Various forms of external energy have been used to treat PD in non-randomized trials including topical ultrasound and lasers. The mechanism is unknown, but it has been suggested that ultrasound and laser treatment may enhance tissue healing. I am not familiar with any studies which have demonstrated any benefit with ultrasound or laser and therefore, cannot speak to the specific modality or energy level that should be used for ultrasound treatment of Peyronie’s disease. One treatment that has gained some attention in Europe and recently in the U.S. is iontophoresis or electromotive drug administration (EMDA). This treatment provides electric current to drive drugs through the skin into the underlying scar tissue. Studies have shown that EMDA can indeed drive verapamil into the plaque tissue and therefore may make some sense. More recent studies have suggested that the combination of verapamil and dexamethasone may provide the best outcomes with regard to improvement of deformity and rapid reduction of pain. But, the overall reduction of curvature tends to be small, in the 10-30 degree range. In my opinion, iontophoresis would be useful in the patients with mild to moderate curvature only or those who also have significant pain, as the EMDA treatment does seem to result in rapid resolution of the pain.
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