An alternative non-invasive treatment for Peyronie's disease

Abstract

Objective: Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT) emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease.Materials and Methods: Twenty-five patients 42 to 68 years old (mean = 54) presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30). All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily) during 3 months and underwent 3 to 6 sessions (mean = 3) of ESWT (3,000 to 4,000 shockwaves) at a power level of l to 2 at 1-week intervals.Results: From 25 patients treated, 16 (64%) reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40). Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 -70) and in the study group was 24.42 degrees (0 -70), statistically significant.Conclusion: Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie’s disease and erectile dysfunction: results from a prospective randomized trial

“…Local complications were similar in both groups while systemic complications were higher in patients receiving ESWT plus tadalafil. However, systemic complications were similar to those reported in previous studies on tadalafil 5 mg once daily [Claro et al. (2004),Donatucci et al.…”

“…To our knowledge, we performed the first clinical study evaluating the role of a combination strategy consisting of ESWT and a chronic PDE5i in the management of PD patients with ED. Although direct therapeutic mechanisms of ESWT on PD plaque have been hypothesized, results from the present study as well as from other clinical studies, failed to demonstrate a significant reduction of plaque size and curvature degree after this treatment strategy [Claro et al. (2004), Wild et al.…”

Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management

“…76 Only one study of combination therapy evaluating vitamin E and extracorporeal shock wave therapy (ESWT) in 35 patients observed a significant decrease in penile curvature compared to vitamin E alone. 73 However, these results have not been reproduced. As such, vitamin E is not recommended treatment in the European Association of Urology (EAU) 2012 PD guideline.…”

“…71,73-76 The free-radical scavenging effect of vitamin E provides the theoretical basis for its use in PD 77 although no strong evidence that it provides benefit exists. Hashimoto et al saw no difference in pain relief, curvature improvement, plaque size reduction, or ED improvement between the vitamin E and no-medication groups in a retrospective review of 31 patients.…”

Peyronie's disease: a critical appraisal of current diagnosis and treatment

“…A novel approach to the management of PD has been to utilize extracorporeal shock wave therapy to treat penile plaques. Although a retrospective cohort of 25 patients 76% reported significantly decreased penile angulation over the follow-up period (mean 8.5 months), 83 shock wave therapy was associated with minor skin hematoma (76%) and urethral bleeding (8%) that resolved with conservative management. The treatment was not associated with pain and local or regional anesthesia was not necessary.…”