Speaker 1: Let's talk about it. Let's talk about the man. Hero.
Speaker 2: Let's talk about it.
Speaker 1: Let's talk about the Man Hero.
Speaker 3: Welcome to the Man Yeah, welcome, Welcome back to the mailroom.
Speaker 3: It gets better here every day. We're not living like
Speaker 3: animals at all. We are living like civilized gentlemen. Jordan Runta,
Speaker 3: I don't I mean guns n' roses. We you know,
Speaker 3: we just you know, we could we could completely go
Speaker 3: off the rails on this crazy train if we get
Speaker 3: too much longer. I know it's not guns n' roses,
Speaker 3: but we're just gonna go with the hard rock theme
Speaker 3: for this this deal, because yeah, we're gonna be dealing
Speaker 3: with something that I deal with day in and day
Speaker 3: out in my office.
Speaker 2: In fact, probably one.
Speaker 3: Of the busiest aspects of my career, both research wise
Speaker 3: in the literature and publications and speaking professorializing with this
Speaker 3: condition that we're going to just come out and say,
Speaker 3: Pironi's Disease.
Speaker 2: Jordan, what's up? Man?
Speaker 4: Not much?
Speaker 5: I am really excited to do this episode because you
Speaker 5: are truly a rock star in the Peroni's Disease world.
Speaker 5: You are the Jimmy Page of Pronis. You were one
Speaker 5: of the leading researchers. Is because every time I was
Speaker 5: doing research on this episode in your name coming up, left,
Speaker 5: right and center.
Speaker 2: Just ramble on, man, just ramble on.
Speaker 3: Yeah, Yeah, I mean, I think we're going to get
Speaker 3: a little professor oil today. It's something that I'm super
Speaker 3: interested in the.
Speaker 2: History of it.
Speaker 3: We'll talk about a little bit and then you know,
Speaker 3: this is going to be another one of these series.
Speaker 2: We're gonna have a bunch of people.
Speaker 3: Some of my friends that I've known for years, that
Speaker 3: are also luminaries in the field of Perne's disease. Because
Speaker 3: this deserves a lot of oxygen. Not just because this
Speaker 3: is a big part of what I do at UCLA
Speaker 3: and both in the clinic and in the operating room
Speaker 3: as well as you know, in the laboratory essentially in
Speaker 3: our research, but also because it's it's a disease that
Speaker 3: has its roots in shame. It has its roots in
Speaker 3: the insecurities of men's health, and so I think these
Speaker 3: are the things we got unpacked we have to demystify.
Speaker 3: And also, you know, it's way more common than we think.
Speaker 3: And when I started practice, Perone's disease is you know,
Speaker 3: really is the one thing that there's no other specialist
Speaker 3: that can deal with this condition truly other than a urologist.
Speaker 3: All right, So you know we're just kind of rambling
Speaker 3: on we as it were. I mean, he gave me
Speaker 3: the Jimmy Page thing. It's no way I can live
Speaker 3: up to that. But I'll pull out my less policy
Speaker 3: what we can do. So, so what is Peoni's disease?
Speaker 3: The condition has been described really probably since about the
Speaker 3: thirteenth century since ay an Italian anatomus Philopius, who also
Speaker 3: those of us, and that no guynecology know of filopian tubes. Wo,
Speaker 3: So he knew a lot about the pelvis a both
Speaker 3: men and women pelvis, and he described this can called
Speaker 3: induracio plastica penis or basically in duration of the lining
Speaker 3: of the tunica virginia, the tough outer membrane of the
Speaker 3: penis that caused deformity. And so he did a lot
Speaker 3: of work in the anatomic dissecting labs, in the cadaver labs,
Speaker 3: and so he must have come across a bunch of
Speaker 3: these lumps in penises of cadavers that he was dissecting
Speaker 3: the pelvis on for other reasons, but it was not.
Speaker 2: Named Filopius's disease.
Speaker 3: It was named Peroni's disease for francoisi Go de le Peroni,
Speaker 3: who was the physician in mid eighteenth century France. He
Speaker 3: was a royal physician and one of the original papers
Speaker 3: that actually described a case report for perones goes back
Speaker 3: to about seventeen forty three or so.
Speaker 2: I'll make it up. I'm sure we can get Google.
Speaker 3: AI generated the answer to exactly when that paper came
Speaker 3: out first. But I said that pons, it's a disease
Speaker 3: that started in shame. And I mean that because the
Speaker 3: way that Roni, the physician described the paper, it was
Speaker 3: a guy that was out filandering in the streets of Paris,
Speaker 3: and he was about thirty two years old, and he
Speaker 3: had a few nights on the town away from his wife,
Speaker 3: and then he came back with this painful and curved direction.
Speaker 3: And that's what Pirone's disease is, quite simply, is just
Speaker 3: when the penis does not maintain its normal cylindrical shape
Speaker 3: that the guy has known all his life, and he
Speaker 3: develops either a painful lump or a plaque.
Speaker 2: We call it a curvature.
Speaker 3: Usually ensues p and l shortening almost always happens. In fact,
Speaker 3: one hundred percent of guys that have pironis will not
Speaker 3: be able to maintain or regain their normal length without
Speaker 3: some kind of intervention, and a lot of times it
Speaker 3: decreases blood flow, so it causes problems with directions. And
Speaker 3: so this guy had what was what Peroni thought was
Speaker 3: a veneerial disease. And that's what you get for stepping
Speaker 3: out on your on your wife is Pernes. And so
Speaker 3: imagine how many times in my career that I have
Speaker 3: a very nice, happily married man that goes on a
Speaker 3: business trip and he comes back and he has this curvature.
Speaker 3: How do you explain that one to your partner? And
Speaker 3: you know it has nothing to do with venereal diseases.
Speaker 3: There's no infectious ideology to Perrone's. But that's how the
Speaker 3: whole thing started in the seventeen forties. So we've known
Speaker 3: about this forever, we've described it. But you're going to say, well, then, okay,
Speaker 3: what causes paronius disease, doctor Mills, And I'll say, well, yes, Jordan,
Speaker 3: thanks for introducing me as this leader in the field.
Speaker 3: And I will say, I have no idea. And that
Speaker 3: was one of the first things that I like to
Speaker 3: disavow of my patients that we know everything.
Speaker 2: We know what it is. We know what the scar
Speaker 2: tissue is.
