Ergün M. et al., 2025: Low-Intensity Extracorporeal Shock Wave Therapy and Platelet-Rich Plasma: Effective Combination Treatment of Chronic-Phase Peyronie's Disease.

Thursday, 02 October 2025

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Müslüm Ergün 1, Süleyman Sağır 2
1Urology Clinic, Atlas University Hospital, 34200 Istanbul, Turkey.
2Urology Clinic, Artuklu University, 47100 Mardin, Turkey.

Abstract

Objective: This study aimed to investigate the effectiveness, safety and outcomes of the combination therapy of low-intensity extracorporeal shockwave therapy (Li-ESWT) and platelet-rich plasma (PRP) for the treatment of chronic-phase Peyronie's disease.

Methods: The clinical outcomes of patients diagnosed with Peyronie's disease and treated with Li-ESWT combined with PRP at our clinic between January 2018 and January 2024 were retrospectively reviewed and analysed. Twenty-three patients were excluded based on inclusion criteria, leaving 26 patients for the retrospective analysis. Each patient received three sessions of PRP and six sessions of Li-ESWT. The treatment regimen involved sessions administered twice weekly over a period of 3 weeks, followed by 1-week post-treatment follow-up. The patients were then monitored for 24 weeks.

Result: After treatment, no significant reduction in average plaque size was observed. However, a statistically significant average improvement of 10° was noted for penile curvature. Among the patients, 14 (53.8%) reported satisfaction with the treatment outcome, and 12 (46.2%) expressed dissatisfaction. No significant adverse effects were observed at the injection sites or in the areas subjected to Li-ESWT post-procedure.

Conclusions: The combination of Li-ESWT and PRP is effective and safe for the treatment of chronic-phase Peyronie's disease.

Arch Esp Urol. 2025 Mar;78(2):164-169. doi: 10.56434/j.arch.esp.urol.20257802.23.
PMID: 40191859 FREE ARTICLE

Comments 1

Jens Rassweiler on Thursday, 02 October 2025 11:00

Introduction: Peyronie’s disease (PD) is a medical condition characterized by fibrosis of the tunica albuginea in the penis, leading to pain, deformity, and erectile dysfunction. Though it can appear at any age, it primarily affects men over 50. Current non-surgical treatments include various pharmaceutical options and low-intensity extracorporeal shock wave therapy (Li-ESWT), with recent interest in combining it with platelet-rich plasma (PRP) therapy.

Study Objective:The study aims to evaluate the effectiveness, safety, and outcomes of combining Li-ESWT with PRP for treating chronic-phase PD.

Methods: Patients diagnosed with PD for at least one year were included. They underwent evaluations for plaque size and penile curvature before and after treatment using photographs and physical assessments. The treatment plan consisted of three PRP sessions and six Li-ESWT sessions over three weeks. The combination treatment regimen involved alternating sessions of both therapies.

Results: Out of 39 patients, 26 met the inclusion criteria. The average age was 56.4 years, with the majority having dorsal plaques. Pre-treatment, the average plaque size measured 1.25 cm, and the penile curvature angle was 40.25°. Post-treatment measurements after 24 weeks showed a significant decrease in curvature angle to 30.15° (p less 0.05), but the reduction in plaque size was not statistically significant. Overall, 53.8% of patients expressed satisfaction with the treatment, correlating with a notable decrease in curvature angle but no significant change in plaque size.

Discussion: Although this study suggests that the combination of Li-ESWT and PRP may improve penile curvature in chronic PD, the change in plaque size was minimal and statistically insignificant. Comparisons were made with other studies, emphasizing that while some reported better results with either treatment alone, the present combination therapy yielded reasonable patient satisfaction rates. It is crucial to note that this study has limitations, including its retrospective design, small sample size, and lack of controlled conditions. Unfortunately, the authors did not discuss the use of high-intensity ESWT in case of severe plaques as recently presented by Rassweiler et al.

Conclusion: The findings indicate that combining Li-ESWT and PRP can improve outcomes for patients with chronic-phase Peyronie's disease, providing a less invasive alternative to surgical treatment. However, further large-scale, randomized studies are needed to confirm these results and assess long-term outcomes.

Additional information: Platelet-rich plasma (PRP) therapy may be effective in the treatment of Peyronie’s disease for several reasons related to its biological properties and the pathological processes involved in the condition:

1. Growth Factor Concentration: PRP contains a higher concentration of platelets, which are rich in growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF). These growth factors can play a role in healing and tissue regeneration, potentially promoting normal tissue repair and remodeling in the tunica albuginea.

2. Reducing Fibrosis: Peyronie’s disease is characterized by excessive collagen deposition and fibrosis in the tunica albuginea, leading to plaque formation. Some studies suggest that the growth factors in PRP can help modulate the fibrosis process, promoting the breakdown of excessive collagen and facilitating a more balanced tissue healing response.

