Method for treating Peyronie's disease

In a method of treating a patient having diffuse plaque and/or a plaque mass associated with Peyronie's disease in a penile region, a battery of tests is performed to quantify an initial state of parameters associated with Peyronie's disease in the patient. Low intensity shock wave therapy is applied to the plaque mass in the penile region, thereby softening the plaque mass and disrupting any calcification in the plaque mass. Carbon dioxide is injected into the plaque mass. The battery of tests is repeated to quantify a current state of parameters associated with Peyronie's disease in the patient and the current state is compared to the initial state. The aforementioned treatment steps are repeated until the current state differs from the initial state by at least a predetermined amount.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to treatment methods and, more specifically, to a method of treating Peyronie's disease.

2. Description of the Related Art

Peyronie's disease (also known as induratio penis plastica) is an acquired inflammatory condition of the penis often associated with penile curvature. It is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. The penile curvature of Peyronie's disease is caused by an inelastic scar, or plaque (which may include calcification), that shortens the involved aspect of the tunica albuginea of the corpora cavernosa during erection.

If left untreated, Peyronie's disease may cause fibrotic, nonexpansile thickening of relatively discrete areas of the corpora tunica, typically resulting in focal bend, pain or other functional or structural abnormalities of the erect penis. Surgery has the disadvantage of being expensive and occasionally resulting in unwanted complications. Several medical treatments have been applied, but results so far have been limited. Surgical treatments have been used to treat Peyronie's disease. Collagenaseclostridium histolyticum(marketed as Xiaflex), an injectable drug, is the most common medical treatment of Peyronie's disease. It is believed that this works by breaking down the excess collagen in the penis that causes Peyronie's disease. This drug has limited success, it can be quite expensive and has significant unwanted complications.

Therefore, there is a need for a reliable and inexpensive non-surgical treatment for Peyronie's disease.

SUMMARY OF THE INVENTION

The disadvantages of the prior art are overcome by the present invention which, in one aspect, is a method of treating a patient having diffuse plaque and/or a plaque mass associated with Peyronie's disease in a penile region, in which a battery of tests is performed to quantify an initial state of parameters associated with Peyronie's disease in the patient. Low intensity shock wave therapy is applied to the plaque mass in the penile region, thereby softening the plaque mass and disrupting any calcification in the plaque mass. Carbon dioxide is injected into the plaque mass. The battery of tests is repeated to quantify a current state of parameters associated with Peyronie's disease in the patient and the current state is compared to the initial state. The aforementioned treatment steps are repeated until the current state differs from the initial state by at least a predetermined amount.

In another aspect, the invention is a treatment method for a patient having a plaque mass associated with Peyronie's disease in a penile region, in which a battery of tests is performed to quantify an initial state of parameters associated with Peyronie's disease in the patient. Low intensity shock wave therapy is applied to a plaque mass in the penile region for about thirteen treatments over a period of seven to eight weeks, including a two week break period of no low intensity shock wave treatment, thereby softening the plaque and disrupting calcification in the plaque mass. A plurality of doses of about 160 cc of carbon dioxide per dose is injected into the plaque mass for a total of about 960 cc. A counter-pulsation treatment is applied approximately twice per week during a period of approximately ten weeks to the patient concurrently with the step of applying low intensity shock wave therapy to further disrupt calcification in the plaque mass. A therapeutically effective dose of Verapamil is injected into a dorsal area of the penis before the step of applying low intensity shock wave therapy to the plaque mass as the calcified plaque dictates. The battery of tests is repeated to quantify a current state of parameters associated with Peyronie's disease in the patient and comparing the current state to the initial state. The aforementioned steps are repeated until the current state differs from the initial state by at least a predetermined amount.