Speaker 3: If I go in to the operating room because I
Speaker 3: have to remove this scar tissue, which is one of
Speaker 3: the surgeries I do, I can send it to my
Speaker 3: pathologists and they will tell me. It's a disorganized bundle
Speaker 3: of multiple types of collagen, primarily type one collagen and
Speaker 3: type three collagen. And there's probably seven plus types of
Speaker 3: collagen in our body, which is that connective tissue that
Speaker 3: makes our nose have shape. It keeps the balance in
Speaker 3: our skin, and so as we age and our skin
Speaker 3: becomes wrinkly and it becomes less firm than that's loss
Speaker 3: of collagen crosslinking or bridging in the penis, it's exactly
Speaker 3: the opposite. It's this giant ball of disorganized collagen. And
Speaker 3: we know that the normal lining of the penis, that
Speaker 3: tunic cal virginia is made up of two separate layers
Speaker 3: of college and we call longitudinal fibers which run straight
Speaker 3: down the cylinder as you imagine in the parallel fashion
Speaker 3: of the penis dangling from the body, and then the
Speaker 3: circular fibers which are what keep it in its cylindrical shape,
Speaker 3: and so the circular fibers go around the cylinder, and
Speaker 3: the two of those usually work in concert so that
Speaker 3: guys will get an erection that maintains its cylinder shape
Speaker 3: as it in gorges with blood and keeps it all
Speaker 3: trapped in and establishes the erection that most guys know
Speaker 3: and love, and pronis goes in and screws all of
Speaker 3: that up and you end up with this disorganized bundle
Speaker 3: of abnormal collagen. So the way I look at this
Speaker 3: is if I'm trying to explain to a guy, I said,
Speaker 3: look you before I lose all confidence as a provider
Speaker 3: that I don't know what's going on. We do know
Speaker 3: that there is a genetic basis for this, and that
Speaker 3: there are guys that are a little more susceptible to
Speaker 3: forming these plaques, which we call them. They're not plaques
Speaker 3: like you'd think cholesterol plaques and arteries, and they're not
Speaker 3: associated with coronary disease. But basically, using the loose definition
Speaker 3: of plaque, is a chunk of tissue that shouldn't be there,
Speaker 3: and that's all it is. It's essentially a chunk of
Speaker 3: this collagen that normally should be nice and elastic is
Speaker 3: now becoming fixed. Broni's is very associated with two other
Speaker 3: conditions of what we call connected tissue disorders, and they
Speaker 3: all have eponyms. So in the hand it's another French
Speaker 3: guy to putrins. And so if you ever notice, guys,
Speaker 3: usually as we age, or women too, can develop these
Speaker 3: contracted fingers where instead of being able to hold your
Speaker 3: palm all the way out, you get this contraction where
Speaker 3: the usually the pinky finger will come in so that
Speaker 3: you can't fully extend your hand or high five somebody.
Speaker 3: You end up with a little bit of a dysfunction
Speaker 3: of that ability.
Speaker 2: So it's difficult if.
Speaker 3: It's your right hand to shake hands, to do five
Speaker 3: fingered exercises, and that can be you know, a serious
Speaker 3: problem because it affects a hand, so it can actually
Speaker 3: affect work if you work with your hands. If you're
Speaker 3: a guitar player, just imagine that trying to fret with
Speaker 3: a with a pinky that doesn't fully expand. And it's
Speaker 3: the same connective tissue disorder. It's the same kind of lumpy,
Speaker 3: bumpy collagen that affects the penis. And then lastly, there's
Speaker 3: something called later host contractors. So German, dude, I guess
Speaker 3: maybe Austrian of the planter fascia of the foot or
Speaker 3: the bottom part of the foot. So it affects the
Speaker 3: arch and so it can be painful. And again it's
Speaker 3: just a lump in that connective tissue or that ligament
Speaker 3: that keeps the foot in a nice arch like fashion.
Speaker 3: It can contract that as well. So yeah, basically, penis, hand, foot,
Speaker 3: same deal. If I took out a piece of contractor
Speaker 3: in the hand or the foot and I send it
Speaker 3: to my pathologist, they would not be able to tell
Speaker 3: me if it came from the penis, the hand or
Speaker 3: the foot.
Speaker 5: Now, I guess, taking it back a little bit, how
Speaker 5: does a man first realize that something is wrong or
Speaker 5: it was a different for every case. Is it a
Speaker 5: visible curve? Is it painful eruption? Is it a lump?
Speaker 5: Is a loss of length? Is it difficulty having sex?
Speaker 2: Yes? Yes, the answer is yes. Yeah.
Speaker 3: So by way of I got all excited and jumped
Speaker 3: in to this whole thing because obviously this is what
Speaker 3: I do. But yeah, this is going to be a big,
Speaker 3: multi part episodes. We're going to unpack all of this
Speaker 3: I'm going to have some friends on as we were
Speaker 3: talking about, and so I think, yeah, what I'll tell
Speaker 3: you that in this intro phase is that it can
Speaker 3: happen all of those ways where a guy can literally
Speaker 3: wake up one morning with an erection that has bent,
Speaker 3: and often it starts in a painful way, and where
Speaker 3: they notice what directions, all of a sudden they develop
Speaker 3: pretty significant kind of either a throbby or a sharp
Speaker 3: stabbing pain because that a normal erectile tissue is limited.
Speaker 3: It can't expand past that scar tissue. So the most
Speaker 3: obvious manifestation is a curvature. The second most is length loss,
Speaker 3: and then it also can turn into length loss curvature
Speaker 3: problems and then not getting good blood flow past the plaque.
Speaker 3: It almost acts like a finger over a garden hose,
Speaker 3: where where if you have this extrinsic force pushing down
Speaker 3: on the blood vessels that normally supply the entire penis,
Speaker 3: then guys will develop what we call distal flacidity where
Speaker 3: they won't get an engorged tip of the penis where
Speaker 3: then they won't get an engorged portion of the penis
Speaker 3: that's past that plaque.
Speaker 2: And so so.
Speaker 3: Yeah, it can happen anyway, Most guys do not know
Speaker 3: what caused this, and so getting back to the genetics
Speaker 3: of this, I think that there are populations that have
Speaker 3: a slightly increased risk of this. We know that men
Speaker 3: that undergo pelvic surgeries or any kind of eurologic instrumentation
Speaker 3: where they're maybe getting surgery for kidney stones or surgery
Speaker 3: on their prostate, those guys tend to have a higher
Speaker 3: risk of developing pronies.
Speaker 2: And we don't know if this is fully causal.
Speaker 3: We also think if you are going to a urologist
Speaker 3: for some kind of eurologic surgery, then you also may say, hey,
Speaker 3: and by the way, I've got this change in my
Speaker 3: penis that I hadn't noticed before, and that becomes us
Speaker 3: what we call association bias or a selection to saying,
Speaker 3: you know, I'm already here for one penile issue or
Speaker 3: one eurologic issue. Do you mind taking a look at
Speaker 3: this lump or this bump I noticed and this card tissue?
Speaker 3: And you know that's the initial diagnosis is we actually
Speaker 3: most of the time, eighty percent of the time, don't
Speaker 3: know why they develop this card tissue, what goes rogue
Speaker 3: in their wound healing processes that allows for a hyper
Speaker 3: trophic wound heal. There are guys that get chloids cars
Speaker 3: you know, those are where you get Yeah, so if
Speaker 3: you see, sometimes it happens after say an ear piercing
Speaker 3: or something. They can happen anywhere on the body, or
Speaker 3: you have a pretty significant laceration or a cut somewhere,
Speaker 3: and instead of just a nice thin scar, they can
Speaker 3: get really lumpy, bumpy skin tissue. And a lot of
Speaker 3: times it happens in the ears and it is very
Speaker 3: You can see it and then say, gosh, what happened
Speaker 3: to that person's skin to that wound healing. That's another
Speaker 3: disorganized way that we heal wounds is to develop these keyloids,
Speaker 3: which are giant blobs of college and that's under the
Speaker 3: skin surface. And there's an association between keyloids and pyerhnies
Speaker 3: as well. But yeah, only about twenty percent of guys
Speaker 3: will tell me they had an inciting incident that led
Speaker 3: to it. And even those, even those, I have to
Speaker 3: be really careful with them to make them not feel
Speaker 3: like they did something wrong. I have to disavow guys
Speaker 3: that there is any component of shame or that I
Speaker 3: did something on my penis, I shouldn't. So a lot
Speaker 3: of younger guys come in thinking they had a masturbation
Speaker 3: injury that led to this.
Speaker 2: I've had, you know, in.
Speaker 3: California surfboard injuries, in Colorado snowboard injuries, where they're there,
Speaker 3: even with a flaccid penis, they may have taken a
Speaker 3: blow of some kind to the penal tissue and then
Speaker 3: they notice the curvature could be But most of the time,
Speaker 3: what we think is that because the most most guys
Speaker 3: that develop peronis, it's really between their forties and sixties
Speaker 3: that it happens because they're getting a little bit of
Speaker 3: these chronic, little flection injuries where the penole tissue may
Speaker 3: not be as in gorgeous it used to be. They're
Speaker 3: still getting erections, but that those little microtraumas lead up
Speaker 3: to at one point that genetic switch turning on to say,
Speaker 3: oh man, we got to put down this type one collagen,
Speaker 3: this type three collagen what I call the spackle of
Speaker 3: the penis.
