Role of Traction Devices in Treating Peyronie's Disease
Penile traction therapy (PTT) devices can be effective for treating Peyronie's disease by reducing curvature, increasing penile length, and potentially avoiding the need for more invasive treatments. 1, 2
Mechanism and Efficacy
Penile traction therapy works through mechanotransduction, applying controlled stretching forces to the penis that:
- Reduces curvature by 11.7-20° (compared to 1.3° increase in controls) 1, 3
- Increases penile length by 1.5-2.3 cm 1, 3
- Improves erectile function in men with concurrent ED 1
- May lead to disappearance of sonographic plaques in up to 48% of patients 2
Clinical Applications
Acute Phase Management
- PTT can be used during the active/acute phase of Peyronie's disease 2
- Benefits include:
Stable Disease Management
- Most effective when the disease has stabilized (typically 3-6 months with unchanged symptoms) 4
- Can be used as:
- Monotherapy for mild to moderate curvature
- Adjunctive therapy alongside other treatments
- Pre-surgical therapy to potentially reduce surgical complexity 2
Treatment Protocol
- Newer devices like RestoreX require only 30-90 minutes of daily use (compared to 3-8 hours with older devices) 1, 3
- Treatment duration of 3-6 months shows optimal results 1, 3
- Counter-bending and visual indicators improve efficacy 1
Surgical Impact
PTT may reduce the need for surgery in 40% of surgical candidates and can simplify surgical procedures (from grafting to plication) in approximately 33% of cases 2
Patient Selection
PTT is most appropriate for:
- Patients with curvature ≥30° 1, 5
- Those seeking non-invasive treatment options
- Patients concerned about penile shortening (common with surgical approaches) 4
- Men with complex curvatures, hourglass deformities, or calcified plaques (not exclusion criteria) 1
Limitations and Considerations
- Requires consistent daily use for optimal results
- Temporary side effects may include mild erythema and discomfort that typically resolve within minutes 3
- May not be sufficient as monotherapy for severe curvature (>90°) 4
- Should be considered within a treatment algorithm that may include other options such as intralesional collagenase clostridium histolyticum for appropriate candidates 4, 6
Comparative Efficacy
In studies where patients had previously used other PTT devices, 100% preferred newer devices like RestoreX, suggesting better tolerability and compliance 1, 3
PTT represents a valuable non-surgical option in the management of Peyronie's disease, with evidence supporting its use for both preventing disease progression in the acute phase and improving outcomes in stable disease.