAPAMIL IN PEYRONIE’S DISEASE

BACKGROUND \nTreatment of Peyronie's disease is a dilemma for the treating urologist. Part of this problem is due to an incomplete \nunderstanding of the aetiopathophysiology of the disease. Multiple nonsurgical treatment are available for Peyronie’s Disease \n(PD) including calcium channel blocker verapamil, both oral and intraplaque injectable. The use of verapamil is based on its \ncapacity to alter fibroblast function and promote collagen degradation. As a result, calcium channel antagonists may have the \ncapacity to slow, prevent or even reverse plaque formation. There are many studies suggesting benefits of intraplaque verapamil \ninjection. In our study, we aim to compare the outcomes of oral versus intraplaque verapamil injection in terms of pain reduction, \ndecrease in curvature and improved sexual function. \nMATERIALS AND METHODS \nIn this randomised study, 20 patients were randomly divided into 2 groups of 10 patients each (Group I patients were treated \nwith oral verapamil and group II patients were treated with intraplaque verapamil injection). Results from both the groups were \ncompared and interpreted in terms of change in plaque size, curvature, erectile function and pain. Size of plaque was assessed \nwith the help of color Doppler in pre and post-treatment period. All the 20 patients were followed for 3 years after completion \nof treatment. None of the 20 patients lost to follow up. \nRESULTS \n30% of group I patients (oral verapamil) showed decreased plaque volume. Softening of plaque was noted in only 60% of the \npatients. Subjective erectile dysfunction improved in only 40% of the patients. In group, II patients who received intraplaque \nverapamil injection, 70% showed decreased plaque volume with improvement in penile curvature. There was softening of the \nplaque in all the patients in group II. Subjective erectile dysfunction improved in 60% of the patients. No local or systemic \ntoxicity was noted except mild ecchymosis in 2 patients of group II. \nCONCLUSION \nThis study concludes that intraplaque verapamil injection is more effective and reasonable option than oral verapamil in \nnonsurgical patients of Peyronie’s disease. Maximum benefits are seen up to 3 months of treatment.