In Your Pants with Dr. Susie G - Treating Peyronie's Disease with Ultrasound

Episode Date: September 12, 2022

Doing a self-examination often can help you to detect Peyronie's disease as well as other concerns (like testicular cancer). The earlier you can detect Peyronie's, the easier it is to treat it as a soft tissue injury. Take one minute while in the shower to: Check your balls for lumps, bumps, and changes in shape Check your penis for any bending/curvatures, rotation, or hard or calcified skin Dr. Jo Milios is a Titled Clinical Researcher and Men's Health Physiotherapist (MACP) who has a special interest in Prostate Cancer.  Dr. Jo has presented the research findings from her PhD at many international conferences including the World Confederation of Physical Therapy (WCPT), Asia-Pacific Prostate Cancer Conferences (APCC),  Australian (APA) & American Physiotherapy Association's (APTA). We cover topics like: Why Peyronie's is commonly thought to be caused by penile injury or a buckling effect, yet only ~10% of men recall an incident Connection between Pyronie's and treatment for prostate cancer or other pelvic surgery (like hernia repairs and bowel surgery) Connection between Peyronie's and cardiovascular changes (like heart disease and diabetes) Injuries during sex that have caused Peyronie's in younger men The low down on treatments you should be considering if you've been diagnosed: therapeutic ultrasound, pumps, traction devices, medications, and more. If you've been diagnosed, what are the treatment options for Peyronie's? In addition to pumps, traction devices, and medications, Dr. Jo's research on the effectiveness of therapeutic ultrasound has been shown to be an extremely effective and gentle treatment for Peyronie's that any physical therapist can use. Refer to her thesis for all the nuts & bolts of ultrasound therapy for Peyronie's, erectile dysfunction, and urinary incontinence: Therapeutic interventions for patients with prostate cancer: A focus on urinary incontinence, erectile dysfunction and Peyronie's disease https://api.research-repository.uwa.edu.au/ws/portalfiles/portal/54573972/THESIS_DOCTOR_OF_PHILOSOPHY_MILIOS_Joanne_Elizabeth_2019.pdf RESOURCES: SOMAerect https://www.amazon.com/Soma-Therapy-ED-SOMAerect-Stf/dp/B00BFVWR2M/ref=pd_sbs_sccl_1_2/133-3828551-2248821?pd_rd_w=AuFXp&pf_rd_p=dfec2022-428d-4b18-a6d4-8f791333a139&pf_rd_r=SPZ1N24BE6HVP9K68Z5X&pd_rd_r=5ba2ec70-5c65-4e52-b40d-bb310a6e6867&pd_rd_wg=1RJy1&pd_rd_i=B00BFVWR2M&psc=1 Dr. Jo's Men's Health podcast, called 'The Penis Project' www.thepenisproject.org Free sex and pelvic pain resources https://drsusieg.com/resources-for-pelvic-pain-in-men Online Pelvic Pain Relief Program for Men https://drsusieg.com/pelvic-pain-in-men-online-program CONNECT WITH DR. JO MILIOS: Websites: www.menshealthphysiotherapy.com.au www.prost.com.au www.thepenisproject.org Twitter: @prostatejojo Facebook: Men's Health Physiotherapy Facebook Group CONNECT WITH ME (DR. SUSIE): Website: https://drsusieg.com/ Instagram: https://www.instagram.com/dr.susieg/ 15-minute call: https://drsusieg.com/pelvic-pain-specialist-15-minute-call Disclaimer: This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.

