What is Peyronies Disease (PD) and why may Shockwave Therapy help?
Peyronie’s Disease (PD) is a connective tissue disorder of the penis affecting approximately 1 in 10 men, resulting in a range of possible symptoms such as penile deformity, pain during sex, associated Erectile Dysfunction and psychological distress. But it may affect as many as 20% of the male population. Peyronie’s Disease (PD) can have an impact on male self-esteem, relationships and erectile function. PD arises due to the formation of inelastic scar tissue, creating plaques in the tunica albuginea (TA) of the penis in genetically susceptible individuals or following microtrauma.
The plaque results in palpable penile scar tissue in the flaccid state and may cause pain, penile deformities, penile curvature and penile shortening that are generally only seen in the erect state.
Who gets Peyronies Disease PD?
Typical sufferers of PD are around 55-60 years of age and the condition is known to be associated with erectile dysfunction (ED), diabetes, obesity, hypertension, A-positive blood group, hyperlipidemia, smoking and following pelvic surgery.
The onset of PD might be associated with a history of buckling during sexual activity, an identified history of penile trauma is uncommon and recalled by only 10% of patients older than 40 years. A further 10% of PD presentations occur in men under 40 years, with teenagers also known to develop the condition.
What are the treatment options for Peyronies Disease (PD)?
Current treatment options for PD include penile injections, vacuum pumps, traction devices and surgery.
PD has an ‘acute phase’ that may last 12-18 months before stability (the ‘chronic phase’), doctors are generally reluctant to introduce treatments too early and often recommend a ‘wait and see approach’. In reality many patients are distressed by a lack of action or treatment options and greatly fear the condition worsening over time. Only some of the patients are offered a specialist urological opinion and only the most severely affected access treatments such as surgery. The rest are left to self manage this distressing condition.
Thus, most men with the condition will find their penile changes to be permanent, which may greatly impact on their quality of life.
Why use Shockwave Therapy for Peyronies Disease (PD)?
Shockwave treatment for Peyronie’s disease has been around since the late 1980s’. Authors hypothesised that the effect on the plaque would be similar to shock wave lithotripsy, breaking the plaque into small particles. Studies using current shockwave therapy reported promising results from around the turn of the century. Several studies have been published, leading the European Urological Association guidelines to recommend this treatment for Peyronie’s related penile pain. It has been slower to be recommended in the UK.
In the UK as far back as 2003 the National Institute for Health and Care Excellence (NICE) reported on the efficacy of Peyronie’s Shockwave Therapy saying that, the main benefits of ESWT were the alleviation of pain and reduction of angulation of the penis. In one study 50% of patients receiving shockwave therapy experienced a decrease in curvature of at least 30%, plus evidence suggesting some improvement of sexual performance.
Another advantage of using Shockwave Therapy for PD is the assistance it provides in the reduction of pain that many men suffer. A study by Abdessater et al in the Asian Journal of Andrology published in 2022 demonstrated an improvement in penile curvature from 31° to 17° using Low Intensity shockwave therapy compared to previous studies, along with a reduction in penile pain and plaque size in patients treated during the acute phase of PD.
Shockwave Therapy for PD is a safe, non-invasive treatment option. Although receiving treatment in the acute phase is more desirable in terms of effectiveness of the results, patients can be seen who have had the condition chronically.
Why use Focused Shockwave Therapy?
Firstly not all shockwaves are created equally. The most effective shockwaves are what we call focused, these machines are more expensive but produce more reliable energy levels for effective treatment of PD. Radial machines (commonly used for soft tissues problems) are not shown to be effective in the treatment of PD.
Then we have different types of Focus Shockwave Therapy equipment and some of the early machines used 10 or 20 years ago were only partially effective. If in any doubt you should be reassured by this article in the Sexual Medicine Review published in 2020 which looked at six Shockwave Therapy devices used on patients with ED and/or PD. These studies had huge differences regarding the power of the machines and the energy levels, they could provide. The authors concluded that there is growing evidence that protocols with greater energy levels may give far better results and that many of the studies with less effective results were with markedly under powered equipment.
We use Storz Medical equipment via Venn Healthcare which is the highest quality of equipment available.
Why come to Edinburgh Shockwave?
Our therapist has been treating PD since 1990 when therapeutic ultrasound was used and using Shockwave Therapy for many years treating a wide range of other conditions. We are experienced providers of Shockwave Therapy for Peyronies Disease (PD)and the clinic has Focused Shockwave Therapy machines from Storz Medical. This equipment is used in most of the clinical studies achieving the best results.
Summary of the use of Shockwave Therapy in the treatment of PD:
- It is a non-invasive and safe treatment option.
- It has been shown clinically to reduce the pain often associated with PD especially in the acute phase.
- It is effective in improving the erectile dysfunction element associated with PD.
- Evidence indicates it can soften (if not reduce) the size of the plaque and in some cases this can aid a small reduction in curvature size. Studies showing this are of mixed strengths and need further work.
- It can be used alongside erectile dysfunction medication or penile pumps.
- It has a high patient satisfaction rating at both 3 months and 12 months post treatment of over 90%.
Abdessater M, Akakpo W, Kanbar A, Parra J, Seisen T, Chartier-Kastler E, Drouin SJ, Roupret M. Low-intensity extracorporeal shock wave therapy for Peyronie’s disease: a single-center experience. Asian J Androl. 2022 Jan-Feb;24(1):45-49. doi: 10.4103/aja.aja_40_21. PMID: 34045390; PMCID: PMC8788614.