Guizhong Li et al., 2024: Low-intensity extracorporeal shock wave therapy for Peyroniès disease: a systematic review and meta-analysis

Wednesday, 05 March 2025

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Guizhong Li 1, Xiao Xu 2, Libo Man 2
1Department of Urology, Beijing Jishuitan Hospital, Capital Medical University, Xinjiekou East Street, West District, Beijing, 100035, China.
2Department of Urology, Beijing Jishuitan Hospital, Capital Medical University, Xinjiekou East Street, West District, Beijing, 100035, China.

Abstract

Background: A systematic review of the evidence was conducted to assess the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with Peyronie`s Disease (PD).

Methods: A comprehensive search of the Cochrane Registry, PubMed and Embase databases was conducted to identify all controlled trials, including randomised controlled trials (RCTs), cohort studies and case-control studies, focusing on the efficacy of LI-ESWT in treating PD, and published before February 2023. The size of plaques, curvature deviation, visual analog scale [VAS] and International Index of Erectile Function (IIEF) were the most commonly used tool to evaluate the treatment effectiveness of LI-ESWT.

Results: There were 7 studies including 475 patients from 1999 to 2023. The meta-analysis of the data revealed that LI-ESWT could considerably enhance the proportion of men experiencing a reduction in penile plaques (RD 0.27, 95% CI: 0.04-0.50, P = 0.02), improvement in penile curvature (RD: 0.13; 95% CI, 0-0.26; p = 0.05), alleviation of pain (RD 0.22, 95% CI: 0.01-0.42, P = 0.04), and complete remission (RD 0.38, 95% CI 0.23-0.52, P < 0.00001). However, there were no significant differences in improvement of sexual function (MD: 1.44; 95% CI, -3.10-5.97; p = 0.53) between LI-ESWT and the placebo group.

Conclusions: According to these studies, LI-ESWT has the potential to decrease plaque size and improve penile curvature or pain in men with PD. The publication of robust evidence from additional well-designed long-term multicenter randomized controlled trials would provide more confidence regarding use of these devices in patients with PD.

BMC Urol. 2024 Oct 8;24(1):217. doi: 10.1186/s12894-024-01607-4. PMID: 39375617
PMCID: PMC11459888 FREE TEXT

Comments 1

Jens Rassweiler on Wednesday, 05 March 2025 10:00

Introduction Peyronie’s disease (PD) is a common condition in men characterized by the progressive fibrosis of the tunica albuginea, leading to symptoms such as:
• Penile pain
• Curvature of the penis
• Palpable plaques
• Erectile dysfunction (ED)
The incidence of PD ranges from 22.4 to 25.7 per 100,000 men, predominantly affecting those aged 50-59. Current treatment options primarily include conservative methods, with Collagenase Clostridium histolyticum (CCH) being FDA-approved. Alternative local treatments have shown limited evidence. Low-intensity extracorporeal shock wave therapy (LI-ESWT) has emerged as a treatment option, although results regarding its effectiveness in improving curvature and pain are mixed.
________________________________________The study aimed to evaluate the effectiveness of LI-ESWT in managing Peyronie’s disease through a systematic review and meta-analysis of existing literature.
________________________________________
Methodology: Seven studies involving 475 patients were analyzed. These included:
o 2 case-control studies
o 1 cohort study
o 4 randomized controlled trials (RCTs)
Included men with a symptom history ranging from 3 to 12 months, particularly those for whom drug treatments had failed.

Treatment Protocols: Various devices were used, with treatment protocols differing in energy flux density (EFD) and session duration. Most studies used EFDs ranging from 0.25 to 0.29 mJ/mm².
________________________________________
Findings: The following study results were summarized in the review.
1. Reduction of Penile Plaques:
o Three studies reported a significant increase in the proportion of patients with reduced plaque size after LI-ESWT (Risk Difference (RD) 0.27, 95% CI: 0.04–0.50, P=0.02).
o However, when measuring the actual plaque size reduction, there was no significant improvement compared to control groups.

