Peter L. Scardino

THE USE OF TOCOPHEROLS IN THE TREATMENT OF PEYRONIE'S DISEASE

Since reporting a new concept in the treatment of Peyronie’s disease in November 1947,‘ the authors have continued to treat chronic cavernositis with tocopherols with encouraging effectiveness. The original group of 2 3 cases has been reviewed and is reported as a follow-up study. In addition, 10 new cases, similarly treated and not previously reported, are presented. Peyronie’s disease is, pathologically, a fibrous replacement of the intercavernous septum of the penis. The fibrosis may extend into Ruck’s fascia and the tunica albugenea on either side of the septum and result in the formation of plaques. Involvement of the corpus spongiosum does not occur. Formation of the plaques frequently results in penile curvature and painful erections, making sexual intercourse difficult or impossible. Previous reports2, 3 , * of the efficacy of the tocopherols in the treatment of various forms of fibrositis suggested to Scott the use of tocopherols in Peyronie’s disease, also a form of primary fibrositis. In January, 1947, the authors began the administration of the tocopherols to patients with Peyronie’s disease. During the ensuing 10 months, 23 patients were treated with 300 milligrams of mixed tocopherols or 200 mg. of synthetic alphatocopherols, without toxic manifestations. The incidence of symptoms and signs before treatment in the first group of 23 cases of Peyronie’s disease is presented in TABLE 1. From inspection of this table it is apparent that the most common symptom was penile curvature. Painful erections occurred in twelve cases, with loss of libido in four cases and loss of potentia in sixteen. Dupuytren’s contracture was present in six cases, and penile plaques were found in all but one patient. Most of the patients noted the onset of the disease during the fifth decade. Inspection of this table reveals that a complete disappearance of curvature occurred in four cases, with some change in all but five of the patients. Pain disappeared in all cases, arid sexual intercourse became normal for ten. Change was noted in the palmar contracture of four of the cases, with marked improvement in one. Objective evidence of response to therapy was measured by the change in penile plaques. In this group, all but two patients showed changes in the size, shape, and consistency of the penile plaques. A follow-up study of these twenty-three palients was undertaken to cletermine their status a t the t h e of the present report. Two particular aspects of the problem were investigated : (a) treatment required to obtain response; and (b) recurrence of signs and symptoms after cessation of therapy. Subjective response, i .e . , relief of pain, was the first symptom notably affected by the drug. Three hundred mg. of mixed tocopherols elicited a change in over 60 per cent of the patients within 30-60 days after therapy

Penile prosthesis for impotence: case report.

Abstract Encouraged with the results of the implantation of acrylic in the laboratory animal and the serendipity of acrylic as a substitute for the male urethra, we surgically implanted an acrylic penile prosthesis that was designed in 1949 in a patient suffering from organic impotency.

TOCOPHEROL THERAPY OF URETHRAL STRICTURES–A PRELIMINARY REPORT

Favorable therapeutic results have been obtained from the administration of alpha-tocopherol for a number of clinical diseases.’, 2 * Prominent in the field of urology is the recent use of tocopherols for Peyronie’s Disease. Scott and Scardino have demonstrated that certain patients who have this disease respond favorably in that both the distressing symptoms and the primary fibrositis can be alleviated? The methods and agents which are available for the treatment of urethral strictures are, in essence, those which have been used for more than fifty years. Dilatation with flexible or rigid instruments, internal urethrotomy, open surgical excision-these and other similar procedures are the ones most commonly relied upon for the maintenance of an adequate channel, once a stricture of the urethra has developed. The inadequacy of such measures is too well appreciated to require comment. Effective medicinal measures, except for those directed toward control of urinary tract infection, have not previously been developed. It has seemed reasonable to assume that tocopherols might resolve the scarring of secondary fibrositis. Urethral strictures represent such a fibrositis. We have had two years’ experience with treating urethral strictures with mixed tocopherols and believe that the results warrant a brief review of our observations.

On the incidence of calcified uterine fibroids

Abstract Five instances of extensive calcification of uterine fibroids were found in over 4,000 abdominal x-ray examinations in the course of urological study. All except one of the patients were over 50 years of age. In 4 women, bladder symptoms were prominent; all had varying degrees of lower abdominal discomfort. Calcification within fibromyomas of the uterus is an apparently innocuous phenomenon, per se, but can produce dramatic pressure effects upon near-by structures.