An Important New Discovery in Peyronie's Care

ExoSurge Etiology Breakthroughs: The Most Common Penile Trauma Variations Causing Peyronie's Disease

4 Most Common Causes of Peyronie’s Disease

The Big Four Causes of Peyronie’s Disease

Once we isolated the core etiology of Peyronie’s, we discovered that like most diseases, it mirrors the 80/20 rule: 80% of all cases are born from just 20% of causes.

Based on retrospective evaluations of our treated patient histories, the following are what we believe to be the four most common sources of penile injury that trigger a Peyronies indication. There is also a list of clinical situations in which a patient is “predisposed” to end up with Peyronie’s disease with even slight microtrauma. These patients have connective tissue wound healing disorders, which are frequently inherited.

Finally, it’s worth noting that we encountered cases where these various trauma kinds occurred together. For example, a patient may have long-standing penile plaque from lifelong microtraumas, but because they haven’t yet encountered a Peyronie’s accelerator, they may not be displaying Peyronie’s symptoms.

They may, however, later suffer a direct or acute penile injury, resulting in a substantial Peyronie’s indication. Because of the changes in related plaque shape and density, the overall picture of penile plaque in such a situation requires a distinct approach as there’s now both less dense recent fibrous plaques and long established, more dense fibrosis .

#1 Cause of Peyronie's: Perpetual Microtrauma to the Penis

Years of microtrauma to the penis is by far the most common source of fibrotic plaque that causes a Peyronie’s indication. According to studies, patients with Peyronie’s disease who have no clear memory of any specific episode account for up to 75% of all Peyronie’s cases. In most of these cases, an otherwise perfectly healthy man simply awakens one morning to the sight of Peyronie’s symptoms like erect curvature, hourglasses shaped, indentions, lost length, etc.

In other similar cases, we discovered that the source wasn’t triggered from Peyronie’s Accelerators but rather the “feather principal” – where only one further tiny penile trauma tips the scales into an easily validated Peyronie’s diagnosis. 

Peyronie’s cases born from perpetual micrtrauma most often include quite dense plaques as they’ve often been established over many years. Quite often, these cases are also unique in terms of the underlying deign or matrix of the fibrosis, including:

  1. A spiderweb-like configuration within the penile tissue.
  2. A measurable thickened/swollen Tunica Albuginea 

We believe that the initial microtrauma(s) caused the penis to fibrose. As the body progressively realizes that “something is still wrong” in that region of the penis, it responds by creating additional fibroblasts in its attempt to protect the “damaged” penile organ. It is uncommon for the new fibrotic material to end up exactly where the original fibrosis occurs. Rather, it generally ends up close-by. Because of this process, we found that long established microtrauma penile plaque is often braided in design to resemble a spider web.

Based on Tunica density differences, we believe that situations of similar patient histories where the Peyronie’s indication is predominantly rooted in a thickened Tunica are similarly slow and eternal in growth. Tunica thickening can be detected in the region’s size and density. Tunica thickening can also cause every negative symptom of a traditional Peyronie’s diagnosis but without the existence of measurable fibrous plaques during ultrasonic testing, often causing a maddening diagnosis discussion between a urologist and patient

Finally, we hypothesize that most younger, healthy patients can slow the growth of fibrosis progression early on. A verifiable Peyronie’s indication, on the other hand, becomes unavoidable as the same patient ages, their health mildly deteriorates, and one or more of the ten “Peyronie’s accelerators” is finally triggered, causing the symptoms to expand suddenly and without warning.

The precise causes of these penile microtraumas are as varied as the human experience. We were able to determine this crucial origin of Peyronie’s indications by differences in the density and design of the microtrauma-type penile plaques, in conjunction with patient interviews. The differences in plaque density within the spiderweb-like plaque striations are a tell-tale sign that some of these microtraumas could probably be traced as far back as “missed ground balls” in Peewee baseball to hours of grinding against a female partner’s pelvic bone during teen years intimate exploration.

The introduction of one or more of the six Peyronie’s Accelerators can sometimes be the tipping point for a Peyronie’s indication from constant microtrauma. These accelerators impair the body’s processes to keep the formation of fibrosis at bay which often leads a Peyronie’s case to go from unnoticed to impeding sexual fulfillment from seemingly “thin air”.

These latter elements support the logic behind Peyronie’s being most common in older patients, as they’ve had a lifetime to accumulate penile microtraumas and are the most vulnerable to ending up with a Peyronie’s accelerator due to their compromised health.

During evaluation, we frequently see a combination of fibrosis, plaques, and tunica thickening, with the amount and severity of each differing by case.

