Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: experience with standard lithotriptor (siemens-multiline)

Abstract

Objectives. To assess in a prospective study whether extracorporeal shock wave therapy (ESWT) using a standard radioscopic location lithotriptor is effective in the treatment of Peyronie’s disease. Methods. Fifty-four patients were included in this prospective study. Before and after treatment, the angulation was calculated by auto-photography. Pain severity was assessed by a visual analog pain scale. A self-evaluation questionnaire (International Index of Erectile Function) was used. All patients had symptoms (35 had pain during erection and 51 angulation greater than 20°). The mean disease duration was 16 months. The mean angulation before treatment was 48° (range 10° to 100°). Twenty-four patients had erectile dysfunction (questionnaire score less than 18). The Multiline Siemens lithotriptor was used. The plaque was located by palpation, and 1 mL of contrast agent was injected. Scopic visualization was used. Each patient received a minimum of one session of ESWT (3000 shock waves, 7 kJ) applied to a flaccid penis. Results. All patients completed the protocol. The tolerance and safety were excellent. Of the 35 patients with pain on erection, 31 (91%) noticed relief immediately after ESWT (mean reduction 2.9 on the visual analog pain scale) ( P <0.00001). For 29 patients (53.7%), an improvement in angulation (greater than 10°) was observed, with a mean reduction of 31° ( P <0.001). For patients with erectile dysfunction, only 6 (25%) had an increased questionnaire score (greater than 4). Twenty-five patients thought the plaque was smoother. Conclusions. ESWT with a standard lithotriptor (without the mobile arm) in Peyronie’s disease is a feasible, safe, and effective treatment for pain on erection and significantly improves the penile angle.