Speaker 2: So if you put a hole in your wall, right,
Speaker 2: what do you do. You go to your.
Speaker 3: Hardware store and you get a tub of spackle and
Speaker 3: you throw it up to patch the wall. It's not
Speaker 3: quite like the wallboard that was installed, but it covers
Speaker 3: up the hole. And I think that's sort of what
Speaker 3: happens with our with our wound healing system, is that
Speaker 3: there's a slight, low grade inflammatory panic where when the
Speaker 3: penis sends, this is a micro trauma that could lead
Speaker 3: to a bigger injury, and all of a sudden, these
Speaker 3: guys that have a genetic predisposition are just throwing down
Speaker 3: spackle and it heals, but it doesn't heal to the
Speaker 3: point where a guy's going to have a completely normal penis.
Speaker 3: So yeah, penile injury, penile fracture. You know, we talked
Speaker 3: about the five p's of the Pinocalypse a few episodes ago,
Speaker 3: and two of those were penis fracture and pernis, and
Speaker 3: those are not very well associated at all. And even
Speaker 3: if a guy doesn't get his penis fracture healed, a
Speaker 3: lot of times they have problems with the rectile function,
Speaker 3: but they don't they don't necessarily develop pernis. So unclear,
Speaker 3: you know. Bottom line is that after this long, long
Speaker 3: consultation I'll have in my office with guys, they're going
Speaker 3: to leave feeling as if they don't really know what
Speaker 3: caused it. But the best and important thing I can
Speaker 3: do is disavow them of any shame factor that they
Speaker 3: didn't do anything to their their penises. I mean, their
Speaker 3: penises are pretty tough, durable organs, right, and they are
Speaker 3: the reason for our genetic procreation, so they're built that
Speaker 3: way to stand and a lot of different shenanigans, and
Speaker 3: so unfortunately sometimes that shananigan gets in the way. And
Speaker 3: here we are with a with a Perone's plaque developing.
Speaker 4: Now this is a really beginner question, but good.
Speaker 5: You talk about developing Perone's disease the manifestation of it.
Speaker 5: Is it truly you wake up one day and there
Speaker 5: is a curve or is it something gradual that occurs
Speaker 5: over days, weeks, months.
Speaker 2: Yeah, again, I'm gonna say yes, yea.
Speaker 3: So it's a reasonable time to talk about something that
Speaker 3: I don't want to talk about anymore. But because we
Speaker 3: argue about this in the academy, we have traditionally classified
Speaker 3: peronis into an acute phase and a chronic phase. Where
Speaker 3: guy notices a disturbance in his normal penis anatomy, and
Speaker 3: that's day one, and then day I don't know, one
Speaker 3: hundred and eighty. He notices that things haven't really changed
Speaker 3: much since day one, And say he wakes up one
Speaker 3: morning and his penis has bent forty five degrees to
Speaker 3: the right or to the left, or up or down,
Speaker 3: because parone's curvature can really go in any direction of
Speaker 3: the cardinal orders. In fact, some guys go up into
Speaker 3: the left, up and to the right, down to the left,
Speaker 3: down to the right, straight down, straight up. But either way,
Speaker 3: if a guy wakes up with that curvature, that change
Speaker 3: in the penal anatomy, he may never change again. In
Speaker 3: other words, you wake up a forty five degree bend
Speaker 3: and six months later it's exactly the same. Some guys
Speaker 3: don't have any pain with this at all. Some guys
Speaker 3: have pain that last two years. Some guys have pain
Speaker 3: that doesn't go away, that can continue throughout the course
Speaker 3: of this condition. And then some guys will have a
Speaker 3: very gradual onset of pain and curvature where they say, gosh,
Speaker 3: you know, well, cop and I noticed it was about
Speaker 3: twenty degrees bent to the right. And a lot of
Speaker 3: guys Jordan have underlying curvature anyway. I mean, there's some
Speaker 3: normal anatomy that allows you know, a variance of about
Speaker 3: twenty degrees, where guys will have a bend, and that
Speaker 3: gradual bend may never get in the way of intercourse,
Speaker 3: and that's just normal for them, and so it's really
Speaker 3: what's abnormal for them. And in fact, some men are
Speaker 3: even born with a significant angulation where where it can
Speaker 3: their penis can be born bent ninety degrees. That's not payerne's.
Speaker 3: That's called either cord where a guy's penis bends downwards,
Speaker 3: and that's an anatomic variant where a guy's penis the
Speaker 3: chambers of the penis don't all grow at the same time,
Speaker 3: and one of them or two of them are mismatched.
Speaker 3: And so whenever guy gets an direction, or even a
Speaker 3: young boy gets an erection, he may have a physiologic curvature.
Speaker 3: And again sometimes they're not bothered, and sometimes we have
Speaker 3: to fix them surgically if they get in the way
Speaker 3: of intercourse. But it is good to distinguish all things
Speaker 3: that are curved are not pynees. And so when we
Speaker 3: talk about paronis from a definition, it is an acquired
Speaker 3: disorder of the shape of the penis, and it can
Speaker 3: happen at age seventeen, it can happen at age eighty seven.
Speaker 3: But you alluded to something, which is this idea that
Speaker 3: we like to categorize in medicine and so acute and
Speaker 3: chronic phase for decades to centuries kind of made sense.
Speaker 3: And I've been really working a long time to disavow
Speaker 3: our patients and our professional societies from trying to do this,
Speaker 3: because sadly in this day and age, now that we
Speaker 3: have treatments for parone's disease, this becomes an issue with
Speaker 3: sometimes getting coverage and care for it, and some insurance
Speaker 3: companies will not allow us to treat guys in the
Speaker 3: acute phase because it seems like we just need to
Speaker 3: wait and see if it gets better. And the other myth,
Speaker 3: because we love taking things down on the show, is
Speaker 3: that paronis will get better on its own. And there
Speaker 3: was one study in the nineteen seventies or so that
Speaker 3: looked at what we call the natural history of Pironi's
Speaker 3: meaning when you say something as a natural history means
Speaker 3: you observe it from the beginning until the guy dies,
Speaker 3: basically without intervening, because for years we didn't really have
Speaker 3: a viable intervention for Pirona's disease. And in that study,
Speaker 3: and I still get physicians that quote this to me,
Speaker 3: or patients that requote what their doctor told them. Is
Speaker 3: that a third of these get better, a third of
Speaker 3: these stay the same, and a third of these get worse.
Speaker 3: And so if you look at the if you wanted
Speaker 3: to dichotomize into acute and chronic phase, then you would say, hey,
Speaker 3: look a guy comes in.
Speaker 2: I woke up with an.
Speaker 3: Erection this morning, and it's bent that maybe my afternoon
Speaker 3: clinic today waiting for me. Most likely because of how
Speaker 3: often I see this condition. I'll probably have six or
Speaker 3: eight new guys in my clinic today with this condition.
Speaker 3: And if they've seen other doctors before they see me,
Speaker 3: they may have told him they say, look, man, this
Speaker 3: just happened to you.
Speaker 2: It's okay.
Speaker 3: You know, probably got about a thirty percent chance, so
Speaker 3: go away in its own, so let's just keep an
Speaker 3: eye on it.
Speaker 2: That would be based on a.