Hi friends, Dr. Susie G here and welcome to another In Your Pants podcast. Thank you so much for being here. On today's show, I have Dr. Joanne Melios, and Dr. Jo is going to talk to us about Peyronie's disease, defining what Peyronie's disease is, the potential causes and risk factors, what symptoms to look out for, and then we dive into treatment options, conventional medical treatment options, and then conservative medical treatment options, which include therapeutic ultrasound, and Dr. Jo Milios dives into her research around the use of therapeutic ultrasound for Peyronie's disease. You won't want to miss this one. To formally introduce Dr. Jo,

she is a titled clinical researcher and men's health physiotherapist who has a special interest in prostate cancer and recently completed PhD studies at the University of Western Australia. in her thesis called therapeutic interventions for patients with prostate cancer a focus on urinary incontinence erectile dysfunction and Peyronie's disease quality of life impacts were investigated in this research two randomized controlled trials were conducted aimed at reducing the impact of urinary incontinence and erectile dysfunction the first investigated pelvic pelvic floor muscle training in men and the second therapeutic ultrasound to treat Peyronie's following treatment for prostate cancer. Jo has presented her research findings at many

international conferences, including the World Confederation of Physical Therapy in 2015 through 2019, the Asia Pacific Prostate Cancer Conferences 2014 to 2018, the Australian and American Physiotherapy Association Conferences in 2019 and 2020, and locally at men's sheds, PCPFA support groups, Woodside Petroleum, and ANZUS. Recent publications include ANZ Continence Journal in 2018 and 2019, the BMC Urology, Rehabilitation Therapy, and Sexual Medicine. Currently, Joe is investigating the impacts of radiation therapy with colleagues at UWA, where the role of pelvic floor muscle training is a new research focus a love of teaching has enabled joe to lecture at charles sturt and curtin universities in australia and internationally since 2015.

during covid the opportunity to provide online courses internationally for medbridge usa and most recently with associate professor craig ellingham in managing the martians have been a career highlight for her. Finally, in 2012, Dr. Joe established PROST, Exercise for Prostate Cancer, a non-profit organization which provides an exercise and peer support program for any man diagnosed with prostate cancer. In June 2020, Joe won the Western Australia of 2020 for her work in men's health from the Australian Men's Health Forum and now delivers a weekly men's health podcast called The Penis Project. Please visit thepenisproject.org for more information. What a very impressive bio, hopefully shedding some light onto Dr. Jo Melios' expertise in

men's pelvic health therapy and her research background. So without further ado, let me introduce Dr. Jo Melios to the show. Dr. Jo Melios, thank you so much for being on the show today. Hi Susie, thanks so much for having me. It's a great pleasure to be here again. I know you've been a guest on the show before where we talked about prostate cancer and treatment and it was such a wonderful conversation and I was inspired to bring you back on the show because your new research around Peyronie's disease and treatment options are showing very promising results. So I want to dive right in into the topic of Peyronie's disease. Let's just define what it is for the listeners out there. Yes. So Peyronie's disease is actually

a condition where there's some scar tissue formation in the penis, and it's a really difficult problem to treat. It does affect one in 10 men across the globe. And I actually encountered it after one of my radical prostatectomy patients had actually suffered with it about a year after their surgery. So its definition is aberrant wound healing in genetically susceptible individuals forming a plaque within the chambers of the penis so around the the penis there's a little elastic like ligament or envelope band called the tunica alba ginea and the tunica can be like a a ligament that gets a tear in it and then it starts to form a plaque which then over time worsens to compromise one of the or even both of the chambers of the penis the chambers

called the corpus cavernosal chambers and then over time as the plaque develops unfortunately tissue changes and then causes physical deformity of the penis which is only seen in the erect state there can actually be pain as well as this physical deformity and the deformity could look like an indentation or it could be a curve or a bend it could be like an hourglass formation or a hinging effect there's so many variations to the physical appearance but for most men it's really distressing to see this problem let alone it also countering pain so it's it's confounded doctors for many, many years as to how to treat it best. And it's been a difficult one because lots of different things have been trialed. And apart from surgery, all the other non-surgical

interventions are only about 30% effective. So I found a bit of a gap in how men were being treated. And that's what led me to doing further research. Well, we thank you for doing this research because it is quite promising as far as the conservative approach of dealing with Peyronie's disease and actually I would say significantly reducing the curvature and so forth. And we'll get into the details of your research, which I'm really excited to do. For those who might not know what the potential causes or risk factors might be, could we kind of go over that a little bit as far as who is more likely to perhaps, you know, experience Peyronie's disease? Sure. So there's a range of factors and it does a little bit depend on the age group. So the most

common age of presentation is between 50 and 60 years of age. And we think that's probably linked to more cardiovascular changes that generally occur during the aging process. Most of those guys who are a little bit older won't have any trauma. But it's actually probably incorrectly suspected that there has to be a physical trauma as the background incidents. Now, I actually uncovered through my clinical presentations of bronies that probably only about 40% of men recall any sort of trauma. And so, the trauma is typically linked to sexual activity. So it's thought that maybe during sex, there's a sudden shift in position causing a buckling effect. And this then creates pain, which is like an acute presentation that men will often recall.

