Peyronie’s Disease is a localized fibrotic disease of the penis that results in a deformed penis, pain and often erectile dysfunction. Surveys show Peyronie’s Disease to be present in about 5% of the men. The prevalence increases with age. The actual number of affected may be underestimated because some older men never seek treatment. This paper is written to help readers gain an understanding of the use of adult stem cells for Peyronie’s Disease. We also want to help you evaluate if stem cell treatment should be an option for you or your loved one. The paper covers the following:
- What causes Peyronie’s Disease?
- What are the current medical treatment options for Peyronie’s Disease?
- What are adult stem cells?
- How adult stem cells harvested from fat?
- How are adult stem cells deployed for Peyronie’s Disease?
- How is Extracorporeal Shock Wave Therapy (ESWT) used in Peyronie’s Disease?
- What to expect after deployment of adult stem cells for Peyronie’s Disease?
Feel free to skip to sections that provide information that is helpful to you. For more information including definitions and descriptions of Peyronie’s Disease visit:
What causes Peyronie’s Disease?
The underlying cause of Peyronie’s Disease is unknown. It is believed that multiple factors have a role in the development of the fibrous area known as a plaque. Factors that are believed to have a role are genetic predisposition, local trauma and blood flow changes to the area. Some studies have found a weak association of Peyronie’s Disease with:
- Genital or lower body injuries
- Radical prostatectomy
- Paget’s disease
Early studies suggested that many plaques resolved in about a year without treatment. However, later studies have shown this to occur only about 12% of the time. The curvature worsens in the first year in 40-48% of men.
The early phase of the disease is believed to be inflammatory and is often associated with penile pain. The inflammatory phase usually resolves in around 18 months. Over 90% of men also see resolution of pain by about 18 months. Unfortunately, up to 50% of men are unable to have adequate sexual function even after the pain resolves. For more on the cause of Peyronie’s Disease see:
What are the current medical treatment options for Peyronie’s Disease?
Current strategy for treating Peyronie’s Disease is rapidly evolving. Most experts believe that early intervention using medications is likely to be more effective than waiting until the disease has stabilized. Commonly used treatment options are:
- Pentoxifylline (brand name: TRENtal). This is an oral drug that blocks the effect of a destructive growth factor (click here to learn more about growth factors) that is present in the forming plaque in Peyronie’s Disease. Pentoxifylline effects may not be present for 4-6 months, so continuation of the drug is important even if no effects are seen. Pentoxifylline is effective when used early on, but less so with a well-established or calcified plaque.
- Other oral drugs include:
- Vitamin E
- Potassium para-aminobenzoate (aka. Potaba)
None of these drugs have been shown to be effective in good clinical trials.
Most are rarely used today.
- Injections into the plaque (intralesional therapy) is safe, well tolerated and has been shown to work in several studies. Medications used include:
- Interferon alpha-2b
All of these treatments have been effective in some patients.
Recommendations vary widely as to how to best use these treatments.
- Topical treatments. Many creams and lotions have been tried, none have been shown to be consistently effective.
- Penile traction. This technique stretches the flaccid penis and is usually used with medications. Early studies show traction to be effective in many patients.
- Surgery. Several different techniques can be used. One small study showed a patient satisfaction rate of 86%.
If you are a man who is doing well with one of more of these options, this might not be the right time to consider adult stem cell treatment. If you have not responded or you do not like the options available to you, adult stem cell therapy is an option you may wish to consider.
What is an adult stem cell?
There are several types of stem cells. Stem cells can be form embryos, newborn umbilical cord blood or adult cell sources. Adult stem cells get their name because they come from the cells of adult individuals. All stem cells, regardless of source have two important characteristics:
- The ability to replicate or make new copies of themselves. Theoretically, an infinite number of cells can be made from a single stem cell.
- The ability to become other types of cell our bodies require. We know that fat derived stem cells can become skin, bone cells, cartilage or muscle. The cell that becomes a new type can then theoretically make an infinite number of copies of the new type of cell.