DETAILED DESCRIPTION OF THE INVENTION

A preferred embodiment of the invention is now described in detail. Referring to the drawings, like numbers indicate like parts throughout the views. Unless otherwise specifically indicated in the disclosure that follows, the drawings are not necessarily drawn to scale. As used in the description herein and throughout the claims, the following terms take the meanings explicitly associated herein, unless the context clearly dictates otherwise: the meaning of “a,” “an,” and “the” includes plural reference, the meaning of “in” includes “in” and “on.”

As shown inFIG. 1, Peyronie's disease causes curvature of the penis10as the result of a plaque mass14forming in the dorsal tunica of the penis10. It can also result from calcification of the corpus cavernosa12in the penis10. As will be shown below, the present treatment protocol includes several steps for improving blood flow through the affected area, along with injecting a therapeutically effective dose of an L-type phenylalkylamine class calcium channel blocker (such as Verapamil)102into the plaque mass14and also injecting carbon dioxide104into the plaque mass14.

In one embodiment of a treatment protocol100for Peyronie's disease, as shown inFIG. 2, comprising performing a baseline test battery110, injecting an L-type phenylalkylamine class calcium channel blocker, e.g., Verapamil, into the plaque118, applying low intensity shockwave treatment concurrently with external counter-pulsation treatment, applying carboxy treatment to the plaque116, then determining if the results of the treatment protocol is sufficient122or if the treatment steps beginning with injecting an L-type phenylalkylamine class calcium channel blocker, e.g., Verapamil, into the plaque118need to be repeated. If the results are sufficient, then maintenance treatment protocols124are followed. Thus, initial test battery is performed on the patient110in order to establish a baseline. This test battery typically includes imaging the plaque with an ultrasound imaging device, measuring blood flow in penile blood vessels of the patient with a duplex Doppler ultrasonography blood flow device and measuring pulse wave velocity in a brachial artery and an ankle artery of the patient. Circulatory blood flow velocity in the patient is tested typically with a duplex Doppler. U.S. Pat. No. 6,251,076, issued to Hovland et al., discloses one method of determining blood flow velocity in a penile artery and is incorporated herein by reference for the purpose of disclosing methods of determining blood flow velocity.

Low intensity shock wave therapy is applied to the plaque mass in the penile region112. This softens the plaque mass and disrupts calcification in the plaque mass. In doing so, low intensity shockwave (LISW) therapy is applied to the plaque mass for about thirteen treatments over a period of seven to eight weeks, including a two week break period of no low intensity shock wave treatment. In the low intensity shockwave treatment (LISW), shock waves having a minimum energy of 0.10 mJmm2 are applied with a local applicator to the penile area once per day for two or three days per week over a course of five weeks. U.S. Publication No. US-2015/0073312-A1, filed by Ein-Gal, discloses one method of low intensity shockwave treatment and is incorporated herein by reference for the purpose of disclosing low intensity shockwave treatment. In a typical treatment, about 300 pulses are applied per minute over the course of between 10 minutes and 20 minutes. The LISW treatment stimulates neovascularization and improves penile blood flow and endothelial function when applied to the corpora cavernosa.

Counter-pulsation treatment is applied twice per week during a period of at least ten weeks114, which can be done concurrently with the low intensity shock wave therapy. This further disrupts calcification in the plaque mass and improves blood flow. The course of external counter-pulsation treatment includes applying external counter-pulsation treatments to the patient for a predetermined number of days per week for a predetermined number of weeks. In applying the course of external counter-pulsation treatments, an electrocardiogram (ECG) sensing device is applied to the patient and the ECG is sensed. U.S. Pat. Nos. 7,314,478 and 7,314,478, both issued to Hui, disclose a counter-pulsation apparatus and method for controlling the apparatus and is incorporated herein by reference for the purpose of disclosing counter-pulsation methods. An inflatable cuff is applied to at least one of the patient's calf, lower thigh, upper thigh or buttocks. Typically, cuffs are applied to both of the lower thighs and to both of the upper thighs. Counter-pulsations are applied to the cuffs by inflating the cuffs to a pressure of about 300 mm Hg or 6 PSI during a diastole sensed by the ECG. Pressure is then rapidly released from the cuffs during onset of the systole, as sensed by the ECG. Counter-pulsations are performed repeatedly during a treatment sessions that last about one hour, which are performed twice per week over a course of ten weeks. (It should be noted that the term “ECP” is sometimes confused with “EECP,” which is a registered a trademark for a brand of ECP. However, the EECP brand can be employed as the type of ECP used.