2. Improvement of Penile Curvature:
o The analysis indicated a significant percentage of patients experienced improvement in penile curvature after LI-ESWT (RD: 0.13, P=0.05), but the actual angle of curvature showed no significant change (Mean Difference (MD): -2.14, P=0.4).
3. Pain Relief:
o The LI-ESWT group demonstrated a higher rate of pain relief (RD 0.22, P=0.04) and complete remission of pain (RD 0.38, P kleiner 0.00001) compared to control groups.
4. Sexual Function Improvement:
o There was no significant improvement in sexual function as measured by the International Index of Erectile Function (IIEF) scores (MD: 1.44, P=0.53) or in overall sexual function between LI-ESWT and control groups.
________________________________________
Discussion The systematic review highlighted the potential benefits of LI-ESWT in reducing pain and improving the percentage of men with lessening penile plaques. However, the exact mechanisms by which LI-ESWT operates remain unclear. Proposed mechanisms include:
• Cell proliferation and tissue regeneration
• Enhanced blood flow and tissue perfusion
• Reduction of inflammatory cytokines

Several limitations were identified:
• Heterogeneity: Significant variability in study designs, patient demographics, and treatment protocols contributed to high levels of heterogeneity (I²=55-79%).
• Sample Size: Most studies had small sample sizes, with the largest including only 102 patients.
• Short Follow-Up Periods: Follow-ups were generally limited to about six months, raising questions about the long-term effectiveness of LI-ESWT.
________________________________________
Conclusions: While LI-ESWT shows potential for improving symptoms associated with Peyronie’s disease, further high-quality, long-term, multicenter randomized controlled trials are necessary to establish its efficacy conclusively. Future research should focus on standardized outcome measures and a better understanding of the treatment mechanisms to optimize patient management strategies for PD. Unfortunately, this review does not offer new significant information. Moreover, recently published studies providing long-term results of ESWT with different energy settings. They also did not discuss the use of Li-ESWT in the management of the acute phase of PD.

Jens Rassweiler

Treatment Protocols: Various devices were used, with treatment protocols differing in energy flux density (EFD) and session duration. Most studies used EFDs ranging from 0.25 to 0.29 mJ/mm².
________________________________________
Findings: The following study results were summarized in the review.
1.	Reduction of Penile Plaques:
o	Three studies reported a significant increase in the proportion of patients with reduced plaque size after LI-ESWT (Risk Difference (RD) 0.27, 95% CI: 0.04–0.50, P=0.02).
o	However, when measuring the actual plaque size reduction, there was no significant improvement compared to control groups.

2.	Improvement of Penile Curvature:
o	The analysis indicated a significant percentage of patients experienced improvement in penile curvature after LI-ESWT (RD: 0.13, P=0.05), but the actual angle of curvature showed no significant change (Mean Difference (MD): -2.14, P=0.4).
3.	Pain Relief:
o	The LI-ESWT group demonstrated a higher rate of pain relief (RD 0.22, P=0.04) and complete remission of pain (RD 0.38, P kleiner 0.00001) compared to control groups.
4.	Sexual Function Improvement:
o	There was no significant improvement in sexual function as measured by the International Index of Erectile Function (IIEF) scores (MD: 1.44, P=0.53) or in overall sexual function between LI-ESWT and control groups.
________________________________________
Discussion The systematic review highlighted the potential benefits of LI-ESWT in reducing pain and improving the percentage of men with lessening penile plaques. However, the exact mechanisms by which LI-ESWT operates remain unclear. Proposed mechanisms include:
•	Cell proliferation and tissue regeneration
•	Enhanced blood flow and tissue perfusion
•	Reduction of inflammatory cytokines

Several limitations were identified:
•	Heterogeneity: Significant variability in study designs, patient demographics, and treatment protocols contributed to high levels of heterogeneity (I²=55-79%).
•	Sample Size: Most studies had small sample sizes, with the largest including only 102 patients.
•	Short Follow-Up Periods: Follow-ups were generally limited to about six months, raising questions about the long-term effectiveness of LI-ESWT.
________________________________________
Conclusions:  While LI-ESWT shows potential for improving symptoms associated with Peyronie’s disease, further high-quality, long-term, multicenter randomized controlled trials are necessary to establish its efficacy conclusively. Future research should focus on standardized outcome measures and a better understanding of the treatment mechanisms to optimize patient management strategies for PD. Unfortunately, this review does not offer new significant information. Moreover, recently published studies providing long-term results of ESWT with different energy settings. They also did not discuss the use of Li-ESWT in the management of the acute phase of PD.