But I often find that this is not something that most patients can. And in fact, my research paper actually states that only about 10% of men over 40 actually recall an incident. So, that's actually really interesting because when doctors assess these patients, they're always anticipating there's been some trauma. So the background more likely is that there's a history of something called Dupuytren's contracture, which is like a ligamentous change in the hand. So about 40% of patients have like a trigger figure appearance of their fourth and fifth fingers.

So there's like a little bundle of connective tissue in the hand. And so that's one of the first physical objectives I look out for. So I always get a check of guys' hands. Then there's a background of potential cardiovascular issues like heart disease or diabetes. I've got several young patients in their 20s and 30s who have had very severe calcified Peyronie's blocks because of the changes to the blood flow. and then there's other risk factors like smoking having a background of erectile dysfunction which is often associated with aging but then there's another group which I stumbled across

which are those guys who've had treatment for prostate cancer so if there's been any pelvic surgery often that can affect the nerves that supply the blood flow to the penis called the capinosal nerves. So after radical prostatectomy, one in six men actually will develop coronary disease following their treatment. And after radiation therapy, one in eight men. I've seen other patients over time who've had other surgeries like hernia repairs or bowel cancer surgeries where there's also been some ongoing changes to the nerve structures. So there's quite a cohort there and then we have the younger patients and the younger patients that I see have been as young as 17 and it's usually with those younger patients more related to sexual

activity usually a sexual encounter where there's actually been yeah that same shifting position with their partner moving too suddenly it occurs in the erect state during sexual trauma and that's really because the penis is not designed to bend but if there's a sudden movement it can actually cause a tearing of that tunica albiginea and then this guy tissue formation presents so there's quite a bit bit to it so and and also i think for you know taking a bit of pressure off of the situation as far as masturbation because i do get that question asked a lot as far as did does masturbation cause this issue for me and what i'm hearing from you and what your research is showing is that the likelihood of that is very low is that

correct i haven't actually ever seen that uh i've seen condition hard flaccid which is a little bit different hard flaccid syndrome is uh you're a little bit more involving the pelvic floor and quite different, but no, I've never had a case. And I'm upward of 500, maybe 800 chronic disease cases individually I've worked with over the last seven or eight years. So yeah, I wouldn't at all link the two in my experience. Great, great. And I'm sure that mitigates a lot of fears and anxiety for some people as well, you know, just wondering like, am I doing this to myself? Yeah, for sure.

Okay, great. Great. Thank you. Now, as you've mentioned a couple of the symptoms already, the curvature, the deformity of the penis, it may or may not include pain. Is that correct? Sometimes pain is part of that. So if there has been some trauma, then that usually sets up an inflammatory process that causes pain. And some patients will come in and they've had a history of bruising and pain, acute pain for, you know, a few months. And we should actually talk about the way that presents now. So Peyronie's disease has an acute phase, which can last 12 to 18 months, and then a more chronic or stabilisation phase, which is anything beyond that time. So, what we want to understand is while there's pain, then the Peyronie's disease is in its active stage and it can progress during this time and we want to literally arrest that process. So, my whole goal in doing the research, as I've discovered, is that the earlier we pick up Peyronie's disease, the easier it is to treat. And we can actually treat it as any soft tissue injury that might occur to any other body part.

