Penile traction therapy: Evidence in 2014

Dr Sanjeev Bandi Mackay Urology

Background

Peyronie’s disease (PD)- more than just penile curvature alone

Current medical options limited and largely ineffective

Surgery associated with “significant and unacceptable” risks

Devices in market

More than one way …

Application and mechanism

Results of Andropenis studies The purpose of the Andropenis treatment is to stimulate growth

of the tissues of the penile shaft, obtaining the following results:

Permanent lengthening of the penis of up to 4 centimeters (1.6

inches) in erection.

Also up to 4 centimeters (1.6 inches) in flaccid state.

And a thickening of up to 1.5 centimeters (0.6 inch) in girth.

The device is worn in a flaccid state for a period of either 4 or 9

hours a day obtaining an accumulative penile enhancement of

0.5 cm (0.2 inch) per month. It should be worn for a period of 4-6

months depending on the growth desired. The results gained are

permanent .

What is the evidence?

In-vivo study Mechanical traction and tissue expansion therapy

results in alteration of connective tissue by cellular proliferation and expansion of ECM

Changes in collagen ultrastructure with an increase in metalloproteinases-8 (MMP-8) expression in cell-culture strain system of PD cells

Alenghat and Ingber. Sci STKE 2002:PE6

Chung et al. J Sex Med 2013;10(5):1259-67

Human trials …

PD and small penis Increase in penile length (up to 1-4 cm) and

improvement in erect penile curvature (up to 40°)

Improvement in erectile function (↑ in IIEF scores by at least 4 points)

Minimum 4-6 hours daily use

Greater improvement if use with combination therapy for PD men

VED associated with increased penile length (up to 1cm) and improved curvature (5-25°) too

Gontero et al. J Sex Med. 2009;6:558-566

Abern and Levine. J Sex Med. 2012;9(1):288-295

Levine and Rybak. J Sex Med. 2011;8:2112-2117

Raheem et al. BJU Int. 2010;106:1178-80

Current issues with PTT

Patient demographics

Patient self-motivation and compliance

Stages and types of PD

PD vs small penis men

Types of PTT devices

Amount of traction required

Unidirectional vs multidirectional (VED) traction

Role of combination therapy

Eric Chung and Gerald Brock: Penile traction therapy and Peyronie’s

disease: a state of art review of the current literature Ther Adv in Urology

Feb 2013;5(1):59-65

Ideal patient characteristics

Men with acute phase of PD or short penises

Greater erect penile curvature

Absence of calcified Peyronie’s plaque

Acceptable penile girth or absence of hour-glass deformity

Normal erectile function

Highly motivated and compliant use

Concurrent multimodal treatment strategy

Eric Chung and Gerald Brock: Penile traction therapy and Peyronie’s disease: a state

of art review of the current literature Ther Adv in Urology Feb 2013;5(1):59-65