Long-term Outcomes of High-Energy Shock Wave Therapy in Chronic Peyronie’s Disease

Overview

This study reports long-term results of high-energy extracorporeal shock wave therapy (ESWT) in 110 men with chronic Peyronie’s disease using two different electromagnetic lithotripters. The treatment demonstrated plaque fragmentation and symptom improvement, with detailed evaluation of curvature, pain, and erectile function over extended follow-up.

Background

Peyronie’s disease is a connective tissue disorder causing penile fibrosis, deformity, pain, and shortening, often progressing from an acute inflammatory phase to a chronic fibrotic phase with plaque formation. Therapeutic options include oral medications, intralesional injections, and surgery, but many have limited efficacy or adverse effects. ESWT was introduced as a non-invasive treatment, primarily for pain relief, but its role in plaque remodeling and curvature improvement remains under investigation. This study evaluates high-energy ESWT using two electromagnetic lithotripters over 20 years to assess long-term outcomes.

Data Highlights

Key Findings

• High-energy ESWT was applied successfully in 110 patients with chronic Peyronie’s disease over 20 years using two different lithotripters.
• Both groups had comparable baseline characteristics including age, disease duration, and comorbidities.
• Plaque fragmentation was observed on ultrasound after treatment, indicating remodeling of fibrotic plaques.
• Curvature was classified into three categories and monitored via self-photography, showing potential improvement post-therapy.
• Pain reduction was assessed using a visual analog scale (VAS), and erectile function was evaluated by IIEF-5 scores.
• Long-term follow-up data were available for 85 patients after excluding those with prior radiotherapy, previous ESWT, or insufficient sessions.

Clinical Implications

High-energy ESWT using electromagnetic lithotripters may offer a non-invasive treatment option for patients with chronic Peyronie’s disease, particularly for plaque remodeling and pain management. Careful patient selection and monitoring with ultrasound and functional scores are essential to optimize outcomes. This modality could be considered when intralesional therapies are unavailable or contraindicated.

Conclusion

Long-term high-energy ESWT demonstrates promising results in managing chronic Peyronie’s disease by facilitating plaque fragmentation and symptom improvement. Further controlled studies are warranted to confirm efficacy and define optimal treatment protocols.

References

1. Coyne et al. 2013 -- Modified Peyronie’s Disease Questionnaire for symptom evaluation
2. EAU Guidelines 2023 -- Management of Peyronie’s Disease
3. Siemens Medical Devices -- Lithostar Plus and Lithoskop lithotripters