And hence, the ultrasound, the therapeutic ultrasound that I end up using is just a simple go-to treatment option that most physios around the world have access to. So, yeah, pain is something that we know will indicate the acuteness of the situation. but then some guys never experience pain and they're the ones who are the non-trauma patients probably about 60 percent of the patients actually that I've seen who are more likely to slow cardiovascular changes over time and and we've actually made quite strong links between erectile dysfunction and penile changes and heart disease and we know that if a man notices that there's any significant change to his penile function that potentially there's a three and a half year window before he might have a cardiac event like a heart attack so we want guys to be

in tune with their blood flow so i always say your hard health and your heart health are related and yeah we then get over time the worsening of these physical appearances the curvature but it's also difficult for some guys who have erectile dysfunction because you'll only see the deformity in the erect state so as with my prostate cancer patients they don't actually know that they've got the proteins developing quite often until their erections improve and that might be one to two years after that might be when they start using a penile injection and it basically occurs because there's been scar tissue development because of the reduced blood flow because of the nerve damage so yeah it's it's a it's a confounding one yes and

what about palpation of or feeling certain nodules or changes so some of some of the patients will actually say that their first what alerted them first is is texture changes or tissue changes that they're feeling when flaccid but but then upon having an erection then noticing that there's a slight bend i mean that we're talking about very mild mild changes in the beginning or perhaps this acute phase that you're talking about um can you speak a little bit about to palpation and if somebody's sure so it surprises me uh sometimes because i often palpate really significant calcified plaques that are bony and guys will say that they've never actually noticed it themselves it's just that one day a plaque yeah sorry a curvature appeared and I

always find that a little bit tricky to understand but what I like guys to do is to like once a month do a bit of a self-assessment even in the shower and basically run their hands down their penis in the flaccid state and it's often like a pea-sized nodule that they'll notice which is quite soft They might ignore it, but then if they notice that it's becoming painful or getting larger, then they really need to action and get some assistance for it. It's very abnormal to have these plaque presentations. And in the early days, as you often find with guys, they'll just dismiss it and think, oh, no, I won't worry about it. It'll go away. Or as one of my patients did, he decided to inject his little nodule there.

and that only made it bruise and worsen quite significantly. So it's really just a case of doing that self-examination. As time goes by, I do find the plaques tend to get denser, bigger, and then move to a calcified state. And we can prevent that by detecting these plaques earlier. They're often recorded as fibrous plaques on the Doppler scans, and that's when we can use the therapeutic ultrasound to treat them quite um easily great that's wonderful so since we're talking about the

therapeutic ultrasound let's segue into into that i was actually wanting to talk about what conventionally before the therapeutic ultrasound had a platform what conventional medical interventions were offered or are offered to to men who experience these changes uh yeah wherever you'd like to start with that we could talk about your research we'll talk about the traditional so so if i relate back to my very first case so he was a 45 year old man that had a radical prostatectomy and then eight months after his surgery he noticed this lump he was using the injections at the time to help with his erectile function and he noticed that uh he was developing curvature but he left alone for another

five months and over that time it actually progressed so he knocked on my door he was quite upset quite devastated this has a big psychological impact he could no longer have sex even though he'd regained um satisfactory erectile function he had a curvature that was angling 75 degrees to the left with a bit of upward rotation so uh he had felt this hard lump and thought that his prostate cancer had returned i reassured him that it was unlikely that we should get a scan, however, and that I would consult with my brother who's a urologist to confirm things. So basically the Peyronie's disease has had a range of options

for treatment with surgery being the only option that is considered curement of the problem. But surgeons don't like to do this until they're in the chronic phase or they're that 12 to 18 months at least post-presentation. In the meantime, many guys actually get a deterioration in their symptoms and probably 90% actually will have a fixed change if they don't get some treatment for it. So medications have been used over the years,

include a range of things like the PDA5s like Viagra and Cialis. then there's been things like collagenase injections something called xyoflex and the medications are thought to have this 30 to 40 percent effectiveness only then we've got vacuum pumps which can help to expand the tissue help hope to re-engorge the the area and there's a really good one called the soma correct which i've used quite often which is a cylindrical inner pipe in it, which enables the curve to be straightened out under that vacuum pressure. Then there's traction devices that are devices that actually need