Speaker 3: Really crappy one paper that I'd love to just toss
Speaker 3: out of literature, and a third of them stay the same,
Speaker 3: I think is also probably not true. In fact, I
Speaker 3: see a lot of guys that will develop the original phase,
Speaker 3: what we used to call a cute phase, where it
Speaker 3: doesn't get any different. It just they wake up their
Speaker 3: penises bent ninety degrees. No trauma, they just kind of
Speaker 3: happened to them. That doesn't get any better, It doesn't
Speaker 3: get any worse.
Speaker 2: It is what it is.
Speaker 3: And so imagine me trying to tell a guy, hey, look, bro,
Speaker 3: you know, come back and see me in six months
Speaker 3: and we'll see what we can do about it. So
Speaker 3: now guys to live with his devastating condition where he
Speaker 3: may be unable to engage in intercourse he may not
Speaker 3: if he's single, try to explain that to a partner,
Speaker 3: and then basically me turning my back on him for
Speaker 3: six months and you know, watching the clock tick down
Speaker 3: to zero and then say okay, now we're going to
Speaker 3: do something.
Speaker 2: And then the other group.
Speaker 3: Of guys, though, the guys that do stabilize after a
Speaker 3: year or so, those are the ones that will have
Speaker 3: this gradual onset where it starts to twenty, then it
Speaker 3: gets to thirty forty forty five degrees and they're noticing, guy,
Speaker 3: I lost maybe a centimeter of length, and then I
Speaker 3: lost two centimeters, and you know, then I lost three.
Speaker 3: Some guys even mentioned they feel as if they've lost
Speaker 3: up to four inches of their normal pnile length. So
Speaker 3: this is not just a subtle deal, but it happens
Speaker 3: that that tissue can get so disorganized and cause such
Speaker 3: a wad of crumpled up a normal, healthy erectile tissue
Speaker 3: that they can never expand.
Speaker 2: And so all of those are real.
Speaker 3: And so my mission is to to not really talk
Speaker 3: about acute and chronic phased Pironi's in and we'll ask
Speaker 3: what our experts say too, and it'll be fun to
Speaker 3: see when they get on and if they want to
Speaker 3: challenge me on this or or they will.
Speaker 2: See their practices a little bit differently.
Speaker 3: But really the most important thing to me is when
Speaker 3: do I intervene with something invasive. An invasive would be surgery.
Speaker 3: And the things that I do like is for guys
Speaker 3: to stabilize to the point where they haven't had much
Speaker 3: change in agulation for at least a few months, because
Speaker 3: if I intervene too soon, I could either over or
Speaker 3: undercorrect those guys, right, if there's any chance that they
Speaker 3: get better, And by the way, you know, just to
Speaker 3: go back to me saying it never gets better. There
Speaker 3: is a very small percentage of guys, you know, maybe
Speaker 3: under ten percent, that notice that paronies can get a
Speaker 3: little bit better without doing anything. But again, we don't
Speaker 3: have those observational studies anymore, because now we do have
Speaker 3: early interventions, which we'll get into over this course of
Speaker 3: this series. And so for somebody to walk into an
Speaker 3: office where paronees and have a physician pat them on
Speaker 3: the back and say, hey, let's see how this goes
Speaker 3: in three months, that's not cool.
Speaker 2: You know.
Speaker 3: We have too many things we can do, even non
Speaker 3: invasive things at all, that we give these guys a
Speaker 3: fighting chance at getting better before it turns into a
Speaker 3: three months, six month, two year process before we get
Speaker 3: them care. Those are two years where the guy's going
Speaker 3: to be psychologically, emotionally and physically devastated by this condition.
Speaker 3: And that's what I want to disavow of is that
Speaker 3: if a guy comes into the acute phase, I have
Speaker 3: treatments available for them that we could start treating them
Speaker 3: immediately instead of waiting and saying, oh, let's see if
Speaker 3: it stabilizes and then we'll go from there.
Speaker 2: We have to stop with that thinking what.
Speaker 4: Are some of those non surgical treatments.
Speaker 3: Yeah, so we're going to have episodes dedicated to this Jordan,
Speaker 3: But the way I look at Perne's in general from
Speaker 3: a treatment standpoint is pills, pokes, and procedures, and that's
Speaker 3: kind of a nice way to organize what we do.
Speaker 3: And the spoiler alert here is that even in twenty
Speaker 3: twenty six, we still have just one FDA approved therapy
Speaker 3: for Perone's disease. And in full disclosure I do the
Speaker 3: condition is treated with something called zyeflex or collagenates, which
Speaker 3: is an enzyme that breaks down.
Speaker 2: The plaques that we're going to talk about.
Speaker 3: And as in say in full disclosure, I was one
Speaker 3: of the principal investigators on the trial that brought that
Speaker 3: to market in twenty three team, So I have no
Speaker 3: stock interests in the company, but they do sponsor some
Speaker 3: fellowship and research for us. So that is that is
Speaker 3: my above board disclosure that I do have ties to
Speaker 3: the company, but none that I directly profit from, so
Speaker 3: I can speak marginally unbiased on this as a as
Speaker 3: a clinician. But yeah, the other things before we get
Speaker 3: to Ziaflex, which I'm going to have one of my
Speaker 3: friends and colleagues talk with me about here in the
Speaker 3: next few episodes at some point, is that there are
Speaker 3: medications that we think have properties that can help treat
Speaker 3: Peyrone's and so the classic therapy is something we call
Speaker 3: anti fibrodict therapy or triple therapy, because there are three
Speaker 3: different things we try and we use in combination because
Speaker 3: they work differently. And again, none of these is FDA
Speaker 3: approved for Pyne's. They're FDA approved drugs that we use
Speaker 3: for other things. One will be very familiar to the audience.
Speaker 3: It's something we call tadalafil, which is a generic name
Speaker 3: of cialis, or sold entifil, which is viager. They work
Speaker 3: very similarly, and those are medicines we typically give to
Speaker 3: guys to improve their rectile function, sometimes their cardiovascular health
Speaker 3: for men and women both that have that have a
Speaker 3: hypertension or high blood pressure within their pulmonary artery system.
Speaker 3: And the reason I mentioned that condition is that we
Speaker 3: know that these are not just boner pills. They're not
Speaker 3: just for giving us better erections, but they have multiple
Speaker 3: different channels that they can improve, and in the realm
Speaker 3: of peronies, we know that they can decrease the amount
Speaker 3: of fibrosis or scar tissue that your body puts down.
Speaker 3: So if you see a guy and he develops peronies,
Speaker 3: and you don't want to treat them. Even if you're
Speaker 3: a primary physician listening or urologist doesn't treat peronis. I
Speaker 3: would try them as you get them into my office
Speaker 3: or get a referral to your local perones expert to
Speaker 3: put them on a daily low dose of ta dalophill
Speaker 3: because it does have both in vitro and in vivo,
Speaker 3: meaning in the body itself, but also in lab tissue cultures,
Speaker 3: it can decrease the amount of scar tissue that forms,
Speaker 3: and so the idea is maybe we can intervene before
Speaker 3: this plaque becomes so dense that the only way we
Speaker 3: can get rid of it is either with an injection
Speaker 3: like collagenase or a surgery where I have to actually
Speaker 3: go in and either excize the plaque or counterbalance the
Speaker 3: plaque through surgeries. We're gonna have a whole episode on
Speaker 3: surgeries as well, so stay tuned for that. But Ciallis
Speaker 3: is kind of a to dal if. It was sort
Speaker 3: of the anchor of this antifibrotic therapy. The other two
Speaker 3: one is actually an amino acid or a supplement called
Speaker 3: el citraline, which is a nitrocoxide donor. It helps improve
Speaker 3: the amount of nitricoxide in a system, and we know
Speaker 3: the nitricoxide is important for dilation or opening up of
Speaker 3: blood vessels and relaxing a smooth muscle, both in the
Speaker 3: penis and everywhere, and so anybody that is a gym
Speaker 3: goer that enjoys pre workouts, one of the big ingredients
Speaker 3: in pre workouts is either something called l arginine or
Speaker 3: l citraline. They both essentially get converted to nitrocoxide through
Speaker 3: either the liver or the kidney, and so, but we
Speaker 3: also use it in pronies and in erect a dysfunction
Speaker 3: as a supplement that may have some evidence. And then
Speaker 3: finally something called pentoxiphiline which has been around for fifty
Speaker 3: sixty years, and that is another medicine that has a
Speaker 3: non specific pathway, just like tadalophil where it can help
Speaker 3: improve blood float of the penis and decrease scar tissue
Speaker 3: as well by inhibiting one of the inflammatory cytokine pathways.
