World J Mens Health.  2019 Sep;37(3):339-346. 10.5534/wjmh.180100.

Extracorporeal Shock Wave Therapy in Peyronie's Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study

Affiliations
  • 1Urology Section, Department of Surgery, University of Catania, Catania, Italy. giorgioivan1987@gmail.com
  • 2Department of Urology, University of Florence, Florence, Italy.
  • 3Andrology Center, Villa Donatello Hospital, Florence, Italy.
  • 4Department of Urology, University of Naples, Naples, Italy.
  • 5Department of Urology, Molinette Hospital, University of Turin, Turin, Italy.
  • 6Department of Urology, University of Pisa, Pisa, Italy.

Abstract

PURPOSE
In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie's disease (PD).
MATERIALS AND METHODS
A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment.
RESULTS
All the patients completed the study protocol. Median age was 59.0 years (55.0-64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm2 (1.43-2.17 cm2) to 1.53 cm2 (1.31-1.96 cm2) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0-14.0 cm) to 14 cm (13.0-15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°-35.4°) to 25.0° (20.2°-30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 vs. 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001).
CONCLUSIONS
Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.

Keyword

Erectile dysfunction; Extracorporeal shockwave therapy; Penile diseases; Penile induration; Peyronie's disease; Treatment

MeSH Terms

Alprostadil
Appointments and Schedules
Clinical Study
Erectile Dysfunction
Humans
Male
Observational Study*
Penile Diseases
Penile Induration*
Shock*
Treatment Outcome*
Alprostadil

Figure

  • Fig. 1 Median difference between questionnaires before and after treatment. IIEF: international index of erectile function, OS: overall satisfaction, IS: intercourse satisfaction, SD: sexual desire, OF: orgasmic function, EF: erectile function, TOT: tatal, PDQ: Peyronie's disease-questionnaire, BD: bother domain, PP: penile pain, PS: physical symptom, VAS: visual analogue scale.