to be worn for a number of hours per day, which have actually been considered quite difficult to maintain. And fortunately, there's a couple of new ones out that don't require patients to wear them for 8 to 12 hours a day. and they have definitely shown improvement with reduction of curvature over time but it's really difficult for men to apply these as a daily activity so we've got treatments there that have been used and utilised but there's a lot of work involved a lot of time and only this sort of 30 to 40 success rate in it so that led me to trying to understand how it could help this first

patient in a way that hadn't been tried apart from those measures in or in addition to them if I if I had him willing to try things but he was just emotionally distressed and quite quite scared about the prospect so that's when I stumbled across some case studies of this ultrasound being effective way back in the 1980s. So that led you to your research, which I'd love to talk about as far as your paper, which I have pulled up here, Peyronie's disease and the role of therapeutic ultrasound or randomized controlled trial. Dr. Jo, could you talk to us about your research?

Yeah, sure. So what happened with this first patient was that I got him to get a Doppler scan and I then went right we'll find out what's going on with this ultrasound so because I was doing my PhD in prostate cancer I was able to look into what might have been helpful previously and ultrasound became an option and I had a conversation with US physiotherapist Sandy Hilton and she'd said that she'd actually used this on three or four patients of her own to good success 20 years earlier and because of that I had the opening to to look at what what was present in research historically and I found a paper from 1983 by a urologist and he'd seen about 25 patients

over seven or eight years where he'd done a therapeutic ultrasound in clusters of sort of 12 sessions and he repeated those uh depending on what what patient presented with anyway he got about a 70 success rate and so all the patients that he saw that had pain had resolution of the pain most reported a reduction curvature and then a reduction or complete resolution of that plaque with the ultrasound being applied so this first patient we pretty much devised a program and over a month I saw him about 10 times and then had his ultrasound his Doppler ultrasound repeated and there was a complete there was no evidence of the plaque anymore in fact he'd had a couple of little foci tiny little calcified spots present on the first scan that were no longer

there either so the radiologist and sonographer that did these studies had been working together for over 25 years and they'd never seen a reversal of this process so they looked at me with the results and said you're onto something joe let's get busy with it so over the next two years they helped me recruit about 50 patients and then we have this random control trial so it had not been a random control trial in in the past so all the other ultrasound studies that backed it up and And it actually had been a few more, stretching back to the 1960s, actually, were case study series. So by having a random control trial design, we had the opportunity to assess men who had coronary disease that received treatment and then not received treatment in a comparative control group every period of time. And then we had the results come forward to show that we were able to repeat that pattern with men having the Doppler scan show us that there was a reduction in plaque size.

And that was just really important because that was me being blinded. So I had no input into what was going on with those scans. And so the before and the after was repeated by the ultrasonographer and the radiologist. The interventions that I could also measure that we called the secondary outcomes were the angle of deformity. So we were able to show that that decreased by an average of 17 degrees or 38% of the curvature over this full to six-week timeframe of using the ultrasound. and that pain reduced in all of those patients who had pain present. And then we did some questionnaires.

So the questionnaires firstly assessed something called the Peyronie's Disease Questionnaire or PDQ score, which is more of a psychological tool as well to assess a man's and his partner's actually, response to the Peyronie's disease visually, the feeling of pain, and then the effect that that might have on his personal satisfaction with sexual activity. And then we used a very standard measure called the International Index of Erectile Function to actually assess erectile function scores.

And all of those are really positive outcomes as well. So we wanted to have measures that were objective as well as subjective. And that combination hadn't been done before. That is fascinating, Jo. And honestly, as you're saying, as you're alluding to the improvement seen across the board, I mean, in your randomized controlled trial, I thought, you know, the graphs that show, you know, the significant differences in curvature, which is a huge difference. that didn't require an injection or traction devices or what have you. It was very, I would say, easy to administer and comfortable for the patient as far as that is concerned.