Speaker 3: And that is a big fancy word for essentially when
Speaker 3: a body feels that it needs to generate either an
Speaker 3: immune or an inflammatory response, like you know, you get
Speaker 3: kicked in the shin, you get redness, you get bruising.
Speaker 3: Those are all inflammatory cytokines that run to the area
Speaker 3: to help increase wound healing. So pentoxifiline or Trento is
Speaker 3: its own brand name. It inhibits something called TGF beta,
Speaker 3: which is one of those inflammatory cytoclines that leads to
Speaker 3: deposition of scar tissue. So it's a very very indirect
Speaker 3: way that we think in that can decrease the amount
Speaker 3: of s car tissue that form. So we only use
Speaker 3: that in guys that haven't had peronis for a very
Speaker 3: long time. What used to be called the acute phase
Speaker 3: and even probably will always be called the acute phase,
Speaker 3: but as I said, I really don't like to use
Speaker 3: that term. But yeah, so those three things get together.
Speaker 3: The literature is pretty sparse on couple of randomized placebo
Speaker 3: control trials that go back to about two thousand and
Speaker 3: six and prior that show maybe a thirty percent chance
Speaker 3: that guys will get an improvement in their curvature if
Speaker 3: we do that within about the first six months of
Speaker 3: onset of conditions. So we'll talk about that with our
Speaker 3: other guests at some point to see what they do
Speaker 3: for it. Because again non FDA proof, so nothing on
Speaker 3: the label that says those things treat pironis. But we've
Speaker 3: cobbled together this little packet of pretty safe medications that
Speaker 3: may have some efficacy.
Speaker 2: One of the other things that we'll.
Speaker 3: Talk about a lot is penile attraction or penile modeling,
Speaker 3: because we do know that if you break your hand,
Speaker 3: then you get put into a cast or splenter. You
Speaker 3: break your arm, you get put into a cast, and
Speaker 3: so if you break the penis, and part of the
Speaker 3: reason that it doesn't work so well is as an
Speaker 3: orthopaedic injuries because again, as I said, this isn't really
Speaker 3: a fracture of the penis. It's more of a deposition
Speaker 3: of scar tissue. But what if we try to if
Speaker 3: you're bent to the right, put on a device or
Speaker 3: something that can help redirect the penis to its more
Speaker 3: straight orientation that you remember before you develop scar teistion.
Speaker 3: That's called penal attraction. There are multiple different brands out
Speaker 3: there that can do that. Some of them can actually
Speaker 3: work as a folkirm or a lever to help rebnd
Speaker 3: the penis at the point of curvature, so that if
Speaker 3: you bend forty five degrees to the right, then you
Speaker 3: bend it. The device forty five degrees to the left,
Speaker 3: so you're providing a counter traction and it kind of
Speaker 3: makes sense, and there's some data, especially if you combine
Speaker 3: that with a more aggressive approach, like some kind of
Speaker 3: therapy that we inject directly into the penis, either zyeflex
Speaker 3: or some of the non FDA prove injection therapies that
Speaker 3: will also cover at some point. But yeah, I mean,
Speaker 3: it kind of works and it's something to do. One
Speaker 3: of the things that we do think happens with traction
Speaker 3: is that you may be able to restore some length loss.
Speaker 3: And so even if a guy doesn't get much curvature improvement,
Speaker 3: maybe we'll restore a little bit of length loss. So again,
Speaker 3: something that we're going to unpack in future episodes. But right,
Speaker 3: definitely some therapies we can do before we start getting
Speaker 3: too aggressive.
Speaker 5: I'm sure you've been seeing people for you know, you said,
Speaker 5: this is the most common thing that you treat in
Speaker 5: your clinic. What's the biggest misconception you hear from patients
Speaker 5: in your practice.
Speaker 3: Yeah, one that it's their fault that they did something
Speaker 3: to their penis, and so again, and you know, we
Speaker 3: have to unpack the shame and say you didn't do anything.
Speaker 3: Even if you did do something, you know you probably
Speaker 3: are well within your realm of what most guys can
Speaker 3: get away with their penis. And so that is something
Speaker 3: that you have to walk out of my office and think, Okay,
Speaker 3: you know I didn't do anything wrong. My partner didn't
Speaker 3: do anything wrong.
Speaker 2: You know.
Speaker 3: If you would talk about referred guilt, it's when a
Speaker 3: guy comes in with a partner or sometimes the relationship
Speaker 3: doesn't survive the injury, where where a person says that
Speaker 3: another person caused this to happen. I've seen guys that
Speaker 3: have had had been sexually assaulted, you know, forcibly by
Speaker 3: by a sexual partner that did something essentially either a
Speaker 3: forcible bend during intercourse that set up this cascade of
Speaker 3: inflammatory tissue that's a whole other thing. Or if a
Speaker 3: couple is still together after the partner may have caused
Speaker 3: the injury, that is another unpacking of guilt where you
Speaker 3: know they probably didn't do anything wrong unless they truly
Speaker 3: truly wanted to instill harm on that partner, which sadly
Speaker 3: I have seen a couple of times, but really just
Speaker 3: a couple and the tens of thousands of guys that
Speaker 3: taken care of.
Speaker 2: But yeah, you didn't do anything wrong.
Speaker 3: You know, it just happens, and there is a genetic
Speaker 3: basis for this, and we do see it and it's
Speaker 3: not I should also say the other major thing that
Speaker 3: we should dispel is that this is a condition. They
Speaker 3: call this in the Scandinavia the Vikings disease, and we
Speaker 3: thought that it had a much higher prevalence in men
Speaker 3: of Northern European descent, and there is a little bit
Speaker 3: of a genetic signal for that. But I see men
Speaker 3: literally from all over the world, either living all over
Speaker 3: the world that come to see me for their condition
Speaker 3: or that their ethnic origins are global. In fact, some
Speaker 3: of the things that I would love to disavow is
Speaker 3: that this is a disease that strictly strikes Northern Europeans,
Speaker 3: because if anybody is listening that is not of that
Speaker 3: origin and they think, well, there's been to my penis.
Speaker 3: But I've heard this is always something that normally affects
Speaker 3: white guys, it doesn't.
Speaker 2: It can affect anybody.
Speaker 3: So that's the other thing is that you know, if
Speaker 3: you are a person that has a penis, you can
Speaker 3: get this.
Speaker 2: I can.
Speaker 3: This is one of the diseases without tmiing my guys
Speaker 3: and say, look, I can wake up tomorrow and have
Speaker 3: this condition. There's you know, I know, I know how
Speaker 3: to prevent erect out as function. I eat right, I sleep,
Speaker 3: I exercise, you do all the things that Mills tells
Speaker 3: me to do because I listen to his podcast, I
Speaker 3: read his book, and I'm like, I'm not going to
Speaker 3: get erect out of his function until you know, I
Speaker 3: cannot keep up anymore with the cruel hands of age.
