Answers to Frequently Asked Questions

How does a man have an erection?

The penis is a very vascular organ that is divided into several compartments including the corpus spongiosum and the corpus cavernosum. The corpus spongiosum is located midline along the penis and contains the urethra, through which urine and semen flow. A man has two corpora cavernosa situated laterally on the left and right sides of the penis. The corpora cavernosa contain erectile tissue that can expand when a man becomes sexually excited. Like a water-balloon that expands when filled with water, the corpus cavernosa elongate when filled with blood. During an erection, blood fills the erectile tissue causing them to become rigid. This engorgement compresses the veins within the penis and maintains the erection by preventing the blood from draining back into the general circulation. When sexual arousal ends, sequestered blood in the erectile tissue drains back into circulation, and the penis becomes flaccid.

Problems with any aspect of this complicated process may result in difficulties sustaining an erection and engaging in sexual intercourse.

What is Peyronie's Disease?

Peyronie's Disease is a build up of a restrictive "plaque" around erectile tissue of the penis. Plaques are firm, fibrous, scar-like tissues that do not stretch. Like a thick rubber-band that constricts the inflation of a balloon, a plaque causes a restriction that prevents the penis from expanding in that area. This can cause an abnormal curvature at the point of restriction as one side of the penis expands and the other does not. In some cases, the curvature is so severe that the man is unable to engage in vaginal intercourse.

Peyronie's Disease is believed to be an inflammatory process initiated by major or repeated minor trauma to the penis during sexual intercourse. Blood that leaks from injured erectile tissue causes inflammation within surrounding tissue. The process is exacerbated by repeated microvascular trauma and could be considered as an abnormal healing response with excessive scar formation.

The prevalence of Peyronie's Disease is thought to increase with age. The peak incidence occurs in men between 40 and 70 years old. A recent study found the mean age of affected men to be 57 years. This finding may be explained by the changes men experience as they age. A young man has strong elastic tissues in his penis that resist injury. An old man has weak tissues that can tear, but his erections are also weak. Consequently, penile injury is unlikely to occur. In contrast, a middle age man begins to lose the tissue elasticity while at the same time still maintaining fairly strong erections. Injury is possible because the tissue is less able to resist injury.

Common presenting symptoms associated with Peyronie's Disease include curvature of the penis or other deformity, painful erections, and identification of a palpable penile plaque. These symptoms are characteristic of the acute (or inflammatory) phase of Peyronie's Disease. This phase lasts 6 to 18 months during which active inflammation occurs in the penile tissues. After this period, the chronic phase begins. During the chronic phase, the plaque normally stabilizes; however, it may progress with enlargement or calcification or it may resolve. One study documented that the disease continued to progress in 40% of patients, stabilized with no progression in 50%, and gradually resolved in 10%. Resolution tended to occur in younger patients in the inflammatory phase. It has been suggested that prognosis improves if treatment is instituted early, during the inflammatory phase.

Conservative Therapy

Treatment for Peyronie's Disease should aim to produce pain-free erections and the restoration of straight, rigid erections. Furthermore, conservative medical treatment should help to avoid surgical intervention.

Aminobenzoate Potassium is an oral, prescription medicine that is indicated for the treatment of Peyronie's Disease. Clinical studies have documented its beneficial effect on plaque size, deviation angle, pain, and progression.

Based on the results of clinical studies, the suggestion of the effectiveness of Aminobenzoate Potassium and its lack of significant morbidity allow it to be prescribed in the expectant treatment of patients with Peyronie's Disease.

What is Aminobenzoate Potassium?

Aminobenzoate Potassium, also known as potassium para-aminobenzoate, is considered a member of the vitamin B complex. Small amounts are found in cereal, eggs, milk, and meats. Detectable amounts are normally present in human blood, spinal fluid, urine, and sweat. Para-aminobenzoate acid is a component of several biologically important systems, and it participates in a number of fundamental biological processes.

Aminobenzoate Potassium appears to have both an anti-inflammation and anti-fibrosis effect. It has been suggested that the antifibrosis action is due to its ability to increase oxygen use at the tissue level. Fibrosis is believed to occur from either too much serotonin or too little monoamine oxidase (MAO) activity over a period of time. Monoamine oxidase requires an adequate supply of oxygen to function properly. By increasing oxygen supply at the tissue level, Aminobenzoate Potassium may enhance MAO activity and thereby prevent or bring about regression of fibrosis.