And then their outcome scores and the Doppler ultrasounds that you were doing to confirm. I mean, just amazing results from this research study. Yeah. And it really was one of those studies that came about purely by accident from that one patient being brave enough to knock on my door having a fortuitous conversation with Sandy Hilton when I was visiting family in America and then you know the first patient having great success and that was in 2014 so moving on eight years I wanted to understand the long-term benefits of this as well so the protocol was to do two or three sessions of this therapeutic ultrasound

a week over four to six weeks a total of 12 sessions and then over time working out whether or not that was a sustained improvement and it actually was and over the subsequent seven or eight years I've had this patient come back every three months and I'm pleased to say he's been um absolutely fine throughout so his uh curvature reduced uh no other medications no traction devices required at all and that's that's the basis of doing research that you can only really try and work with one domain and one parameter i found that a little frustrating at times because i knew other things might help in a multi-modal sense um maybe some medication in a vacuum pump to assist which clinically i'm able to do but yeah doing the research was quite challenging for me as

well to be able to um only provide one treatment modality right and i was you just read my mind because i was going to ask you clinically are there benefits to combining having a multimodal treatment approach with using therapeutic ultrasound and also a pump or traction devices etc yeah in fact in my in my research i did actually add a vacuum pump and i did another whole second wave of experimentation where i continued working with one group who didn't use a vacuum pump and another group who did and i used the soma correct which was the cylindrical device input and yes i definitely found that there was an even faster progression or regression of the curvature improvement in particular

and that really helps psychologically men have, you know, that normal appearance once again. So in the real world, in the clinical world, we can actually add these extra devices in. And so a standard treatment these days, working with urolitis, we now have a bit of a standard protocol where patients have the Doppler studies they get Cialis low dose medication that they take for roughly three months which is a five milligram daily dosage and depending on their angle of curvature if it's more than the

30 degree curvature then I prescribe them a vacuum pump but the good news is local doctors even GPs as well as urologists are now on board with this treatment and they want to try and minimize the development of it so we're i'm finding less and less we actually need to add in those extra devices because they're being picked up in the very early phase and often within three ultrasound sessions we've got a resolution of pain and then maybe just another three ultrasounds or i now use a little bit of shockwave therapy which is a outcome that is really helpful for those patients with calcified parts. So yeah, we often need only three to five sessions for those early acute stages that are picked up within the first three

months or so. That's wonderful. Now, a couple of questions come to mind as far as shockwave therapy. Is that a new area of research for you as far as using shockwave therapy for Peyronie's disease is that in the horizon or well yes and no uh i actually had the opportunity to speak at a conference here in australia the australian physiotherapy association in 2019 and at the conclusion of my presentation which was basically just presenting my results here uh i had a rep come up to me from a company who was using the low-dose focal shock wave in early studies for chronic disease and they wanted me to trial it out and I was a little bit skeptical to be honest and the actual product is extremely expensive and I because 70% of my patients were already

getting better with the ultrasound I just thought you know I wasn't sure if this was going to work So, what did make me curious was the 30% of patients that I couldn't help with their therapeutic ultrasound were those that actually had the calcified plaques, which the ultrasound couldn't penetrate. So, I decided to trial this shockwave machine for a six-week period. And anybody that had not benefited from the ultrasound, I brought them in for treatment. And surprisingly, a number of those reported improvement. so because COVID just started happening all my patients then stopped coming through so no one was going anywhere it was just this machine sitting there with no patients to use use it on so it sort of stopped for a few months but then here in Western Australia where I live

we had zero cases we but it's basically shut down to the world and I was able to continue on with lots of referrals coming through from the initial radiology group that helped me out with referring patients in the trial. And then I was even more taken aback because we repeated the study in a more informal way. And about another 50% who had been unresponsive to the ultrasound therapy started responding to the shockwave. But the recommendation was for six treatment sessions.

And I was finding it was more needing to be upwards of 10 to 15. And I was losing a little bit of faith along the way because this is an expensive machine and an expensive treatment option. And I didn't want to have false hope or create this disillusionment for patients. But then one of my original participants came back and said he wanted to trial it because although his curvature had sustained well for three years, he was post-ultrasound therapy,

he was noticing a slight curve again. And within 10 sessions of the shockwave therapy, there was complete resolution, and then that sustained. Now, that made me think, let's get a little bit more proactive with looking at this. So we really did then have the opportunity to trial shockwave on a range of different patients, including post-prostatectomy patients for erectile dysfunction, and then I saw its value emerging.

