Saitta G. et al., 2026: . Extracorporeal shock wave therapy (ESWT) in the treatment of Peyronie's disease: our initial experience.

Saitta G, Trovato R, Striano V, Di Salvatore S, Di Paola G, Ceresoli AS, Mantovani FA, Meazza AL, Seveso M.
Arch Ital Urol Androl. 2026 Mar 2:14737. doi: 10.4081/aiua.2026.14737

Abstract

Background: Peyronie's disease (PD) is a connective tissue disorder of the penis that causes pain, curvature, and erectile dysfunction. Methods: A prospective study was conducted on 112 patients treated with ESWT. Each received three sessions of 3,000 shockwaves at 0.11-0.17 mJ/mm2. Pain, curvature, and erectile function were assessed.

Results: Pain relief occurred in 90% of patients (mean VAS reduction: 3, p<0.00001); 57.1% had curvature improvement (mean 30°, p<0.001); 26.2% of ED patients improved ≥ 4 points in IIEF.

Conclusions: ESWT appears safe and effective in improving pain and curvature in PD patients.

Comment Jens Rassweiler

The article discusses a prospective study evaluating the efficacy and safety of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for Peyronie's disease (PD), a condition characterized by the formation of fibrotic plaques in the penis that can lead to curvature and pain during erections.

Introduction

Peyronie's Disease Overview

   - PD is a connective tissue disorder often linked to microtrauma, leading to abnormal wound healing and plaque formation in the tunica albuginea of the penis.

   - The disease progresses through two phases: an active phase with worsening symptoms (curvature and pain) and a stable phase where symptoms cease to progress but deformities persist.

Diagnosis

   - Diagnosis involves a detailed patient history and physical examination to assess the severity and phase of the disease.

Treatment Options

   - Treatment is individualized, with conservative therapies recommended in the active phase, including medications and LI-ESWT. Surgery is reserved for stable cases with significant curvature. LI-ESWT aims to induce tissue remodeling and improve symptoms without invasive procedures.

Material and Methods

The study involved 112 patients treated with LI-ESWT with 3,000 shockwaves delivered per session at an energy density of 0.11-0.17mJ/mm², administered at three-week intervals over approximately nine months. Participants received a minimum of three LI-ESWT sessions, with outcomes assessed using visual analog scales for pain and the International Index of Erectile Function (IIEF) for erectile function.

Results

Pain relief was significant, with 90% of patients in the acute phase experiencing immediate relief. 57.1% of patients showed improvement in penile curvature, averaging a reduction of 30 degrees. Improvements in erectile function were reported by 26.2% of patients.

Minimal adverse effects were noted, primarily minor bruising.

Discussion

The study supports LI-ESWT as a safe and effective conservative treatment for PD, demonstrating significant improvements in pain and curvature. However, the study faced limitations such as the lack of a control group and a short follow-up period, necessitating further research to confirm long-term efficacy and understand the biological mechanisms behind LI-ESWT's effects. Moreover, only three treatment seems to be not sufficient, particularly with respect to the correction of the curvarture.

The authors also do not address high-energy shock wave therapy, which is a different approach that can involve higher energy levels and may have different mechanisms of action and outcomes.

High-Energy Shock Wave Therapy Overview:

Mechanism of Action: High-energy shock waves are thought to induce more significant tissue disruption and remodeling compared to low-energy waves. They may also promote angiogenesis and enhance blood flow, potentially impacting the fibrotic tissue more aggressively.

Potential Benefits: High-energy shock wave therapy could lead to more pronounced improvements in penile curvature and plaque size, potentially offering a more definitive treatment option for severe cases of Peyronie's disease.

Clinical Evidence: The literature on high-energy shock wave therapy for Peyronie's disease is less extensive compared to low-energy approaches. More randomized controlled trials and clinical studies would be needed to establish its efficacy, safety, and appropriate patient selection.

Comparison with LI-ESWT: While LI-ESWT has shown promise in symptom relief and has a favorable safety profile, high-energy shock wave therapy might be considered in cases where more aggressive intervention is warranted, particularly in patients with severe curvature not responsive to conservative treatments.

Conclusion

The authors' omission of high-energy shock wave therapy in their discussion may limit the understanding of the full spectrum of shockwave therapies available for Peyronie's disease. Future research could explore and compare the efficacy and safety of both low and high-energy shock wave therapies to provide clearer guidelines for treatment options based on the severity and characteristics of the disease. It's essential for clinicians to stay informed about all therapeutic modalities to tailor the best approach for individual patients.

Nevertheless, LI-ESWT shows promise as a non-invasive option for managing Peyronie's disease, but further studies are needed to validate these findings and explore its role in the acute phase of the disease.

Jena Rassweiler