Long-term results of extracorporeal shockwave therapy for Peyronie's disease.
OBJECTIVE
To analyze the long-term results in patients undergoing extracorporeal shockwave therapy (ESWT) for Peyronie's disease.


METHODS
Patients treated with ESWT (3000 shockwaves on a Storz Minilith SL lithotripter) for Peyronie's disease were included. The mean disease duration prior to treatment was 23.2 months (range 4-60 months). Penile angulation was measured before and after treatment by artificial vacuum induction of erection. Pain during erection was measured using a visual analog scale (VAS 0-5). The average number of ESWT sessions was 3.4 (range 2-9). The mean follow-up post-treatment was 44.1 months (range 42-48 months). Of 44 eligible patients, 38 patients (86.4%) were contactable for evaluation.


RESULTS
Of the 38 patients, 10 (26%) subsequently underwent corrective surgery for failed ESWT. Of the remaining 28 patients, 18 (47% of the total) had a statistically significant reduction in angulation, with a mean reduction of 33.2 degrees +/- 14.4 degrees (SD) (range 10 degrees -75 degrees ) (P < 0.001). Nine patients (24%) obtained no benefit, and one had an increase in angulation of 10 degrees . Of the 24 patients with pain, 16 (66.6%) reported relief after ESWT, the mean reduction being 2.5 (range 0.5-4.0) on the VAS (P < 0.001). Of the 28 patients who had not undergone surgical correction, 18 (65%) reported erections suitable for intercourse; 14 (48%) were satisfied with ESWT, 8 (30%) dissatisfied, and 6 (22%) uncertain. Although one patient complained of some penile shortening, no other long-term adverse events were noted.


CONCLUSIONS
Although a quarter of ESWT patients resorted to surgery, in the absence of other effective nonsurgical treatments, ESWT may provide a useful, safe, conservative management option. Extracorporeal shockwave therapy cannot yet be recommended as standard for Peyronie's disease, and randomized controlled studies are required to validate its efficacy and identify the subset of patients most likely to benefit.
Srirangam
Shalom J
SJ
Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom.
Manikandan
Ramaswamy
R
Hussain
Jawad
J
Collins
Gerald N
GN
O'Reilly
Patrick H
PH
D000328:Adult; D000368:Aged; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome