title: Objective and subjective changes in patients with Peyronie's disease after management with shockwave therapy.
abstract: OBJECTIVE
  Very few reports have been published on the management of Peyronie's disease by shockwave therapy. Existing publications on this topic are based on subjective improvement described by the patients themselves. Our aim was to determine objectively the effect of shockwave therapy on the signs and symptoms caused by Peyronie's disease.
  
  
  METHODS
  To date, 65 patients (age 58.4 +/- 8.7 years) have been enrolled in a therapeutic pilot study. The disease duration was 33.7 +/- 42.9 months. Inclusion criteria were palpable plaque together with deviation, pain (visual pain scale), or loss of distal rigidity. Clinical examination (prior to first therapy and 1, 6, and 18 months after last shockwave delivery) included palpation and sonography of the plaque (mean surface size 2.2 +/- 1.1 cm(2)), measurement of deviation, assessment of pain and distal loss of rigidity (artificial erection induced by intracavernosal injection of 5 microg of alprostadil [Caverject]). Shockwaves (1,000 impulses at 12 kV per square centimeter of plaque) were delivered to the nonerect penis once a week for a period of 5 weeks with the Minilith; Storz Medical.
  
  
  RESULTS
  Eighteen months (N = 35) after the last shockwave session, the deviation angle had decreased from 59.3 degrees +/- 38.1 degrees to 49.3 degrees +/- 32.5 degrees (N = 24; P = 0.1496). Pain during erection disappeared in 15 of 17 patients and was reduced in 1 other patient (P < 0.0001). There was no effect on distal rigidity in any patient. Six patients achieved satisfactory sexual intercourse (vaginal penetration) before and 15 patients after shockwave therapy. The adverse effects were small skin hematomas in 90% of patients and initial transient macrohematuria in 30%.
  
  
  CONCLUSIONS
  Our study demonstrates objective and subjective changes in patients with Peyronie's disease after shockwave therapy. Artificial erection served as a control to assess improvement of the deviation angle.
authors.affiliation: Department of Urology, University Hospital, Mannheim, Germany. maurice-stephen.michel@uro.ma.uni_heidelberg.de
authors.forename: Maurice Stephan
authors.initials: MS
authors.lastname: Michel
authors.forename: Taras
authors.initials: T
authors.lastname: Ptaschnyk
authors.forename: Anton
authors.initials: A
authors.lastname: Musial
authors.forename: Peter
authors.initials: P
authors.lastname: Braun
authors.forename: Sylvia Tamara
authors.initials: ST
authors.lastname: Lenz
authors.forename: Peter
authors.initials: P
authors.lastname: Alken
authors.forename: Kai Uwe
authors.initials: KU
authors.lastname: Köhrmann
mesh_terms: D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D016896:Treatment Outcome