3. Enhancing Blood Flow: PRP may improve local blood flow to the penis through the action of VEGF and other factors, which can enhance tissue oxygenation and nutrient delivery, thereby supporting healing and recovery processes.

4. Inflammatory Response Modulation: PRP might help to modulate the local inflammatory response, which is often chronic in Peyronie’s disease. By promoting a balanced inflammatory response, PRP could help to alleviate some of the symptoms associated with PD and support the healing process.

5. Biostimulation: The introduction of PRP into the plaques associated with Peyronie’s disease may stimulate surrounding cells and tissues, enhancing their regenerative potential. This stimulation can lead to changes in plaque composition and improve the mechanical properties of the penile tissue.

6. Tissue Softening: Some patients report subjective improvements in plaque consistency (softening), which could correlate with the pain reduction and improvement in penile curvature following PRP therapy. This change might be due to the remodeling effects of growth factors in the PRP.

7. Complementary Effects with Li-ESWT: When combined with low-intensity extracorporeal shock wave therapy (Li-ESWT), PRP may synergistically enhance healing. Li-ESWT is thought to promote angiogenesis and improve blood flow as well, therefore working in tandem with PRP to enhance healing and tissue regeneration in the affected areas.

While these mechanisms suggest a rationale for using PRP in Peyronie’s disease, clinical evidence remains limited, and more rigorous studies are needed to confirm its efficacy and understand the optimal protocols for treatment.

Jens Rassweiler

Study Objective:The study aims to evaluate the effectiveness, safety, and outcomes of combining Li-ESWT with PRP for treating chronic-phase PD.

Methods: Patients diagnosed with PD for at least one year were included. They underwent evaluations for plaque size and penile curvature before and after treatment using photographs and physical assessments. The treatment plan consisted of three PRP sessions and six Li-ESWT sessions over three weeks. The combination treatment regimen involved alternating sessions of both therapies.

Results: Out of 39 patients, 26 met the inclusion criteria. The average age was 56.4 years, with the majority having dorsal plaques. Pre-treatment, the average plaque size measured 1.25 cm, and the penile curvature angle was 40.25°. Post-treatment measurements after 24 weeks showed a significant decrease in curvature angle to 30.15° (p less 0.05), but the reduction in plaque size was not statistically significant. Overall, 53.8% of patients expressed satisfaction with the treatment, correlating with a notable decrease in curvature angle but no significant change in plaque size.

Discussion: Although this study suggests that the combination of Li-ESWT and PRP may improve penile curvature in chronic PD, the change in plaque size was minimal and statistically insignificant. Comparisons were made with other studies, emphasizing that while some reported better results with either treatment alone, the present combination therapy yielded reasonable patient satisfaction rates. It is crucial to note that this study has limitations, including its retrospective design, small sample size, and lack of controlled conditions. Unfortunately, the authors did not discuss the use of high-intensity ESWT in case of severe plaques as recently presented by Rassweiler et al.

Conclusion: The findings indicate that combining Li-ESWT and PRP can improve outcomes for patients with chronic-phase Peyronie's disease, providing a less invasive alternative to surgical treatment. However, further large-scale, randomized studies are needed to confirm these results and assess long-term outcomes.

Additional information: Platelet-rich plasma (PRP) therapy may be effective in the treatment of Peyronie’s disease for several reasons related to its biological properties and the pathological processes involved in the condition:

1. Growth Factor Concentration: PRP contains a higher concentration of platelets, which are rich in growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF). These growth factors can play a role in healing and tissue regeneration, potentially promoting normal tissue repair and remodeling in the tunica albuginea.

2. Reducing Fibrosis: Peyronie’s disease is characterized by excessive collagen deposition and fibrosis in the tunica albuginea, leading to plaque formation. Some studies suggest that the growth factors in PRP can help modulate the fibrosis process, promoting the breakdown of excessive collagen and facilitating a more balanced tissue healing response.

3. Enhancing Blood Flow: PRP may improve local blood flow to the penis through the action of VEGF and other factors, which can enhance tissue oxygenation and nutrient delivery, thereby supporting healing and recovery processes.

4. Inflammatory Response Modulation: PRP might help to modulate the local inflammatory response, which is often chronic in Peyronie’s disease. By promoting a balanced inflammatory response, PRP could help to alleviate some of the symptoms associated with PD and support the healing process.

5. Biostimulation: The introduction of PRP into the plaques associated with Peyronie’s disease may stimulate surrounding cells and tissues, enhancing their regenerative potential. This stimulation can lead to changes in plaque composition and improve the mechanical properties of the penile tissue.

6. Tissue Softening: Some patients report subjective improvements in plaque consistency (softening), which could correlate with the pain reduction and improvement in penile curvature following PRP therapy. This change might be due to the remodeling effects of growth factors in the PRP.