Aminobenzoate Potassium Capsules contain 0.5 gram of medicine. The average adult daily dose is 12 grams. This can be taken as 6 capsules four times a day or 4 capsules six times a day. It is recommended that this medicine be taken with meals.

The length of therapy may vary. Clinical studies document that benefits persist during 1 and 2 year treatment periods. Because the plaques are made of firm, scar-like, fibrous tissue, results may become noticeable by two to three months of treatment.

The primary side effects associated with this medication are anorexia, nausea, fever and rash. These have occurred infrequently and subside when the drug is stopped. This medicine should not be taken anyone who is also taking sulfonamides. Patients with kidney disease, diabetes, and hypoglycemia should consider this medication only after careful evaluation by their doctor. Likewise, patients who have restricted intake of potassium for medical reasons must also request careful evaluation by a doctor.

Aminobenzoate Potassium Capsules are available by prescription through pharmacies nationwide. Please note that this medication is generic for the brand medicine - Potaba® (trademark of Glenwood, LLC).

In the interest of fair disclosure, several challenges associated with this medication should be reviewed before initiating treatment.

1. Dosing Schedule: The dosing schedule of ingesting several capsules four times a day is demanding. The medicine is rapidly metabolized and excreted from the body; therefore, frequent dosing is required in order to maintain uninterrupted therapeutic tissue levels.
2. Cost: Aminobenzoate Potassium Capsules from Hope Pharmaceuticals is a relatively inexpensive generic medication that is covered by many pharmacy insurance plans and is eligible for Medicaid reimbursement. Nevertheless, the cost of treatment adds up because of the number of capsules that must be taken each month.
3. Onset of Effect: Treatment does not provide instantaneous effects. The fibrous plaques associated with Peyronie's Disease can be favorably influenced by prolonged exposure to therapeutic drug levels. Medical studies document improvement of objective measurements of penile conditions and subjective patient opinions within two to three months of starting treatment.
4. Results: It is not possible to guarantee the outcome of treatment. Studies document clinical benefits in most of the patients who participated, but not everyone. Treatment outcome depends on factors such as compliance with the prescribed dosing and the extent of the disease when treatment is started. As discussed above, prognosis improves if treatment is instituted early.

References

1. Weidner W, Hauck E, Schnitker J. Potassium Para-Aminobenzoate (Potaba®) in the Treatment of Peyronie's Disease: A Prospective, Placebo-Controlled Randomized Study. European Urology 47 (2005), 530-536.
2. Maan Z, Arya M, Shergill I, Joseph J, Patel H. Peyronie's Disease: An Update of the Medical Management. Expert Opinion Pharmacotherapy 5 (2004), 799- 805.
3. Tunuguntla H. Management of Peyronie's Disease - A Review. World Journal of Urology 19 (2001) 244-250.
4. Schroeder-Printzen I, Hauck E, Weidner W. New Aspects in Peyronie's Disease - A Mini-Review. Andrologia 31 Suppl. 1 (1999) 31-35.
5. Carson C. Potassium Para-aminobenzoate for the Treatment of Peyronie's Disease: Is It Effective? Techniques in Urology 3 (1997) 135-139.
6. Fitkin J, Ho G. Peyronie's Disease: Current Management. American Family Physician 60 (1999) 549-552.
7. Zarafonetis C, Horrax T. Treatment of Peyronie's Disease with Potassium Para-Aminobenzoate. Journal of Urology 81 (1959) 770-774.
8. Hasche-Klunder R. Treatment of Peyronie's Disease with Potassium Para-Aminobenzoate (Potaba®). Urologea 17 (1978) 224-227.
9. Hasche-Klunder R. Conservative Treatment of Peyronie's Disease with Potassium Para-Aminobenzoate Progress and Reproductive Biology. Prog. Repro. Biol. Med 9 (1983) 57-64.
10. Riley A. Peyronie's Disease: A Report on a Series of 18 Patients Treated with Potassium Para-Aminobenzoate. Br. J. of Sex. Med. 6 (1979) 29 -33.
11. Mohanty K, Strachan R, Isaacs J. Peyronie's Disease: A Report of Nine Cases. Br. J. Sex. Med. (1987) 282.
12. Aminobenzoate Potassium USP Capsules Prescribing Information. Hope Pharmaceuticals 2005.