File
Milios J.E.1, Ackland T.1, Adams S.2, Kaard A.3, Green D.1,4
1University of Western Australia, Perth, Australia, 2Integrated Sexual Health, Perth, Australia, 3SKG Hollywood Radiology, Radiology, Perth, Australia, 4Reseach Institute for Sport and Exercise Science, Liverpool, United Kingdom
Background: Peyronies Disease (PD) is a debilitating condition characterised by penile pain, curvature and deformity, palpable plaque formation and erectile dysfunction in men. Aetiology may be variable but is generally linked to trauma affecting the penis, causing local inflammation, inelastic scar tissue development and fibrosis of the tunica albuginea, leading to altered appearance and sexual dysfunction. Studies have shown that PD occurs in 1-4% of the normal population and up to 19% of men following treatment for prostate cancer. This can greatly impact on male self esteem leading to relationship issues, psychological distress and the development of depression. Due to a large clinical presentation of PD following radical prostatectomy, the author felt obligated to investigate further. Physiotherapists have utilised therapeutic ultrasound (TPU) since the 1940s to assist in tissue healing and scar tissue breakdown and it was hypothesised that PD may also benefit from this treatment approach. Three cases of PD using TPU were investigated, a first for physiotherapy.
Purpose: PD is a common condition that has had limited options for treatment. Currently, despite extensive investigation over many years and across many medical disciplines, effective non-invasive options remain elusive. Only one previous study has investigated the use of TPU in PD and results were encouraging. Surgical correction remains the gold standard but typically results in further penile shortening and scar tissue development.
Methods: All participants provided written consent and underwent Penile Doppler Ultrasound (PDU) to confirm the diagnosis of PD and to measure penile length, by an expert radiologist blinded to the subsequent physiotherapy intervention. Participants then completed the Peyronies Disease Questionare (PDQ) and International Index of Erectile Dysfunction scoresheet (IIEF-5). At a rate of three sessions/week x4 weeks, 12 doses of TPU were provided, using a 3MHz ultrasound probe x10 mins / session, at 1.5-2.5w/cm2 applied directly to the penile tissues. Upon completion, a second PDU was performed and the PDQ and IIEF-5 repeated.
Results: Analysis of PDU results confirmed complete resolution of PD or significant improvement in penile length and reduced plaque size in n=3. Subjective PDQ and IIEF-5 questionaires indicated significant reduction in penile curvature, improved sexual function and increased self esteem. As a result ,a random controlled trial is now under way with a cohort of 40 men with PD proposed.
Conclusion(s): TPU has not been used for PD in a Physiotherapy setting before. The widespread and effective use of TPU in soft tissue injury management generally, provided impetus to explore its use for an increasing clinical population seen in a Men´s Health practice. All three cases investigated in this series demonstrated significant improvement in both subjective and objective outcomes, prompting the design and approval of further research.
Implications: Men´s Health is a new frontier in Physiotherapy and will be launched at WCPT17. All physiotherapists already have the necessary skills to provide therapeutic ultrasound to soft tissue injuries. Given the expected rise in obesity, erectile dysfunction and prostate cancer, global presentation of PD is likely to increase.This research provides clinical evidence to further enhance the role of Men´s Health Physiotherapy globally.
Funding acknowledgements: Professor Green´s research is supported by the Australian Research Council (ARC): Grant DP130103793
Topic: Women's & mens pelvic health
Ethics approval: All studies were approved by the University of Western Australia´s Human Research Ethics Committee and the participants provided written consent.
All authors, affiliations and abstracts have been published as submitted.