Jens Rassweiler

Introduction Peyronie’s disease (PD) is a common condition in men characterized by the progressive fibrosis of the tunica albuginea, leading to symptoms such as: • Penile pain • Curvature of the penis • Palpable plaques • Erectile dysfunction (ED) The incidence of PD ranges from 22.4 to 25.7 per 100,000 men, predominantly affecting those aged 50-59. Current treatment options primarily include conservative methods, with Collagenase Clostridium histolyticum (CCH) being FDA-approved. Alternative local treatments have shown limited evidence. Low-intensity extracorporeal shock wave therapy (LI-ESWT) has emerged as a treatment option, although results regarding its effectiveness in improving curvature and pain are mixed. ________________________________________The study aimed to evaluate the effectiveness of LI-ESWT in managing Peyronie’s disease through a systematic review and meta-analysis of existing literature. ________________________________________ Methodology: Seven studies involving 475 patients were analyzed. These included: o 2 case-control studies o 1 cohort study o 4 randomized controlled trials (RCTs) Included men with a symptom history ranging from 3 to 12 months, particularly those for whom drug treatments had failed. Treatment Protocols: Various devices were used, with treatment protocols differing in energy flux density (EFD) and session duration. Most studies used EFDs ranging from 0.25 to 0.29 mJ/mm². ________________________________________ Findings: The following study results were summarized in the review. 1. Reduction of Penile Plaques: o Three studies reported a significant increase in the proportion of patients with reduced plaque size after LI-ESWT (Risk Difference (RD) 0.27, 95% CI: 0.04–0.50, P=0.02). o However, when measuring the actual plaque size reduction, there was no significant improvement compared to control groups. 2. Improvement of Penile Curvature: o The analysis indicated a significant percentage of patients experienced improvement in penile curvature after LI-ESWT (RD: 0.13, P=0.05), but the actual angle of curvature showed no significant change (Mean Difference (MD): -2.14, P=0.4). 3. Pain Relief: o The LI-ESWT group demonstrated a higher rate of pain relief (RD 0.22, P=0.04) and complete remission of pain (RD 0.38, P kleiner 0.00001) compared to control groups. 4. Sexual Function Improvement: o There was no significant improvement in sexual function as measured by the International Index of Erectile Function (IIEF) scores (MD: 1.44, P=0.53) or in overall sexual function between LI-ESWT and control groups. ________________________________________ Discussion The systematic review highlighted the potential benefits of LI-ESWT in reducing pain and improving the percentage of men with lessening penile plaques. However, the exact mechanisms by which LI-ESWT operates remain unclear. Proposed mechanisms include: • Cell proliferation and tissue regeneration • Enhanced blood flow and tissue perfusion • Reduction of inflammatory cytokines Several limitations were identified: • Heterogeneity: Significant variability in study designs, patient demographics, and treatment protocols contributed to high levels of heterogeneity (I²=55-79%). • Sample Size: Most studies had small sample sizes, with the largest including only 102 patients. • Short Follow-Up Periods: Follow-ups were generally limited to about six months, raising questions about the long-term effectiveness of LI-ESWT. ________________________________________ Conclusions: While LI-ESWT shows potential for improving symptoms associated with Peyronie’s disease, further high-quality, long-term, multicenter randomized controlled trials are necessary to establish its efficacy conclusively. Future research should focus on standardized outcome measures and a better understanding of the treatment mechanisms to optimize patient management strategies for PD. Unfortunately, this review does not offer new significant information. Moreover, recently published studies providing long-term results of ESWT with different energy settings. They also did not discuss the use of Li-ESWT in the management of the acute phase of PD. Jens Rassweiler

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