Shock Wave Therapy of Peyronie's disease: 18 months' follow-up of a prospective study for standardised and objective evaluation of symptom changes under artificial erection

The literature contains few studies dealing with shock wave therapy of Peyr onie's disease. These studies are based on the subjective symptom improveme nt described by the patients. The aim of this study was the objective deter mination of shock wave effect on the symptoms caused by Peyronie's disease. Up to now, 65 patients (age: 58.4 +/-8.7 years) were enrolled into a therap eutic pilot study. The disease duration was 33.7 +/- 42.9 month. Inclusion criteria were: palpable plaque with one of the following symptoms: deviatio n, pain (visual pain scale), loss of distal rigidity. Clinical examination (prior to first therapy, 1, 6, 18 month after last shock wave application) included: Palpation and sonography of the plaque (size), measurement of dev iation, pain and distal loss of rigidity (artificial erection, Caverject 5 mug). 1000 shock waves (12 kV) per cm(2) plaque were applied onto the non-e rected penis once a week for a period of five weeks (Minilith, STORZ medica l). 18 month (n = 35) after the last shock wave therapy session the deviation a ngle was decreased form 59.3 +/- 38.1 degrees to 49.3 +/- 32.5 degrees (n = 24). Erection pain was eliminated in 15 out of 17 cases and reduced in 1 o ut of 17 cases. Distal rigidity was in none of the cases influenced. Six pa tients were capable of sexual intercourse before and 15 patients after shoc k wave therapy. Other significant side effects than small skin haematomas ( 90%) were not observed. This study demonstrates the objective symptom changes of patients with Peyr onie's disease who underwent shock wave therapy. In contrast to other studi es no significant improvement of deviation angle was observed using artific ial erection as control parameter. In order to determine the factual signif icance of this treatment option it seems to be essential to continue with s tudies.