New approach to Peyronie's Disease

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I would like to share with you the results of meta-analysis of the use of extracorporeal shock wave therapy in the management of Peyronie’s disease, published in the International Journal of Impotence Research in 2016. Low energy extracorporeal shock wave therapy or low intensity shock wave therapy is a relatively new rapidly developing treatment modality of Impotence and penile curvature.

 Peyronie’s disease (PD) is a relatively common disorder originating from connective tissue and characterized by progressively fibrotic plaques in the penile tunica. It is one of the most frequent causes of penile curvature, and change of penile length and diameter during erection, and is often accompanied by pain and/or Erectile Dysfunction.  Although PD has been described for over 250 years, its etiology, pathophysiology and treatment are still unidentified.

To date, dozens of therapies have been tried to treat PD, including conservative treatments (oral, intralesional, and topical treatment) and surgery. Though acceptable outcomes would be obtained by intralesional treatment with collagenase, curative effects by conservative therapies have not been definite. Furthermore, although surgery is considered as one of the most effective choices for palliation of PD, it will cause iatrogenic penile shortening and frequently Erectile Dysfunction.  As a topical treatment, extracorporeal shock wave therapy (ESWT) was first used to treat PD in 1989. ESWT was regarded as a promising new choice, and since then, many studies have been conducted to evaluate its efficiency and safety.

However, controversial results have been reported.

According to the European Association of Urology guidelines for PD, ESWT fails to improve penile curvature and plaque size, and should not be used with this intent, but it may be beneficial for penile pain.

In May 2015, two reviewers independently conducted a systematic search of three databases, PubMed, Embase and the Cochrane Library, for all English literature published on or before 20 May without any restrictions.

All available randomized controlled trials (RCTs) and controlled studies (prospective or retrospective) that compared ESWT with placebo in patients with PD were included for analysis.  In total, 122 items were initially retrieved from three databases, and six comparative studies including 443 men were finally identified.

Lessening of plaques
The size of penile plaques was measured using ultrasonography. Three studies including a total of 225 patients reported the results of the treatment on penile plaques. The percentages of patients who experienced a lessening of plaques were 39.8% (33 of 83) in the ESWT group compared with 30.3% (43 of 142) in the control group.

Improvement of penile curvature
Penis deformity was assessed based on photographs before and after treatment. Data describing improvement of penile curvature were pooled from three studies including 198 men, and revealed that 44% (37 of 84) of patients in the ESWT group experienced a significant improvement of penile curvature compared with 42.1% (48 of 114) of patients in the control group. However, the difference between groups was insignificant

Relief and complete remission of pain
The degree of pain was evaluated by a self-scored visual analog scale that ranged from 0 (no pain) to 10 (strong pain). Compared with the control group, in which 51.6% (66 of 128) and 18.8% (12 of 64) of patients experienced relief and complete remission of pain, respectively, the ESWT group presented significantly higher rates with 82.1% (69 of 84) experiencing pain relief  and 61% (61 of 100) experiencing complete remission.

Improvement of sexual function
All publications evaluated in our study reported results regarding sexual function improvement based on self-reported questionnaires. In total, 296 patients with PD had complained of varying degrees of ED, and 39.9% (55 of 138) of patients in the ESWT group had a recovery compared with 29.7% in the control group (not statistically significant difference).

In summary this study showed that Low intensity shock wave therapy or ESWT is associated with significant improvements in patient with Peyronie Disease and can cause plaque lessening, pain relief and complete remission of pain, whereas effectiveness for penile curvature recovery and sexual function improvement was not obvious.  It could be influenced by retroactive study design and definitely requires more studying using randomized clinical trials to get more credible answers.

Do you have any questions?
Get in touch with Dr. Kotkin.

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