Carbon dioxide is then injected into the plaque mass116, which is referred to as “carboxy therapy.” In this step, about 960 cc of carbon dioxide is injected into one or both of the corpus cavernosum, the dorsal tunica of the patient or other area of plaque mass (typically in injections of about 160 cc each, in several different locations). This is typically performed twice per week, but 48 hours apart, for twelve consecutive weeks. Typically, the carboxy therapy is performed after the low intensity shockwave treatment and the counter-pulsation treatment steps to reduce the dispersal of the carbon dioxide in the injected tissues. U.S. Pat. No. 9,132,245, issued to Mantell, discloses a carboxy therapy application and is incorporated here by reference to disclose one device and method for administering carboxy therapy. The carboxy therapy infuses carbon dioxide into the tissues, causing the body to interpret the presence of the carbon dioxide as an oxygen deficiency, which results in the production of vascular endothelial growth factors (VEGF) in the tissues. This encourages vascular growth and local reduction in fat tissue, which results in increased blood flow to the corpora cavernosa.

An L-type phenylalkylamine class calcium channel blocker, of the type known generically as “Verapamil,” is injected into a calcified plaque area of the penile area118. Typically, in this step 0.625 mg to 2.5 mg of Verapamil is injected into a dorsal tunica of the patient. About 12 Verapamil treatments are administered at a frequency of one every 14 days.

The test battery is repeated120to quantify patient treatment progress. If there has not been sufficient improvement over the baseline test, then the treatment steps are repeated122. Indicia of sufficient improvement include the observance of no plaque in the ultrasound imaging and the observance of a doubling in blood flow in the affected area. Once the desired result is achieved, the patient can return periodically for examination and maintenance treatments124if such treatments are indicated.

Alternate embodiments discussed supra for a treatment protocol for Peyronie's disease are illustrated inFIGS. 3-7.

The treatment protocol300ofFIG. 3begins with the baseline test battery110, followed by LISW treatment112which is followed by applying the carboxy treatment to the plaque116, with checking additional test results at122to see if results are sufficient. If not, the treatment steps are repeated, beginning with LISW treatment112until the test results are sufficiently improved over baseline and maintenance treatments are provided to the patient124.

Alternative treatment protocol500inFIG. 4also begins with baseline test battery100, followed by concurrent treatments of LISW and external counter-pulsation treatments115. These are followed by applying carboxy treatment116, with subsequent evaluation of results122. If insufficient compared with baseline, the steps are repeated beginning with concurrent LISW and counter-pulsation treatments115until sufficient test result improvement over baseline is achieved and maintenance treatment protocols are executed124.

Treatment protocol embodiment400ofFIG. 5begins with the baseline test battery100, followed by injection of the exemplary Verapamil into the plaque118. This injection is followed by application of LISW treatment112which is then followed by application of carboxy treatment to the plaque116, with subsequent evaluation of results122. If insufficient compared with baseline, the steps are repeated beginning with injection of the exemplary Verapamil118until sufficient test result improvement over baseline is achieved and maintenance treatments124are provided to the patient.

The methods of the present invention could also be useful in treating calcification in an individual's hand, or other extremity.

The above described embodiments, while including the preferred embodiment and the best mode of the invention known to the inventor at the time of filing, are given as illustrative examples only. It will be readily appreciated that many deviations may be made from the specific embodiments disclosed in this specification without departing from the spirit and scope of the invention. Accordingly, the scope of the invention is to be determined by the claims below rather than being limited to the specifically described embodiments above.