Speaker 3: But Pirroonius does not have that. Every day I wake
Speaker 3: up and I think this could be the day that
Speaker 3: that I developed this. And so you can't live in
Speaker 3: fear of it. If you're sitting there listening to this
Speaker 3: show and think, well, man, I'm really glad I don't
Speaker 3: have that, But boyd you know, do I have to
Speaker 3: be careful of something? You really don't, you know. But
Speaker 3: the point is that this can happen to anybody. There
Speaker 3: is really not a lot of predispositions, and I you
Speaker 3: know the goal of this whole podcast is to spread
Speaker 3: joy and joy and love and peace and love, peace
Speaker 3: and love and not a I know ringo.
Speaker 2: Yes, So if we all listen to him a little.
Speaker 3: But really the goal is is to just you know,
Speaker 3: not worry about developing these things. But if you do,
Speaker 3: then we got treatments for it too. That's the other
Speaker 3: myth is that hey, you really, you know, this is
Speaker 3: something that just happens. You can't do much about it.
Speaker 3: I cannot believe in twenty twenty six, I still get
Speaker 3: guys that come into my office that really had to
Speaker 3: go past what their local doc told them to either
Speaker 3: get on the internet or just seek out Peroni's experts
Speaker 3: and end up in my office with the misconception that
Speaker 3: there's really nothing we can do to get this better.
Speaker 3: It still happens today. It has been now thirteen years
Speaker 3: since the FDA approved collagenase for the penis or zyaflex
Speaker 3: thirteen years and so this is not a cutting edge, novel,
Speaker 3: novel therapy by any means. It's something that again we're
Speaker 3: going to dedicate an episode to, but it is something
Speaker 3: that's still that the majority of youurologists actually don't use
Speaker 3: this medication for reasons that will unpack later. But there
Speaker 3: are plenty of guys are very well trained. In fact,
Speaker 3: you know too. Every year I train two eurologic surgeons
Speaker 3: in how to administer that drug in a safe and
Speaker 3: effective way. So there are lots of guys out there
Speaker 3: that have excellent training in this, and so right, don't
Speaker 3: go in if you are listening anything, Geez, I do
Speaker 3: have this lump on my penis I didn't have before.
Speaker 3: I had this curvature. I don't know what to do
Speaker 3: about it. And you're listening to the show, then don't
Speaker 3: give up, you know, don't give up and think there's
Speaker 3: nothing I can do about it, because we have all
Speaker 3: kinds of treatments. We have pure fellowships now for the
Speaker 3: last many years that have been dedicated to training surgeons
Speaker 3: and providers to how to treat guys that have this. So, yeah,
Speaker 3: that's a huge misconception. There's so many things we can
Speaker 3: do for these guys.
Speaker 4: It sounds like you've taken care of our You're probably
Speaker 4: going to be okay. Segment for this episode.
Speaker 3: Yeah, you know that is true, and I do think
Speaker 3: that that's very helpful.
Speaker 2: Is that.
Speaker 3: The other thing I will talk about is that the
Speaker 3: mental health component of this, because we really hit this
Speaker 3: heart on the show, is so important. We I collaborated
Speaker 3: with some colleagues from Krolinski Institute in Sweden. Sweden and
Speaker 3: Scandinavian general has amazing patient databases because it is a
Speaker 3: system that has universal health care and people turns out
Speaker 3: they really enjoy living in Scandinavia, so they don't move
Speaker 3: that much. They're not that transient of a society, and
Speaker 3: so they can have amazing longitudinal records because they have
Speaker 3: many touch points over the patient's life from when they
Speaker 3: were born to when they die. And so we had
Speaker 3: a database of over nine thousand men that we looked
Speaker 3: at with PIRNS and this was published, i want to say,
Speaker 3: about twenty twenty two or so in the Journal of Virology,
Speaker 3: So one of our premier journals that looked at the
Speaker 3: mental health aspect of men that had Perni's disease when
Speaker 3: they had this painful or painless curvature deformity to the penis,
Speaker 3: and the number of guys that had mental health issues
Speaker 3: as really whether as a result of the Pernies or
Speaker 3: whether it was just an association, you know, we weren't
Speaker 3: really powered to look at. Essentially, the association is about
Speaker 3: a three to one fold history of guys that have
Speaker 3: had touch points with mental health providers. There's a huge
Speaker 3: increase in guys that are on anti depressant medications that
Speaker 3: have Perni's disease and really tragically and this is something
Speaker 3: that I hear Jordan not frequently, but it happens is
Speaker 3: guys with suicideality that have considered ending their life because
Speaker 3: of this condition.
Speaker 2: And so one of the.
Speaker 3: Things I love, as you know, being funny and humorous
Speaker 3: and light. But this is where I'm not going to
Speaker 3: do it because I've had men that have come into
Speaker 3: me where they're urologists, have made fun of it and said,
Speaker 3: you know, it's just a bend to the penis, It's funny,
Speaker 3: you got a banana between your legs. Not the right
Speaker 3: thing to say. And there are lots of things to
Speaker 3: have fun and make light of. But you know, I
Speaker 3: would challenge any guy out there that if one day
Speaker 3: you woke up and you had a bend to your
Speaker 3: penis and it wasn't the penis, that you knew that
Speaker 3: that would be anything that would be funny about it.
Speaker 2: And it has.
Speaker 3: You know, it's been on it's been on Saturday Night Live.
Speaker 3: It's been lampooned that this condition and so so can
Speaker 3: you find humor in it?
Speaker 2: Sure?
Speaker 3: And I'm hoping we'll bring a guest on at some
Speaker 3: point that that has had this condition that maybe can
Speaker 3: look at this with a humorous light, but as a
Speaker 3: provider for me to discount this as like, hey, at
Speaker 3: least you're not going to die from this, not cool
Speaker 3: at all. And there are guys that come in and
Speaker 3: feel a lump in their penis and that's the first
Speaker 3: thing they think is that, oh my god, I have cancer.
Speaker 3: And I will tell you, in the years, in decades
Speaker 3: i've been practicing, I've never misdiagnosed cancer for Prona's disease
Speaker 3: or Pronu's diasers for cancer, they're very, very different manifestations.
Speaker 3: They don't look alike, they don't feel alike, and so
Speaker 3: again get evaluated. But most likely you don't have cancer
Speaker 3: and it just doesn't present that way in the penis.
Speaker 3: But yeah, I mean, the things that have really changed
Speaker 3: in terms of how guys present is wonderfully and delightfully.
