What is the role of traction devices in treating Peyronie's (Peyronie's disease) disease?

Role of Traction Devices in Treating Peyronie's Disease

Penile traction therapy (PTT) devices are not recommended as primary treatment for Peyronie's disease due to insufficient evidence supporting their efficacy, though they may have a limited role as adjunctive therapy in specific cases. 1

Current Treatment Guidelines

The American Urological Association (AUA) does not include penile traction therapy among its recommended treatments for Peyronie's disease. Instead, the AUA guidelines categorize PTT under "Other Treatments" that have insufficient evidence to support even a conditional recommendation 1.

The primary recommended treatments for Peyronie's disease include:

1. First-line therapy for stable disease with curvature 30-90°:

   • Intralesional collagenase clostridium histolyticum (Xiaflex) with modeling 2
   • Intralesional interferon α-2b as an alternative 2

2. Surgical options for stable disease:

   • Tunical plication for patients with adequate rigidity and less severe curvature 1
   • Plaque incision/excision with grafting for more severe deformities 1
   • Penile prosthesis implantation for patients with concurrent erectile dysfunction 1

Evidence on Penile Traction Therapy

Despite not being recommended in guidelines, some research suggests potential benefits:

• A 2019 randomized controlled trial using the RestoreX® device showed improvements in penile length (1.5 cm increase) and curvature reduction (-11.7 degrees) with 30-90 minutes of daily use over 3 months 3

• A 2008 pilot study using the FastSize Penile Extender demonstrated curvature reduction (average 33% reduction from 51° to 34°) and increased stretched penile length (0.5-2.0 cm) after 6 months of use for 2-8 hours daily 4

• A 2023 meta-analysis found a significant positive effect of PTT on penile curvature (p=0.0373) but no significant effect on penile length or erectile function 5

Potential Applications of Traction Therapy

While not recommended as primary therapy, PTT may have limited roles:

1. Adjunctive therapy:

   • Before penile prosthesis insertion to maximize length 6
   • After surgical correction to maintain length gains 6

2. Early/acute phase treatment:

   • May help with curvature correction in the acute phase of Peyronie's disease 7
   • Role in chronic phase remains unclear 6

Limitations and Considerations

• Time commitment: Traditional devices require 3-8 hours of daily use, which limits compliance 3

• Evidence quality: Most studies have small sample sizes and methodological limitations 5

• Patient selection: Not suitable for all patients, particularly those with severe curvature (>90°) or significant erectile dysfunction 1

• Disease stability: Treatment should only be considered after disease has stabilized (typically 12-18 months after symptom onset with stable curvature for 3-6 months) 1

Practical Approach

For patients interested in traction therapy:

1. Confirm disease stability (symptoms unchanged for at least 3 months)
2. Consider as an adjunct to other treatments, not as primary therapy
3. Set realistic expectations regarding modest improvements in curvature and length
4. Recommend newer devices that require less daily use time if considering PTT
5. Monitor for adverse events, though these are typically mild and transient

Remember that the primary recommended treatments for Peyronie's disease remain intralesional injections for appropriate candidates with stable disease, and surgical approaches for those with severe deformity or concurrent erectile dysfunction 1, 2.