Peyronie’s Disease can be successfully treated
What is LI-ESWT (Shock Wave Therapy)?
LI-ESWT (Low Intensity- Extracorporeal Shock Wave Therapy) is a new and painless treatment that has been quite effective in improving erectile dysfunction in most men, with recent studies showing promise in the early treatment of Peyronie’s Disease.
Studies have found the treatment to reduce penile pain and have some efficacy in the improvement of both penile curvature and plaque, and to decrease the progression of the disease. It has proven to be safe, and to have a high patient satisfaction rate.
In what ways can LI-ESWT help treat my Peyronie's Disease?
Peyronie’s Disease (PD) can lead to penile pain, penile curvature, erectile dysfunction, scar tissue that can be felt (plaque), and an overall decrease in quality of life.
Each one of these factors may be improved by LI-ESWT.
Penile Pain: In multiple clinical studies, patients receiving LI-ESWT had their penile pain decrease significantly faster than patients receiving no treatment or placebo. This rapid reduction in penile pain can have a significant improvement on a patient’s quality of life. It is important to recognize that penile pain will almost always improve over time, but the research conducted to date has found that LI-ESWT will speed up this process.
Penile Curvature and Progression of Curvature: Multiple clinical studies seem to show that early treatment with the LI-ESWT resulted in either improvement of the penile curvature, or a slowing of the progression of the curvature when compared to men who are untreated.
One classic study showed that when PD goes untreated, 14% of patient’s penile curvature showed improvement, 40% showed slower progression, and 47% remain unchanged. In addition, multiple clinical studies found that men treated with LI-ESWT showed either a significant reduction in their curvature, or a significantly reduced progression of curvature compared to untreated men. The stabilizing effect LI-ESWT can have on the spontaneous progression of the disease can also decrease the chance that surgical intervention will be needed.
Erectile Function: There is excellent data showing that LI-ESWT treatment of the penis improves erectile dysfunction. LI-ESWT has not yet been approved in the US by the FDA for the treatment of ED. However, we currently offer it as an “off label” treatment to individual patients where appropriate, because both the literature and our clinical experience show significant improvement in the majority of treated patients.
The protocol used for PD and ED is quite different. However, the research in LI-ESWT for PD does show a consistent improvement in erectile function. This may result from a combination of factors. Most likely, it stimulates improved blood flow into the penis through the penile blood vessels (which is thought to be the main mechanism). Also, a man’s erections may improve as a result of decreases in pain, curvature, and plaque size.
Plaque Size: Studies indicate that treatment with the LI-ESWT leads to a decrease in scar tissue (plaque). This may partially account for the decrease in penile curvature. Many men are unhappy with the way their penis feels with the plaque, both non-erect and erect. Decreased scar tissue positively impacts how they feel about their penis and about themselves.
Quality of Life (QoL): Data from studies almost uniformly show a significantly increased QoL for most men treated with LI-ESWT for Peyronie’s Disease.
How does LI-ESWT work for Peyronie's Disease?
Shock (pressure) waves are applied to the penis through a probe on the skin. It is believed that the shock waves cause mild trauma to the blood vessels, which then release growth factors. These growth factors stimulate the formation of new blood vessels (neo-angeogenesis) as well as repair of the lining of the existing blood vessels (the endothelium.) Other theories suggest that it may break up the plaque which is blocking the blood flow in small vessels, or it may cause stem cells to migrate to the area, which then create new blood vessels. LI-ESWT is being successfully used in plantar fasciitis and anti-inflammatory treatment of soft tissues. It is currently being studied for heart blood vessels, musculoskeletal disorders, and diabetic ulcers.
LI-ESWT is thought to help treat Peyronie’s disease by:
-Breaking down the plaque directly.
-Inducing blood flow to the treated area.
-Creating an inflammatory reaction which causes the plaque to be broken down, the calcium reabsorbed, and the waste from this process being removed by a subset of white blood cells (called macrophages).
-One study has shown that the actual configuration of the scar tissue within the plaque changes with treatment.
It is postulated that the reduction of curvature is due to the shock waves stimulating plaque remodeling, followed by resorption of the calcification. The result of this is softer plaque that corrects or potentially resolves the penile curvature. The treatment may also have a preventative effect on the progression of Peyronie’s. LI-ESWT may slow or even halt the progression of penile curvature, as well as the development of plaques during the active phase of the disease. The most immediate effects from treatment are pain reduction for patients in the active phase of disease progress.