Speaker 3: They're presenting much earlier than they were before. So we
Speaker 3: had another and we'll maybe bring this up with one
Speaker 3: of our guests as well. But when we were looking
Speaker 3: at the original trials for Pironi's disease, which gosh, those
Speaker 3: clinical trials dated back to I want to say around
Speaker 3: two thousand and six, two thousand and seven, and we
Speaker 3: published a subset analysis, meaning we looked at a lot
Speaker 3: of different ways. We looked at the data and how
Speaker 3: guys presented, and in the clinical trials that brought Zieflex
Speaker 3: to market, we excluded men that had not had Paroni's
Speaker 3: disease for greater than a year. And the reason for
Speaker 3: that was not scientific in terms of thinking that it
Speaker 3: would be less efficacious, but unfortunately insurance companies that weaponized
Speaker 3: us on that and said is not studied in guys
Speaker 3: under a year, So that's why they make people wait. Thankfully,
Speaker 3: you know, with a lot of advocacy and a lot
Speaker 3: of pushback that haven't really had that problem for a
Speaker 3: number of years now, but it's still something that I
Speaker 3: hear frequently. But what we found is that the average
Speaker 3: age of presentation for pironis in the old days was
Speaker 3: guys who could have it four or five years before
Speaker 3: they really saw it any kind of definitive therapy. And
Speaker 3: what we also found, which is kind of good for
Speaker 3: you're probably going to be okay, is that if you
Speaker 3: are listening to this and you've noticed this curvature for
Speaker 3: a while and you haven't found the right physician or
Speaker 3: urologists to treat this, that your treatment course is going
Speaker 3: to be just as effective. And we found that even
Speaker 3: if a guy had Perone's plagued for a year or
Speaker 3: even ten years, that if we initiated therapy with intralegional
Speaker 3: injections in this case, I afflix that the outcomes were
Speaker 3: about the same. Guys still can benefit from therapy even
Speaker 3: a year out. But I'm not seeing guys that have
Speaker 3: had this now for ten years anymore. That In fact,
Speaker 3: I've had guys you know that immediately they see it,
Speaker 3: they get on the internet, they find out, they define
Speaker 3: what it is, and they come see a provider, you know,
Speaker 3: within days, two weeks to months. And so again those
Speaker 3: are the guys that what we know is. And we
Speaker 3: have a couple of nice papers out in the literature
Speaker 3: recently that treating guys in the acute phase. But again
Speaker 3: I hate to use that term, but guys that have
Speaker 3: had this for less than six months they do just
Speaker 3: as well as guys that have had it, you know,
Speaker 3: for years. And so why make a guy suffer and wait,
Speaker 3: you know for some magic time to kick in before
Speaker 3: you could start actually treating them for their condition. So
Speaker 3: another thing we have to break down is that acute
Speaker 3: versus chronic phase should not affect a treatment course. If
Speaker 3: you think a man's a candidate for interlagional therapy. The
Speaker 3: only thing I would say is that if you're a
Speaker 3: patient listening and you see somebody and you have this
Speaker 3: acute phase where you've had it for three months, six months,
Speaker 3: and they want to operate on you, I would That's
Speaker 3: where I would slow the roll a bit because I
Speaker 3: don't typically and there's not a set in stone. Again,
Speaker 3: we'll talk to some of our other providers will get
Speaker 3: on the show, but for me, I want things to
Speaker 3: be really stable for at least six months, maybe even
Speaker 3: a year. And again because we have things we can
Speaker 3: do before that time, like zyeflex, then we can see
Speaker 3: potentially an improvement that we can either decrease the amount
Speaker 3: of surgery we have to do in a guy or
Speaker 3: obviate the need for surgery in general. We looked at
Speaker 3: our data not too long ago and found that about
Speaker 3: eighty percent of guys will get a rational good response
Speaker 3: to intralegional therapy or the injection therapy with zyeflex and
Speaker 3: only about seven percent of my men that had gone through,
Speaker 3: of course with eyefles end up actually needing surgery, and
Speaker 3: so that that's a pretty good number. It means you
Speaker 3: have a ninety three percent chance of finding a nonsurgical
Speaker 3: solution to this condition. So those are the kind of
Speaker 3: numbers that we want to keep posting. And as we
Speaker 3: get more and more familiar with this compound and we
Speaker 3: change and refine our techniques a little bit more, as
Speaker 3: well as adding on additional therapies. Potentially one of the
Speaker 3: things that we know that that pronins is associated with,
Speaker 3: for example, is hypogonadism or low testosterone, which we have
Speaker 3: talked a lot about on this show. But that's also
Speaker 3: optimizing testosterone levels, optimizing blood flow. And however, we do
Speaker 3: that to the penis through diet, exercise, and stress reduction,
Speaker 3: all those things they all help, you know. And so
Speaker 3: again we have to treat this condition holistically. We have
Speaker 3: to treat it not just as I have a chunk
Speaker 3: of scar and my penis and I need a surgical solution. No,
Speaker 3: if we treat a guy holistically, we treat their mental health,
Speaker 3: we treat their hormonal health, and we treat their physical health.
Speaker 3: Or or the plaque directly. That's the winning combination. So
Speaker 3: has I really got to find a provider that can
Speaker 3: do all of that for you?
Speaker 5: Well said, I mean, I know one of the questions
Speaker 5: I had my final question for you was what's changed
Speaker 5: most in proni's treatment during your career. Sounds like you've
Speaker 5: been actively involved in a lot of those changes, from
Speaker 5: both how it's treated holistically and also the medications that
Speaker 5: you know are used, the injections that are used to
Speaker 5: help the non surgical options.
Speaker 4: So that's yeah, incredible.
Speaker 3: Yeah, I mean, I will say, so I started practice,
Speaker 3: my fellowship ended two thousand and mid two thousand and eight,
Speaker 3: and then Zieflex was ft proved in twenty thirteen, and
Speaker 3: I was involved in the clinical trials throughout right. So
Speaker 3: I had a few years where we didn't have zyeflex
Speaker 3: except for on an experimental basis. And I will say
Speaker 3: something kind of surprising that comes up, in fact, they
Speaker 3: just came up at a national meeting in DC a
Speaker 3: couple of weeks ago, is that my surgical practice has
Speaker 3: exploded at the event as eyeflex. And there's this thing
Speaker 3: in medicine when when a new drug comes out called
Speaker 3: there's two things. One is good and one is bad.
Speaker 3: And the good thing is called disease state awareness or DSA,
Speaker 3: and pharmaceutical execs like to talk about DSA where you
Speaker 3: have something that maybe not so many people knew about,
Speaker 3: because pronius is an exact is an amazing case study,
Speaker 3: you know for an MBA and disease state awareness. The
Speaker 3: if you look at old textbooks that the overall incidents
Speaker 3: of guys walking down the street that have pronius is
Speaker 3: about zero point nine percent up to three percent. That
Speaker 3: goes back to Philopius and looking at cadavers and saying, hey,
Speaker 3: here's here's a scar tissue in the penis, and I
Speaker 3: found this, you know, in one out of one hundred cadavers.
Speaker 3: Then that's the incidents of pronies one percent. Well, now
Speaker 3: that we've had a disease state awareness because we have
Speaker 3: a d rug, that incidence is pretty practically and I
Speaker 3: think realistically gone up to about ten percent. So ten
Speaker 3: percent of guys walking down the street have this condition.
Speaker 3: So we used to call this an orphan condition. It's
Speaker 3: not an orphan disease. It has lots and lots of guys.
Speaker 3: And I always tell people, you know, when they come
Speaker 3: in and they're waiting to see me in that in
Speaker 3: that waiting room, there's you know, I practice male fertility,
Speaker 3: I practice sexual dysfunction of all kinds and hormone management.
Speaker 3: But really almost forty percent of my practice is devoted
Speaker 3: to Peroni's disease, and one hundred percent of my practice
Speaker 3: is devoted to men's health. And so there's a really
Speaker 3: good chance that you're going to be in a waiting
Speaker 3: room with somebody else that has that condition as you're
Speaker 3: waiting to see me. So my Pironi's career has exploded
Speaker 3: for sure over that time. But the surgeries I'm doing
Speaker 3: because I'm seeing so many more guys that have this,
Speaker 3: and because Eyeflex is not a miracle drug, and despite
Speaker 3: what you know, we would want people to say. And
Speaker 3: again I'm not a speaker for the company that produces Eyeflix,
Speaker 3: so I could say this, and in fact I said
Speaker 3: that in the New York Times maybe ten years ago
Speaker 3: when it was first coming out, and I said, this
Speaker 3: is incredible drug because we had nothing before and now
Speaker 3: we have an.
Speaker 2: FDA proved therapy.
Speaker 3: But again, not everybody, twenty percent of guys or so
Speaker 3: don't get a satisfactory response to zyoflex, and a percentage
Speaker 3: of those guys are going to want to operate. And
Speaker 3: if I see conservatively, you know, tens of thousands of
Speaker 3: patients my clinics, these thousands of guys a year on
Speaker 3: a new patient basis, we probably see four to five
Speaker 3: thousand men a year, and a forty percent of those
Speaker 3: ad pernis and eighty percent of those guys get a
Speaker 3: good response to ziaflex. If I think they're a candidate,
Speaker 3: then that still leaves me in the oar quite a bit.
Speaker 3: And so I'm still once or twice a week operating
Speaker 3: on men for pronus disease. And so now you have
Speaker 3: a medical condition that has a surgical solution that we're
Speaker 3: really going to get into in future episodes. And I
Speaker 3: think that's really important to know. And so you're right.
Speaker 3: I love that you're probably going to be okay, because
Speaker 3: my goal is to say, look, we're going to find
Speaker 3: a solution. I don't know how yet, I don't know
Speaker 3: if it's going to be it'll get better on its own,
Speaker 3: but I can almost guarantee that's not it. But we'll
Speaker 3: start you on some medications, we'll optimize your hormones. We'll
Speaker 3: get you on a good nutritional regimen. You'll make sure
Speaker 3: you're eating well, exercising, doing all the things to make
Speaker 3: you live along in healthy life and potentially help improve
Speaker 3: your peronis. And then we'll start talking about medications, and
Speaker 3: then we'll we'll eventually have the discussion about surgery. But yeah,
Speaker 3: we're gonna figure out how get some degree of functionality back.
Speaker 3: The other misconception, though, that I think is really important
Speaker 3: is setting, And I have this discussion always when when
Speaker 3: I'm talking or training younger physicians, is that you do
Speaker 3: have to set the expectation that there's a good chance
Speaker 3: that that man will not get the penis he had
Speaker 3: back before this condition. You know, you'll get some degree
Speaker 3: of functionality. The best case scenario is that you will
Speaker 3: correct the curvature. You may regain some length, if not
Speaker 3: all length, but that you have to accept the fact
Speaker 3: that you had an injury, you had a disease state
Speaker 3: that led to a permanent change in your penile architecture.
Speaker 3: But we're going to make it better. You know, We're
Speaker 3: going to figure out a way to get to the
Speaker 3: point where you're functional again. And I think that may
Speaker 3: be the most important thing to walk away from this
Speaker 3: podcast is that you're going to be okay. Don't know
Speaker 3: how yet, don't know when you're going to be okay,
Speaker 3: but you may not be who you were before. You're
Speaker 3: going to have to learn to adapt a bit and
Speaker 3: have that conversation.
Speaker 4: Well to be continued.
Speaker 5: I know we have some folks coming on, some fellow
Speaker 5: folks in the field and some people who have dealt
Speaker 5: with this with bravery and humor, and yeah, yeah, I'm
Speaker 5: really excited to dive into this. I have to say
Speaker 5: I was one of those people who was really not
Speaker 5: familiar with this before I started speaking with you about it,
Speaker 5: and it's really shocking to me to hear that, you know,
Speaker 5: as many as ten percent of men are dealing with this,
Speaker 5: and so it's good to get the word out there.
Speaker 3: Yeah, no, I mean I was I think in medical
Speaker 3: school I had exactly zero lectures on this, and so
Speaker 3: this is not something that medical students probably are really
Speaker 3: exposed to unless they're going to a center of excellence
Speaker 3: or a metic school that has providers that spend a
Speaker 3: lot of time treating this. And you know, thankfully UCLA
Speaker 3: I have a lot of medical students either in my
Speaker 3: research group or come through my office, and so so
Speaker 3: we are getting the word out and I think it
Speaker 3: is becoming even those students that don't go into urology
Speaker 3: but go into a field that where they are taking
Speaker 3: care of men in some fashion, they at least have
Speaker 3: a bit of that disease state awareness.
Speaker 2: Oh yeah, I just a foreclosure.
Speaker 3: The other thing is that we don't like is a
Speaker 3: term disease mongering, where you're trying to muster up a
Speaker 3: disease that a guy may not have. Paronis. You can't
Speaker 3: fake it. You just can't fake it. And so when
Speaker 3: people are surprised, it's just you know, the amount of
Speaker 3: guys out there with Pironi's disease. That nothing has changed,
Speaker 3: there's nothing in the water. It's just a fact that
Speaker 3: it's way more common than we think. And nobody, you know,
Speaker 3: nobody wants to come in and say, hey, give me
Speaker 3: that drug for pironis because nobody wants this condition.
Speaker 2: And so I think that's the other thing.
Speaker 3: About this is that it is very, very distinct and
Speaker 3: it is a very condition that has very real therapies.
Speaker 3: But yeah, just because you see the ads on TV,
Speaker 3: the only people that ever respond to those the guys
Speaker 3: are like, oh, man, I had no idea that this
Speaker 3: is something that I had or that I had a
Speaker 3: treatment for. I just kind of figured as a normal
Speaker 3: part of getting older. And so that's where I think
Speaker 3: disease state awareness is great. It allows guys a little
Speaker 3: bit of a vehicle and a mechanism to reach out
Speaker 3: and find somebody that can that can take care of you.
Speaker 2: And so there are.
Speaker 3: Good finders online. Prone's disease finders where you can find
Speaker 3: providers that specialize in this. The plug for one of
Speaker 3: the groups I'm a part of, the Sexual Medicine Side
Speaker 3: of North America or the International Society of Sexual Medicine ISSM.
Speaker 3: Both I have great websites where you can get good
Speaker 3: patient information on and also often find providers that specialize
Speaker 3: in this. And so those are good resources, very well
Speaker 3: vetted that patients can reach out to for information. In
Speaker 3: addition to the email room with doctor Jessemils, which I
Speaker 3: hope also will be a good source of information for
Speaker 3: guys dealing with.
Speaker 4: This themeilrompod at gmail dot com.
Speaker 2: Bam, there it is.
Speaker 3: So yeah, let's uh, you know, let's call it a
Speaker 3: rapp for today and then say T B C and
Speaker 3: uh have guys come back and and figure out, you know,
Speaker 3: how how I engage my friends and in treating this
Speaker 3: condition and and spreading the word.
Speaker 4: It's bringing out my friends. Thank you for all you do.
Speaker 3: Dude, thanks for calling me the Jimmy page your Peroni's disease.
Speaker 3: I I don't think. I don't know how I'm ever
Speaker 3: going to live up to that, but I can die
Speaker 3: a happy man.
Speaker 2: Now.
Speaker 4: Put that on your website, but then in your business card.
Speaker 2: Boa there you go.
Speaker 3: Vetted by by Rolling Stone correspondent Jordan Rumpt. I'll take
Speaker 3: it all right, man, Hey, dude, have we didn't get
Speaker 3: to catch up, but I hope things are going well
Speaker 3: for you. And uh, and I'll see you next time.
Speaker 3: I'll bring a buddy of mine and we'll we'll we'll
Speaker 3: hash this out some more.
Speaker 4: Heck yeah, looking forward to it, sir.
Speaker 2: All right, bro, be good, see you next time.
Speaker 1: Let's talk about it. Let's talk about the maro. Let's
Speaker 1: talk about it. Let's talk about it a maro. Let's
Speaker 1: talk about it. Let's talk about.
Speaker 5: The mailroom with doctor Jesse Mills was a production of iHeartRadio.
Speaker 5: It was executive produced by Jordan Runtogg. It was edited
Speaker 5: mixed and mastered by Beheid Fraser, and the theme was
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