Tunica thickening without fibrosis or plaques is also occasionally found, which is why we added “and/or tunica thickening” to our revised definition of Peyronie’s Disease. We believe tunica thickening will be an important factor in future studies on perennial penile microtrauma and Peyronie’s Disease

#2 Cause of Peyronie's: Acute Penile Injury

A meaningful and memorable acute injury to the penis is the second most common cause of a Peyronie’s indication. Two common types of acute penile injury include sexual injuries produced by a partner being “on top” and lowering themselves at an unpleasant angle onto the penis, and sexual injuries caused by extremely violent thrusting during intercourse that results in pain from misalignment.

Non-sexual causes of acute penile injuries include groin injuries from sports and severe impact on the penis from unforeseen incidents. One of our patients lost his footing while trekking in the Yukon and plunged into waist-deep, freezing water, causing an acute penile injury resulting in Peyronie’s disease.

According to our observations, acute penile injury Peyronie’s plaque appears as a “big glob” of penile plaque as commonly referenced within existing Peyronie’s medical photos.

#3 Cause of Peyronie's: Healthcare Related Penile Injuries

No aspect of healthcare is designed to hurt or injure a patient. However, our research reveals that the number of men ending up with a Peyronie’s diagnosis as a byproduct of a medical procedure is perhaps more common than many realize.

Medical procedures[23] that produce penile damage can result in a Peyronie’s diagnosis. This type of Peyronie’s Disease most commonly occurs when a urinary catheter or other bladder control treatment is utilized while under anesthesia. On rare occasions, a nurse may inadvertently inflate a catheter in the urethra rather than the bladder, resulting in injury. Furthermore, because they were born with a small urethra, certain patients are predisposed to experiencing penile injury from catheterization.

In certain patients, a catheter implanted to protect the penis while receiving particular cancer therapies developed Peyronie’s triggering plaque. Another common medical cause of penile injury is a prostatectomy. While a radical prostatectomy typically results in more harm, some patients who undergo a robotic prostatectomy experience a fibrotic reaction.

[23] Tal R, Heck M, Teloken P, et al. Peyronie’s disease following radical prostatectomy: incidence and predictors. J Sex Med 2010;7:1254-61

# 4 Cause of Peyronie's: PGE Injections

We uncovered another less commonly recognized source of recurrent penile microtrauma within urology: long-term intravenous injection of Alprostadil (PGE) to treat erectile dysfunction.

Despite the fact that long-term PGE use is recommended as reasonably safe by standards of care, we continue to see patients with intracorporeal fibrosis caused by continuous needle injection of PGE medicine.

Intracorporeal plaque (Peyronie’s plaques within the corpora) is a relatively rare type of the disease unless the patient receives PGE injections.

In 2018, we began a study where all new erectile dysfunction patients who contacted our clinic for therapy and had a history of PGE injections were submitted to duplex Doppler ultrasonography testing. We identified intracorporeal fibrosis in 56.2% of ED patients who had PGE injections on a regular basis for more than two years using ultrasound analysis of the areas for injection sites. Although less than one third exhibited any sypmtoms at the time of the ultrasound testing, we now understand that rising factors from one or more Peyronie’s Accelerators will eventually result in all those patients ending up with a Peyronie’s diagnosis.

Based on this discovery, we created a new protocol in which all PGE injection patients, new and old, receive a single ExoSurge® treatment every sixty days if they’re using PGE for ED. There is no evidence of fibrotic buildup in any of these patients after PGE injections as confirmed from ultreasonic testing.

Etiology Breakthroughs: Crucial Peyronie’s case management insights

Peyronie’s Accelerators

How is it that a man awakens and notices his morning erection is now noticeably curved when it was perfectly straight the night before?

What causes a constant micro trauma case with no symptoms to suddenly develop into a full-blown Peyronie’s disease with palpable plaque and obvious curvature?

The scenario is set for an extended Peyronie’s case when a patient with a history of persistent microtrauma collides with one or more “Peyronie’s Accelerators” that practically every man eventually experiences with aging.

We discovered that a PD indication can suddenly become evident and problematic when one or more of these accelerators are introduced to a long-standing instance of constant microtrauma that has never previously displayed symptoms.

Peyronie’s Accelerators, as their name suggests, exacerbate a PD case. Peyronie’s accelerators make it harder to achieve meaningful plaque reduction even with our ground-breaking ExoSurge® technology if the patient doesn’t adhere to our instructions to hit and maintain the targeted metrics for each Accelerator.

We’ve identified six distinct Peyronie’s accelerators at this point in the development of our technology. We’re not able to share the details of these conditions and at what levels they must be optimized to repair a Peyronie’s case as they’re still a hidden aspect of our intellectual property.

Earlier Peyronie’s penile fibrosis that never truly “went away”

How many men have heard this: do nothing after a penile injury since it goes away on its own in 13% of cases. We believed this common precept for years as a building block of our curative solution.

