AOFAS 1999 ANNUAL SUMMER MEETING
Surgical Treatment of Painful Plantar Fibromatosis

G. James Sammarco, M.D.; Peter G. Mangone, M.D.

PURPOSE: We examined the use of intraplaque injection of verapamil for the treatment of Peyronie's disease through its effects on pain, curvature, indentation, sexual function and erectile capacity.

MATERIALS AND METHODS: A total of 156 men underwent treatment with intraplaque verapamil injection. Patients were assessed objectively, during dynamic penile duplex ultrasound, as well as subjectively using a questionnaire before and after initiation of the treatment protocol. Patients were also stratified by duration of disease before therapy and into 1 of 3 Kelami classification groups based on pretreatment plaque size and severity of curvature. Differences before and after treatment and among the Kelami classification groups were assessed.

RESULTS: Of the 140 patients who completed treatment 73 (60%) had an objectively measured decrease in curvature while 79 (62%) reported a subjective decrease in curvature during the follow-up interview. After treatment 111 (83%) men reported an increase in girth, 107 (80%) an increase in rigidity distal to the plaque and 92 (71%) an improvement in sexual function. Among each Kelami class curvature was objectively measured to decrease in 41%, 68% and 62% of patients in classes I, II and III, respectively. There was no significant difference in response based on duration of disease (60% improvement versus 61% improvement for disease duration of less or greater than 1 year in duration, respectively). Mean follow-up was 30.4 months (range 10 to 81) and there was no reported recurrence of penile deformity in those men with an initial posttreatment positive response.

CONCLUSIONS: Verapamil injection of Peyronie's plaques appears to be a clinically effective treatment option for pain and curvature and can contribute to subjective improvement in sexual function and erectile capacity. The low incidence of complications indicates that this therapy is also clinically safe.

QUICK LINKS

• DUPUYTRENS CONTRACTURE
• FROZEN SHOULDER
• LEDDERHOSE
• PEYRONIES
• TIGGER FINGER
• KELOIDS
• HYPERTROPHIC SCAR