Stem cells obtained from mature adult tissues are referred to as adult stem cells. Adult stem cells have the potential to become any type of cell. The most widely available sources of stem cells in adults are fat and bone marrow.
We refer to adult stem cells obtained from fat as adipose derived adult stem cells. Adipose derived adult stem cells (stem cells from fat) exist in larger numbers and are generally easier to obtain than bone marrow derived adult stem cells. Read more about stem cells.
How are adult stem cells harvested from fat?
Harvesting adult stem cells from fat is a fairly simple, office based procedure. It is done in the doctor’s office while you are awake. The harvest usually takes about 30 minutes. First we pick an area like the stomach or thigh from which to harvest the fat. We sterilized and inject a local anesthetic solution into the harvest area. Using a special syringe and cannula, we suction 50 ml (about 1 1.2 oz.) of fat.
Afterwards, some swelling and/or bruising is common. The swelling and bruising typically resolves after 2-3 weeks. Applying ice to the harvest area for the first few days after the procedure reduces any swelling and bruising. Patients are provided with a prescription for pain medications for use if needed. Antibiotics are given prior to the harvesting procedure. No further antibiotics are needed afterwards.
Following the harvest we process the fat to obtain the stem cells. Processing takes 1-2 hours. We refer to the final product as Stromal Vascular Fraction (SVF). Typically, 50 ml of fat will yield 10- 25 million stem cells. SVF also contains a large amount of growth factors. Growth factors are the chemical messengers our cells use to communicate with each other. The combination of adult stem cells and growth factors appears to be important in the effectiveness of SVF for many conditions. The final step is to deploy the SVF for your Peyronie’s Disease. SVF is also being used for many other disorders. The Cell Surgical Network has investigational protocols available for a large number of disorders. Read more about the harvesting process.
How are adult stem cells deployed for Peyronie’s Disease?
We refer to using the adult stem cells/SVF (Stromal Vascular Fraction) as deployment. The typical deployment for Peyronie’s Disease is into the shaft of the penis using a small needle. We do some special treatments to the penis using a device called Extracorporeal Shock Wave Therapy (ESWT) (see ESWT below). We begin with an ESWT treatment. After 2-3 days we do another ESWT treatment and harvest and deploy the SVF. The SVF is deployed into the shaft of the penis using a needle. First we numb the penis, and then we deploy the SVF into the area of the Peyronie’s plaque. Some work is done to disrupt the plaque during the injections of SVF. Finally, after 2-3 more days a third ESWT treatment is performed.
How is Extracorporeal Shock Wave Therapy (ESWT) used in Erectile Dysfunction?
Extracorporeal Shock Wave Therapy (ESWT) devices are used widely for the treatment of kidney stones. These devices focus shock waves to the area of the stones and break them apart. The devices used for kidney stones are very large. Smaller versions of ESWT are used for cellulite on women’s legs, orthopedic injuries, and scar improvement. ESWT treatments have been successfully used for erectile dysfunction and Peyronie’s Disease without the deployment of adult stem cells/SVF. Most patients say the treatment is most similar to a deep massage.
For Peyronie’s disease we give three ESWT treatments about 2-3 days apart. On the day of the second treatment we deploy the adult stem cells/SVF as described above. This combination of adult stem cell/SVF deployment and ESWT treatment is our advanced protocol for Peyronie’s disease.
What results can I expect from adult stem cells for Peyronie’s Disease
Although the early results using adult stem cells/SVF and ESWT are very promising, insufficient numbers of patients have been treated to give a definitive answer to this question. The Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder including Peyronie’s Disease. Fortunately, we do have enough experience to talk about early trends in therapy. Numbers are small, but so far every patient treated has seen an improvement in erectile function and a reduction in penile curvature. It is likely that many patients will desire a repeat round of ESWT and adult stem cell/SVF deployment about 6-12 months after the initial deployment. We do not yet know the percentage of patients that will undergo a second round. We define a satisfied patient as a patient that is happy they had the procedure and would do so again. Using those criteria, so far all the patients reported to the network have been satisfied.
We hope we have answered the majority of your questions. If you have other questions or wish to schedule a consultation please call: 214-420-7970.