Extracorporeal shock wave therapy (ESWT) is a therapy where shock waves are aimed at tissue or structures to disrupt them. It has been used in many conditions although it has been used most frequently for the fragmentation of stones inside the body, such as gallstones and kidney stones. For these conditions it has proven to be an excellent treatment and represents the primary treatment of small stones in the kidney. Based on the application of this therapy in orthopedic medicine for a variety of conditions some researchers in Europe applied ESWT to Peyronie’s disease. The concept is intriguing as we as of yet do not have an excellent medical therapy for reversal of penile deformity in Peyronie’s disease. The concept is that the shock waves when applied to the scar (plaque) can disrupt it, perhaps resulting in an improvement in penile deformity. It remains unclear exactly what the mechanism is by which ESWT correct penile curvature.
As of February 2004 there are 17 papers in the literature discussing the use of ESWT in Peyronie’s disease. Unfortunately, there is no consensus among any of the centers that are using this technique as to what the correct machine to be used is (there are many different kinds of machines used for shock wave therapy), how many shocks should be applied to the penis and at what energy, and finally how many sessions should be used. The studies exemplify many of the inadequacies of the clinical Peyronie’s disease literature in general, specifically the absence of a control group (there should be a group of men who received “fake” ESWT to ensure that the treatment is actually resulting in correction and that it is not just the natural history of the condition), small numbers and inadequate follow-up. Finally, there is not a single study that has shown that ESWT applied to the penis is safe. Theoretically, shockwaves should be damaging to erectile tissue causing scarring from the trauma that shock waves cause. Scarring in erection tissue could have a significant negative effect on erectile function perhaps leading to erectile dysfunction (softening of erections).
The best conducted studies have shown a 21-64% incidence of penile deformity correction, although most of these studies have less than 30 patients studied, have no control group and have less than 12 months follow-up on the patients. While it is likely the reason that ESWT has not received widespread acceptance by urologists in the USA is the lack of insurance reimbursement, the safety concern is the main reason that the experts have not yet commenced large-scale ESWT programs for Peyronie’s disease. At this time, most authorities are encouraging patients to be cautious. If you are considering this option speak to an expert before you do so.