Can needle aponeurotomy be done for Peyronie’s disease?

Needle aponeurotomy for the hand is all I see online. I am a Kaiser Permanente subscriber and even at that, I don’t see anywhere online where needle aponeurotomy is performed on a penis…Got any suggestions? Do you know of any Urologist in my medical plan who does needle aponeurotomy for Peyronie?


Martin Carroll, Jr.


Greetings Martin,

Well, you are certainly an adventurous person.

Needle aponeurotomy is a type of surgery done on the palm of the hand to surgically reduce the cords that develop in  Dupuytren’s contracture.   It is surgery performed by inserting a needle under the skin of the palm, and then blindly slashing and tearing at the cords and contracted fascial tissue since the skin is never opened by the surgeon so he/she never actually sees the tissue that is being cut and torn.  The purpose of this procedure is an attempt to weaken and reduce the cords under the skin, so that during the operation the surgeon eventually is able to break or snap the weakened Dupuytren cords.  The recurrence rate for this procedure is fairly high, about a year or two faster than conventional hand surgery.

There are many hand surgeons who are proponents of this technique, and others who are not.  No surgical technique is perfect, and they  all carry risks.   

This same technique of using a large gauge needle to act as a cutting tool is already being done to reduce the Peyronie’s plaque while the actual slashing and tearing of the tissue is not observed during the penis surgery.   This technique of weakening the Peyronie’s plaque with a needle tip is called the Leriche technique for Peyronie’s disease.  When done for Peyronie’s disease it is not called an aponeurotomy since there is no aponeurosis in the shaft of the penis.  To coin a phrase it could be called something like a Needle Tunicotomy, since it is the tunica albuginea of the penis that would be surgically cut  by the needle tip and left in place, but I have never seen that term published anywhere since i just made it up.  To read more about this procedure click on Leriche technique for Peyronie’s surgery

I must wonder why you are interested in exposing yourself to the risks of any surgical procedure four your penis if there are less risky non-invasive Alternative Medicine options that you have not explored?   TRH

What is Ledderhose disease (Plantar Fibromatosis, Morbus Ledderhose)?

Ledderhose disease treatment ideas similar to Dupuytren and Peyronie treatment

Ledderhose disease is a problem of the sole of the foot at the arch, known by several different names: Ledderhose’s disease (LD), Morbus Ledderhose, and plantar fibroma.   This condition was first described in 1897 by the German surgeon Georg Ledderhose, for whom it is named.  Regardless of what it is called, the technical description of the actual tissue pathology is a plantar fibromatosis, just like Dupuytren’s contracture and Peyronie’s disease.  Ledderhose disease occurs less frequently than Dupuytren contracture, but usually in combination with it and less so does it appear with Peyronie’s disease.

Because there is similarity with many aspects of Ledderhose disease and Dupuytren contracture and Peyronie’s disease, anyone with plantar fibromatosis or Ledderhose disease who wishes to avoid surgery, and the probability of recurrence of the problem after surgery, should consider using Alternative Medicine methods to increase the ability of the body to eliminate these plantar nodules or lumps on the bottom of the feet.   Simply go to either the Dupuytren Contracture Institute or the Peyronie’s Disease Institute websites for natural treatment information.

Fibroma is a medical term that means a non-cancerous growth or tumor composed of fibrous or connective tissue elements.

Fibromatosis is a term that describes a non-cancerous soft tissue swelling or mass that contains a large group of well developed and distinct tissue cells known as fibroblasts and collagen protein, a tendency to aggressively infiltrate normal healthy tissue and to recur within the same local area.  The fibromatosis mass of Ledderhose disease usually takes the form of one or more nodules or lumps appearing the superficial layers of the tissue on the bottom of the foot near the highest point of the arch, but occasionally can also present as a cord – just as in Dupuytren contracture, but not as often.

Ledderhose disease characteristics

The Ledderhose nodules are usually painless; as they enlarge they can cause considerable pain when pressure or rubbing is applied as when walking or standing.  Size of these nodules range from 0.5 to 3.0 cm.  The skin overlying the Ledderhose nodules tend to be moved laterally with ease, at least during the early stages of the problem.  Over time, as the condition progresses and as the nodules enlarge they are able to apply pressure to blood vessels and nerves of the foot, causing even greater pain with less walking or standing.

Both feet are involved about 20%–50% of the time, and when involvement is bilateral the extent of involvement is seldom the same in both feet.

Because Ledderhose disease likely has the same or similar genetic cause as Dupuytren’s contracture, and is thought to also be triggered the same by trauma, liver and lung disease, diabetes or chronic alcohol consumption, and stressful work that involves that part of the body.  And just like Dupuytren contracture, Ledderhose disease predominantly appears primarily in men (10:1) during the fifth decade and beyond.  Of four people with Dupuytren contracture, one will also have Ledderhose disease. Unlike Dupuytren’s contracture which affects the hands and causes progressive flexion of the involved fingers toward the palm, Ledderhose disease seldom causes flexion deformity of the toes.  As another point of differentiation, the nodules of Ledderhose are larger than in Dupuytren contracture.   Just as with Dupuytren contracture, recurrence of the lesion of Ledderhose disease is high at 50-75% five years after surgery to remove the fibrous nodules and plantar aponeurosis thickened tissue.

The absence of contracture of the toes in Ledderhose disease is explained by the way the foot is typically used on an almost constant basis to walk, stand and climb stairs; all requiring frequent and repetitive stretching of the plantar (bottom of foot) soft tissue.


Phenobarbital cause of Dupuyten contacture?


Would you discontinue phenobarbital and replace with another anticonvulsant drug when realizing you have DC? Seems like the best alternative correct? Wow! My life is really going to change over the next several months!

Also, do you have a list of things to avoid doing? I’ve been all over the internet regarding this subject and still I come back to you as you seem to have the best overall info.


Phenobarbital is the oldest and most commonly prescribed anti-convulsion drug in the world.  Even so, it can cause a variety of side effects, mostly associated with the central nervous system.

Side effects include sleepiness, varying degrees of sedation and sense of fatigue, memory impairment, tics and poor  coordination of movement, depressed breathing function, as well as involuntary eye movements called nystagmus. Phenobarbital also is associated with muscle and joint pain of the upper extremity,  most notably what is called called “shoulder/arm syndrome.”   A variety of other symptoms related to the skin, digestive system and liver, and endocrine system can occur.  Certain types of brain cancer are related to prolonged phenobarbital use.   Less well known is the ability of phenobarbital to cause Dupuytren’s contracture, as well as Peyronie’s disease.

My suggestion is that you contact the doctor who is treating you for your seizures and advise him/her of your Dupuytren contracture.  Ask for a consultation where you two might review not only the recent development of Dupuytren contracture, but other symptoms and health problems you are experiencing that might also  be related to phenobarbital use.

As far as an avoidance list is concerned I would suggest that you avoid cigarette smoking, heavy alcohol drinking, reduction of refined carbohydrate intake to minimize diabetic tendencies and that you minimize heavy manual work that could traumatize your hands as well as heavy vibration to the hands.  All these factors have been suspected as triggers to Dupuytren contracture for those who are genetically predisposed.

Good luck to you.  TRH