Reference

1. Kang DH, Yin GN, Choi MJ, Song KM, Ghatak K, Minh NN, et al. Silencing histone deacetylase 7 alleviates transforming growth factor-β1-induced profibrotic responses in fibroblasts derived from Peyronie's plaque. World J Mens Health. 2018; 36:139–146. PMID: 29706035.
Article
2. Chung E. Penile reconstructive surgery in Peyronie disease: challenges in restoring normal penis size, shape, and function. World J Mens Health. 2018; DOI: 10.5534/wjmh.170056. [Epub].
Article
3. Gabrielson AT, Alzweri LM, Hellstrom WJ. Collagenase clostridium histolyticum in the treatment of Peyronie's disease: review of a minimally invasive treatment option. World J Mens Health. 2017; 35:134–145. PMID: 28879693.
Article
4. Park TY, Jeong HG, Park JJ, Chae JY, Kim JW, Oh MM, et al. The efficacy of medical treatment of Peyronie's disease: potassium para-aminobenzoate monotherapy vs. combination therapy with tamoxifen, L-carnitine, and phosphodiesterase type 5 inhibitor. World J Mens Health. 2016; 34:40–46. PMID: 27169128.
Article
5. Shaw EJ, Mitchell GC, Tan RB, Sangkum P, Hellstrom WJ. The non-surgical treatment of Peyronie disease: 2013 update. World J Mens Health. 2013; 31:183–192. PMID: 24459651.
Article
6. Cocci A, Russo GI, Briganti A, Salonia A, Cacciamani G, Capece M, et al. Predictors of treatment success after collagenase clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study. BJU Int. 2018; 122:680–687. PMID: 29791971.
Article
7. Cocci A, Russo GI, Salonia A, Cito G, Regis F, Polloni G, et al. Predictive factors of patients' and their partners' sexual function improvement after collagenase clostridium histolyticum injection for Peyronie's disease: results from a multi-center single-arm study. J Sex Med. 2018; 15:716–721. PMID: 29699756.
Article
8. Cocci A, Cito G, Urzì D, Minervini A, Di Maida F, Sessa F, et al. Sildenafil 25 mg ODT + collagenase clostridium hystoliticum vs collagenase clostridium hystoliticum alone for the management of Peyronie's disease: a matched-pair comparison analysis. J Sex Med. 2018; 15:1472–1477. PMID: 30245025.
9. Tal R, Hall MS, Alex B, Choi J, Mulhall JP. Peyronie's disease in teenagers. J Sex Med. 2012; 9:302–308. PMID: 21981606.
Article
10. Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, et al. Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol. 2004; 171:2350–2353. PMID: 15126819.
Article
11. Dibenedetti DB, Nguyen D, Zografos L, Ziemiecki R, Zhou X. A population-based study of Peyronie's disease: prevalence and treatment patterns in the United States. Adv Urol. 2011; 2011:282503. PMID: 22110491.
Article
12. Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, et al. Shock wave technology and application: an update. Eur Urol. 2011; 59:784–796. PMID: 21354696.
Article
13. Wang N, Tytell JD, Ingber DE. Mechanotransduction at a distance: mechanically coupling the extracellular matrix with the nucleus. Nat Rev Mol Cell Biol. 2009; 10:75–82. PMID: 19197334.
Article
14. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61:344–349. PMID: 18313558.
Article
15. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology. 1999; 54:346–351. PMID: 10443736.
Article
16. Gelbard M, Hellstrom WJ, McMahon CG, Levine LA, Smith T, Tursi J, et al. Baseline characteristics from an ongoing phase 3 study of collagenase clostridium histolyticum in patients with Peyronie's disease. J Sex Med. 2013; 10:2822–2831. PMID: 24112401.
Article
17. Russo GI, Milenkovic U, Hellstrom W, Levine LA, Ralph D, Albersen M. Clinical efficacy of injection and mechanical therapy for Peyronie's disease: a systematic review of the literature. Eur Urol. 2018; 74:767–781. PMID: 30237020.
Article
18. Gonzalez-Cadavid NF, Rajfer J. The two phases of the clinical validation of preclinical translational mechanistic research on PDE5 inhibitors since Viagra's advent. A personal perspective. Int J Impot Res. 2019; 31:57–60. PMID: 30258189.
Article
19. Hauck EW, Mueller UO, Bschleipfer T, Schmelz HU, Diemer T, Weidner W. Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol. 2004; 171:740–745. PMID: 14713800.
Article
20. Palmieri A, Imbimbo C, Longo N, Fusco F, Verze P, Mangiapia F, et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie's disease. Eur Urol. 2009; 56:363–369. PMID: 19473751.
Article
21. Hatzichristodoulou G, Meisner C, Gschwend JE, Stenzl A, Lahme S. Extracorporeal shock wave therapy in Peyronie's disease: results of a placebo-controlled, prospective, randomized, single-blind study. J Sex Med. 2013; 10:2815–2821. PMID: 23898925.
Article
22. Gao L, Qian S, Tang Z, Li J, Yuan J. A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease. Int J Impot Res. 2016; 28:161–166. PMID: 27250868.
Article
23. Hauck EW, Hauptmann A, Bschleipfer T, Schmelz HU, Altinkilic BM, Weidner W. Questionable efficacy of extracorporeal shock wave therapy for Peyronie's disease: results of a prospective approach. J Urol. 2004; 171:296–299. PMID: 14665898.
Article
24. Shirazi M, Haghpanah AR, Badiee M, Afrasiabi MA, Haghpanah S. Effect of intralesional verapamil for treatment of Peyronie's disease: a randomized single-blind, placebo-controlled study. Int Urol Nephrol. 2009; 41:467–471. PMID: 19199072.
Article
25. Moskovic DJ, Alex B, Choi JM, Nelson CJ, Mulhall JP. Defining predictors of response to intralesional verapamil injection therapy for Peyronie's disease. BJU Int. 2011; 108:1485–1489. PMID: 21733073.
Article
26. Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A, et al. EAU guidelines on penile curvature. Eur Urol. 2012; 62:543–552. PMID: 22658761.
Article
27. Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012; 187:1769–1775. PMID: 22425129.
Article
28. Gruenwald I, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy--a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med. 2012; 9:259–264. PMID: 22008059.
Article
29. Frairia R, Berta L. Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles Ligaments Tendons J. 2012; 1:138–147. PMID: 23738262.
30. Kendirci M, Trost L, Sikka SC, Hellstrom WJ. Diabetes mellitus is associated with severe Peyronie's disease. BJU Int. 2007; 99:383–386. PMID: 17313425.
Article
31. Tefekli A, Kandirali E, Erol B, Tunc M, Kadioglu A. Peyronie's disease: a silent consequence of diabetes mellitus. Asian J Androl. 2006; 8:75–79. PMID: 16372122.
Article
32. Pavone C, D'Amato F, Dispensa N, Torretta F, Magno C. Smoking, diabetes, blood hypertension: possible etiologic role for Peyronie's disease? Analysis in 279 patients with a control group in Sicily. Arch Ital Urol Androl. 2015; 87:20–24. PMID: 25847891.
Article
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