Whatever the mechanism, studies strongly indicate the efficacy of LI-ESWT in the treatment of Peyronie’s disease.
Is this treatment for Peyronie's Disease backed by research?
The good news is that LI-ESWT has been used for the treatment of PD for over 10 years, and almost all studies show significant improvements in most, if not all, measured clinical parameters. These include: pain resolution, penile curvature, rigidity and duration of erections, quality of life, as well as the diminishment of plaque size. However, LI-ESWT is not FDA approved for the treatment of PD, which is why the treatment is considered “off-label” use of the device. Accordingly, LI-ESWT is not currently covered by health insurance.
The protocols for LI-ESWT for Peyronie’s Disease have not been standardized, and vary between several studies. We have decided to use one of the more intensive protocols, which had excellent results and used the Duolith made by Storz Medical. View the study.
How does LI-ESWT compare to other treatments for Peyronie's Disease?
The main benefit of LI-ESWT over other treatment options is that it is less invasive and limiting than other treatments. Other forms of treatment may require you to abstain from sexual activity for periods of time. During shockwave therapy, you are free to engage in sexual activity, even during the day of therapy.
Who are the best candidates for LI-ESWT for Peyronie's Disease?
The best candidates for LI-ESWT are men who have a less than twelve month history of Peyronie’s Disease. During the initial twelve months, the disease is still in the active phase, making it more susceptible to mechanical processes. Men with more mild curvature of the penis also tend to see better results.
Treatment may not be as effective for men who have complex Peyronie’s Disease. This includes curvature over 90 degrees, more than one palpable plaque, a greater than 12 month history of Peyronie’s Disease, more than one axis of curvature, or an hour glass deformity.
If you have complex Peyronie’s Disease, don’t lose hope. Come in for an evaluation and we will find the optimal way to treat your individual case of Peyronie’s.
How should I decide whether LI-ESWT or Xiaflex injections are the first step for me?
Any medical intervention should increase a patient’s quality of life. If you have a small penile plaque that is stable and does not cause pain, curvature, or erectile dysfunction, and it also does not bother you, there is no reason to begin treatment. If you do feel that your Peyronie’s Disease is having a negative effect on your quality of life, your first step would be to have an evaluation to determine what treatment option will be the most effective.
In our opinion, the best candidates for LI-ESWT are patients with a relatively new onset of PD, those with pain, and those with a curvature of less than 30 degrees. The advantage of LI-ESWT for these patients is typically not only a rapid improvement in their pain and quality of life, but a strong likelihood that the condition’s progress will slow or improve before the disease moves from the active to the stable phase; usually, without treatment, the disease worsens.
If you have PD in the stable phase, calcified lesions, complicated curvature, or multiple plaques, you should consider Xiaflex injections. Though more invasive, they have an excellent track record and are FDA approved in men with curvature greater than 30 degrees, and those who don’t have a curvature that points down (ventral.) The Xiaflex is covered by the vast majority of insurance plans. However, if you are not insured or it is not covered by your plan, the medication itself costs more than $25,000 for a course of treatment.
Is it safe?
Yes. Fortunately, safety is not an issue. There is no evidence of any long term negative effects of treatment. In a study that utilized a different treatment protocol than ours, a very small number of men had temporary bruising to the area where the treatment was applied, which resolved quickly. All of the research has shown that there is no damage done to the penis and that the treatment is well tolerated and needs no anesthesia. The downsides are minimal: treatment time, possible mild discomfort, and cost.
How many treatments would I need?
There is a total of 12 treatments spread out over six weeks. Each treatment will last for approximately 15-20 minutes. We follow the published protocol which consists of two treatments per week for six weeks, with no non-treatment weeks included.
Do the treatments hurt?
Most patients describe only a mild buzzing or tapping sensation during treatment.
What are my next steps?
If you’re suffering from Peyronie’s Disease and are looking for a safe and pain-free treatment option, or have already used other medical therapies and would like to avoid surgical intervention, Shock Wave Therapy for Peyronie’s Disease may be the right choice for you.
Early diagnosis and treatment by an experienced urologist is critical to achieving successful results. Learn more about Dr. Michael Werner’s expertise treating PD.