So Peyronie's disease has definitely got a role for shockwave and particularly for patients who are chronic without pain. If we use shockwave too early, I find that the inflammatory effect that it produces is often intolerable. so I actually now combine those painful patients about three ultrasound sessions to reduce the inflammation and the pain and then move on to shockwave so I did actually end up purchasing that machine and I arranged a payment sort of process that I was comfortable with that makes it available to many many patients now rather being cost prohibitive yes I'm delighted to say

that i'm finding it really really helpful in terms of formal research uh i've decided not to pursue that because there's another couple of trials going on okay um anyway with that and um it's really difficult to uh go through that whole rigorous randomized control process but which i so admire i admire the effort the it's so it's so challenging just yeah i don't think people realize how much how much blood sweat and tears and you've done it too so yeah yeah but i'm happy to contribute to other people's research and i am doing quite a lot of that and reviewing other people's research and a sounding board for others and a little bit of mentoring around the world i i'm really surprised but of all the work i've done this is this perennials disease is

filled in a gap because there hasn't been this opportunity to provide a simple non-invasive treatment that actually doesn't have any side effects it's really comfortable for patients it's always embarrassing the very first time but after that you know it's it's a 10-minute application two or three times a week that any physiotherapist around the world can replicate so So I'm sitting here today because I do have faith in the scientific process that we did, making sure that it's reproducible with others following the trial components. And it is quite straightforward in the paper.

So any physios out there, health providers that are looking to get the protocol that was used in your research, it's laid out there very well, nicely to be reproduced, just as you say. so thank you for that gift and sandy hilton of course and your and your courageous patients yeah well one thing we haven't mentioned is the huge psychological impact that this condition has so a lot of the time i've seen patients have had but up to 30 years without going to see anybody and fortunately as you know times evolve younger younger people are much more open to having these discussions and we'll go and seek advice earlier and we want to use to utilize this

opportunity because the acute phase is when we can do something about it we can reverse it if you leave it longer with surgical interventions and that can impact on the sexual function too it can cause erectile dysfunction particularly if we have to start removing um plaques the The plaques then damage the nerves surrounding that area and then you're left with erectile dysfunction. But Peyronie's disease usually results in penile shortening as well and that is something that really impacts on a man's sense of self-esteem and masculinity.

With the pain associated with Peyronie's disease in the early phases, often they don't want to engage in sexual activity. That can have impact on their relationships or there can be this discomfort for their partner because of the causing pain to the partner during sexual activity and then the actual physical appearances is really quite devastating for some men with we know 50% of men who have this condition actually have clinically diagnosed depression and more than 80% are psychologically distressed and impact by it with more than 50% having relationship

difficulties because of it. And so when men hide away dealing with this problem, it's really potentially quite devastating on their mental health. So as with all my studies and clinical work, it's all about actually maximising the man's quality of life and that of the people in his life because, you know, you don't want to hide these situations. they're really easy to manage if we get onto it early right right yeah and and sometimes watchful

waiting is not a good idea in this circumstance especially if time is of the essence to to act fast and early on to reduce the impact of the outcome yeah and um one of the most prolific researchers in this field dr john marlhall from the us um he actually was reviewing around about 250 patients diagnosed with Crohn's disease over one year without intervention. And he found only 12% of them got better and 48% of them got worse and 40% didn't change from where they started. So in actual fact, that was 88% of guys being stuck with their condition and progressing over that time in half of them. So it's not going to go away in its own usually. Right, right. And that was a question that, again, I had on my mind of asking you spontaneous resolution. You know, how often does that happen with with parodies? And you basically addressed it in what you just said, of spontaneous resolution. And so I suppose then, how do we, Dr. Jo, in your opinion, how do we, how do we break the barriers to help men reach out to someone like yourself?

yourself and other physios like myself to get care sooner what do we what do we have to change what has to change what has to change is yeah no we just first of all the research papers actually having something in writing and that's never going to go away now we've actually proved that the uptown has a role so a lot of the time it'll be patients themselves men in the community who are accessing all this information on the internet probably half my referrals now are from self referring patients so that's really important so we've got that education process then we have the capacity for men to share these papers if they find them with their GPs and with their urologists because you know not not all doctors are going to be across what physiotherapists

can do. So there's, you know, quite a gap there. I often find that my male patients are my best ambassadors and I can write a doctor's report, but it might never be read. But if a man goes in with a very meaningful situation and a resolution, then the doctor's going to really hear that. It's really on the onus then of, I think, men becoming more in tune with what a change or abnormal state for them and that self-assessment self-palpation like a monthly first of the month campaign I'd love to have that where men check their penis and then their testicles and then be aware of things like prostate health just like women do with self breast examinations make the first of every month the day they do their personal check

it should only take one one minute if that and then we have a role as physical therapists I think to actually ask our patients if they've been aware of any pain or aware of any change in their sexual function or penile shape or appearance and they're not easy questions to ask But once you've asked them 10 times, it's like asking a question about the ankle or the knee. It becomes part of your everyday questioning and assessment. And yeah, I mean, I get to examine five to eight different men's penises every day. And I always know that it's very confronting for my patient and that I'm very comfortable with it because that's what I spend a lot of time doing and treating now. But I always have to remember that for this patient, it's usually extremely confronting and not something that he's wanted to attend.

He's probably quite mortified by being there. But, you know, it's just a case of making the guy feel really comfortable, letting him show me where he's noticed a plaque or he's noticed a bend. And I try and make it a very non-threatening situation. Sometimes guys ask me if they need to have an erection for me to see their plaque or see their bend. And that's not required at all. So we have the benefit of just everyday palpation, but also the Doppler scan, which is always good to have. And most men who have a Doppler scan don't get the penile injection because they don't have erectile dysfunction. They just have this deformity.

So it's another reason within my study, I didn't want to be too invasive. so I didn't want to subject men to injections and we didn't actually have to because they didn't have erectile dysfunction most of the time and yeah that just takes a lot of barriers away so that physiotherapists can actually work from beginning to end with a patient as well. Yeah that's wonderful thank you so much Dr. Jo really appreciate you being on the show today and sharing with us such amazing knowledge and having these conversations to help other men who might be in this situation

find help sooner than later. So it really is such a gift and thank you so much for all the work that you have done and you continue to do for all of us, for us clinicians and for patients alike. So thank you. Where can listeners connect with you, find you? I know you've got your own podcast

and other things going on. so please share yeah so thanks for mentioning that Susie and thank you so much for your invitation today and your generous support of my work so yes I actually teamed up with a colleague Melissa Hadley Barrett who's a nurse practitioner and sexologist and we have a podcast a weekly podcast called the penis project and we actually interview patients and medical specialists and different experts across the field of men's health. But we've got probably five podcasts relating to Peyronie's disease. So if anyone wants to go and look at wherever they get their podcasts,

it's on Spotify as well as all the usual platforms. Episodes six and seven are about Peyronie's disease. And then if you screen through, we've got about 80 now. I think number 46 is a really helpful one to listen to. and another couple of ones there. My research paper, potentially we can add that to the show notes. I was hoping you were going to say that.

Yeah, so Susie's going to share that so anyone can download that, read it, take it to their GP, to their physiotherapist or vice versa. And then I am always available on social media. I have a Men's Health Physiotherapy Facebook group for physiotherapists around the world so that's just called men's health physiotherapy and it is it's got 3.8 000 physiotherapists dedicated to looking after men across the

world now all linking in and then on twitter i'm prostate jojo and i'm available on linkedin and Instagram is drjoemiliosphysio and I have a website menshealthphysiotherapy.com.au and that should be enough. Very generous thank you Dr. Jo Melios thank you again for being on the show and to all of our listeners and viewers there thank you so much for joining us until next time my friends this is Dr. Suzy G and loving wellness for your pelvis. Take care. Thanks for listening to today's episode. Be sure to head on over to drcg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast,

and leave us a rating and review. We'd love to hear your feedback. Thanks again.