Is Shockwave Therapy (LiSWT) Effective Treatment For Peyronie’s Disease?

What Is Peyronie’s Disease?

Peyronie’s Disease is a plaque that forms on the cover (tunica albuginea)  of the paired erectile bodies (corpora cavernosa.) It’s an acquired condition. (Nobody is born with Peyronie’s Disease.) The first sign of PD may be observation of a hard spot under the skin of the penis. Other symptoms can include pain with erections, or bending of the phallus with an erection. Usually, the pain improves with time, but the bend in the penis can make having sexual intercourse challenging, or even impossible.

How Common Is Peyronie’s Disease?

Peyronie’s Disease is much more common than one might think, given the lack of attention it receives. While obviously PD is not life-threatening, it can definitely affect the quality of life, and be a source of embarrassment, frustration, and depression.  Approximately 9% of men over the age of 40 have PD.

What Is The Cause Of Peyronie’s Disease

Most urologists feel that PD is caused as a consequence of some form of trauma sustained during sexual intercourse. This trauma may be so minor that it was never even appreciated at the time of the event. The trauma may be repetitive an set off a cascade of events, resulting in a reduction in the elasticity of the tunica.

Does Peyronie’s Disease Inevitably Get Worse With Time?

For most patients (89%),  the pain aspect of the condition usually improves, even without any form of intervention. Half of all patients diagnosed with PD will either remain stable, or improve. Unfortunately, half of the patients will show progression, with worsening bending of the phallus with erections. This group is particularly susceptible to emotional distress from their condition.

Can Peyronie’s Disease Lead To Erectile Dysfunction?

There is a relationship between ED and PD. Half of all patients with PD noted ED prior to the onset of their Peyronie’s Disease. Similarly, about one third of PD patients suffer from ED.

What Are The Treatment Options?

  1. Non-steroidal anti-inflammatory agents. This can be used for control of pain, especially in the early stages of PD.
  2. Injections directly into the plaque. Potential agents include collagenase, interferon alpha-2b, intralesional verapamil.
  3. Shockwave therapy. (AUA GUIDELINES reserve this treatment for patients with pain.)
  4. Surgery. Options can include excision of the plaque, with grafting or placement of a penile prosthesis.
  5. Other. A variety of other strategies have been attempted by various investigators. None of these have gained widespread popularity. Included among this group is combination therapy, traction therapy, and the use of various topical agents.

Does Shockwave Therapy Work For The Treatment Of Peyronie’s Disease?

It is generally accepted among urologists that SWT is effective therapy for the pain component of ED, as evidenced by it’s approval for this condition by the AUA guidelines. Peyronie’s Disease (2015)

There are mixed results in the literature regarding outcomes for the reduction of penile deformity.

There is general agreement in the literature that treatment with shockwave therapy is very safe, and well tolerated by patients. Clearly, shockwave therapy is among the least invasive and safest options for treatment of PD.