Background and purpose: To assess in a prospective study whether shockwave therapy (SWT) is effective as a first-line treatment for Peyronie's disease.
Patients and methods: Forty patients with previously untreated Peyronie's disease underwent SWT with the Epos overhead-module device (Dornier). The pain severity (visual analog pain scale [VAS] 0-5), the degree of penile angulation after vasoactive drug injection, plaque size by ultrasound measurement, and erectile dysfunction (IIEF score) were assessed prior to and after treatment. Of the 40 patients, 7 underwent two sessions and the rest three sessions. The time interval between treatments was 2 weeks. At a power level of 2 to 5 (mean 4), a maximum of 3000 shockwaves per plaque per treatment were applied. The mean follow-up was 12 months.
Results: All patients completed the protocol. The tolerance and safety were excellent. Of the 25 patients with pain on erection, 12 (48%) noticed relief after the first session, while 9 more were pain free at the end of the treatment (VAS reduction 2.8; P<0.0001, and 2; P<0.001, respectively). For 25 patients (62.5%), an improvement in penile angulation>20 degrees was observed, with a mean reduction of 35 degrees (range 20 degrees-60 degrees ) (P<0.001). No significant change in plaque size was noted. Among 28 patients with erectile dysfunction, 18 (64.2%) had a marked increase in erection quality (IIEF score change: +4 for 10 patients, +6 for 4 patients, +8 for 2 patients, +9 for 2 patients).
Conclusion: Our results support SWT as an effective and safe first-line treatment for Peyronie's disease.