We now strongly believe this presumption might not be entirely true. To put it another way, we think some healthy boys can occasionally overcome the symptoms of a Peyronie’s diagnosis, but we doubt that the injury that caused the symptoms would fully recover during that process.

Three patients who were under our care had previously experienced a penile injury, and they remembered experiencing palpable fibrosis and an erect penile curvature before the problem resolved on its own. Take a step forward more than 20 years despite deteriorating health inputs. The bending and tangible stiffness came back. We can only speculate as to whether that is what happens because no urologist has undertaken duplex Doppler testing to obtain images of the area where the plaque “went away.”

We think it’s feasible that the fibrosis gets better, but the underlying issue from the initial damage still exists and frequently gets worse if Peyronie’s accelerators start working as a result of aging, etc.

The present AUA standards of care for PD recommend a “hands off” approach to an early stage Peyronie’s indication as it might simply “go away” on its own. We theorize that assumption might not be 100% correct. In other words, we believe the symptoms of a Peyronie’s diagnosis can sometimes be overcome be overcome by select healthy males, however we question whether the injury that triggered the symptoms completely heals during that process.

We noted three patients under our care that suffered an earlier penile injury, recalled having palpable fibrosis and erect penile curvature and the condition went away on its own. Fast forward over twenty years in the face of declining health inputs. The curvature and palpable firmness returned. In the absence of a urologist having performed duplex Doppler testing to gather imagery of the area where the plaque “went away” we can only theorize about if that is what occurs.

We believe it’s possible the fibrosis improves but the core basis from the original injury remains and often becomes worse once one or more “Peyronie’s accelerators” kick-in over time.

Hereditary predisposition for Peyronie’s Disease

Select “predisposed for Peyronie’s” characteristics virtually invariably result in a PD diagnosis for a patient. Such predispositions turn what for the ordinary male would be a little microtrauma into a full-blown penile injury case with an accompanying severe fibrotic plaque response.

Most are tied to hereditary diagnosis related to wound healing disorders. We sometimes compare men that fall into these categories are the “hemophiliacs of Peyronie’s because even routine sex and manual masturbation are sometimes enough to trigger the formation of penile fibrosis.

Examples of Peyronie’s predisposition conditions include Dupuytren’s contractures, tympanosclerosis, connective tissue disorders, and Marfan syndrome.

Although they cannot develop Peyronie’s as quickly as men with the symptoms mentioned above, males with a congenital curvature can be also categorized as a subpopulation of men who are predisposed to the disease.

According to our estimates, a man with a congenital curvature has about twice the risk of getting hurt during sexual activity.

The 10 Variations in Peyronie’s Penile Plaque

Historically, Peyronie’s plaque was categorized into two states: calcified and uncalcified. Our research unearthed basic ten distinctive forms of penile fibrosis and plaque linked with Peyronie’s disease; and each demands a modified approach when it comes to penile plaque removal. It’s worth noting that in many cases, a patient will have more than one of these major forms of plaque at the same time. Also, we discovered cases where calcified plaques were imbedded within fibrous plaques, only becoming obvious after the fibrous outer shells were dissolved. 

After all our intellectual property projects are completed in accordance with our new partnership with a large pharmaceutical collaborator, we will publish more details about these unique Peyronie’s plaque variances and how each is best treated. It’s one of the most exciting aspects of our discoveries with the etiology of Peyronie’s Disease.

Our philosophy

Our clinic is focused on finding a cure for Peyronie’s Disease. After more than two decades of research and development, we’ve achieved many major milestones in pursuit of our purpose, including:

  1. We identified the underlying epidemiology of Peyronie’s.
  2. Our research identified six Peyronie’s Accelerators that need to be regulated and optimized to treat the disease.
  3. Our patented therapeutic uses pulsated gas injections to penetrate Peyronie’s fibrous plaques, allowing medications to breakdown fibrosis without surgery.
  4. Our new therapy algorithm takes into account all variables of a Peyronie’s case, such as plaque size, density, and position, as well as health factor rating and the state of each Peyronie’s Accelerator. This will assist future clinicians in treating cases.

Earlier in our Peyronie’s technology development, we were unable to restore the original size of the penis following the removal of Peyronie’s plaques, therefore we developed unique approaches for cosmetic urology (penis augmentation). Since then, we’ve learned ways to restore lost size from Peyronie’s during therapeutic treatments, but our cosmetic urology platform, led by renowned reconstructive urologist Kenneth J. Carney, MD, PHARM, FACS, has been highly successful.  Our cosmetic platform has provided the principal funding for our Peyronie’s research.

We are now developing technology to accelerate the progression of obstinate Peyronie’s cases using enhanced techniques and innovative medications. We have initiated negotiations to partner with a multinational pharmaceutical platform to fund our FDA approvals and help ensure the ExoSurge breakthrough is available internationally in the coming years.

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