7. Complementary Effects with Li-ESWT: When combined with low-intensity extracorporeal shock wave therapy (Li-ESWT), PRP may synergistically enhance healing. Li-ESWT is thought to promote angiogenesis and improve blood flow as well, therefore working in tandem with PRP to enhance healing and tissue regeneration in the affected areas.

While these mechanisms suggest a rationale for using PRP in Peyronie’s disease, clinical evidence remains limited, and more rigorous studies are needed to confirm its efficacy and understand the optimal protocols for treatment.

Jens Rassweiler

Introduction: Peyronie’s disease (PD) is a medical condition characterized by fibrosis of the tunica albuginea in the penis, leading to pain, deformity, and erectile dysfunction. Though it can appear at any age, it primarily affects men over 50. Current non-surgical treatments include various pharmaceutical options and low-intensity extracorporeal shock wave therapy (Li-ESWT), with recent interest in combining it with platelet-rich plasma (PRP) therapy. Study Objective:The study aims to evaluate the effectiveness, safety, and outcomes of combining Li-ESWT with PRP for treating chronic-phase PD. Methods: Patients diagnosed with PD for at least one year were included. They underwent evaluations for plaque size and penile curvature before and after treatment using photographs and physical assessments. The treatment plan consisted of three PRP sessions and six Li-ESWT sessions over three weeks. The combination treatment regimen involved alternating sessions of both therapies. Results: Out of 39 patients, 26 met the inclusion criteria. The average age was 56.4 years, with the majority having dorsal plaques. Pre-treatment, the average plaque size measured 1.25 cm, and the penile curvature angle was 40.25°. Post-treatment measurements after 24 weeks showed a significant decrease in curvature angle to 30.15° (p less 0.05), but the reduction in plaque size was not statistically significant. Overall, 53.8% of patients expressed satisfaction with the treatment, correlating with a notable decrease in curvature angle but no significant change in plaque size. Discussion: Although this study suggests that the combination of Li-ESWT and PRP may improve penile curvature in chronic PD, the change in plaque size was minimal and statistically insignificant. Comparisons were made with other studies, emphasizing that while some reported better results with either treatment alone, the present combination therapy yielded reasonable patient satisfaction rates. It is crucial to note that this study has limitations, including its retrospective design, small sample size, and lack of controlled conditions. Unfortunately, the authors did not discuss the use of high-intensity ESWT in case of severe plaques as recently presented by Rassweiler et al. Conclusion: The findings indicate that combining Li-ESWT and PRP can improve outcomes for patients with chronic-phase Peyronie's disease, providing a less invasive alternative to surgical treatment. However, further large-scale, randomized studies are needed to confirm these results and assess long-term outcomes. Additional information: Platelet-rich plasma (PRP) therapy may be effective in the treatment of Peyronie’s disease for several reasons related to its biological properties and the pathological processes involved in the condition: 1. Growth Factor Concentration: PRP contains a higher concentration of platelets, which are rich in growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF). These growth factors can play a role in healing and tissue regeneration, potentially promoting normal tissue repair and remodeling in the tunica albuginea. 2. Reducing Fibrosis: Peyronie’s disease is characterized by excessive collagen deposition and fibrosis in the tunica albuginea, leading to plaque formation. Some studies suggest that the growth factors in PRP can help modulate the fibrosis process, promoting the breakdown of excessive collagen and facilitating a more balanced tissue healing response. 3. Enhancing Blood Flow: PRP may improve local blood flow to the penis through the action of VEGF and other factors, which can enhance tissue oxygenation and nutrient delivery, thereby supporting healing and recovery processes. 4. Inflammatory Response Modulation: PRP might help to modulate the local inflammatory response, which is often chronic in Peyronie’s disease. By promoting a balanced inflammatory response, PRP could help to alleviate some of the symptoms associated with PD and support the healing process. 5. Biostimulation: The introduction of PRP into the plaques associated with Peyronie’s disease may stimulate surrounding cells and tissues, enhancing their regenerative potential. This stimulation can lead to changes in plaque composition and improve the mechanical properties of the penile tissue. 6. Tissue Softening: Some patients report subjective improvements in plaque consistency (softening), which could correlate with the pain reduction and improvement in penile curvature following PRP therapy. This change might be due to the remodeling effects of growth factors in the PRP. 7. Complementary Effects with Li-ESWT: When combined with low-intensity extracorporeal shock wave therapy (Li-ESWT), PRP may synergistically enhance healing. Li-ESWT is thought to promote angiogenesis and improve blood flow as well, therefore working in tandem with PRP to enhance healing and tissue regeneration in the affected areas. While these mechanisms suggest a rationale for using PRP in Peyronie’s disease, clinical evidence remains limited, and more rigorous studies are needed to confirm its efficacy and understand the optimal protocols for treatment. Jens Rassweiler

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