Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Long-term outcomes of extracorporeal shock wave therapy for acute Peyronie’s disease: a 10-year retrospective analysis

International Journal of Impotence Research volume 36, pages 135–139 (2024)Cite this article

Subjects

Abstract

The aim of this paper was to describe the long-term outcomes of extracorporeal shock wave therapy (ESWT) in patients with acute Peyronie’disease (PD). An observational retrospective study was conducted in men with acute PD who underwent ESWT between 2009–2013 at a single institution. ESWT protocol consisted of 1 session (3000 shock waves, 0.10–0.25 mJ/mm^2, 4–6 Hz) per week for 4 weeks. Penile pain was chosen as the primary outcome. Penile curvature angle, erectile function, and satisfaction with ESWT were selected as secondary long-term outcomes. A total of 194 patients were included. The mean follow-up duration after ESWT was 125.6 months. Mean penile curvature worsened significantly at 3 months (18.3 vs. 21.5 degrees; p = 0.023) and 12 months (21.5 vs. 28.6 degrees; p = 0.001) and stabilized over the long-term (28.6 vs. 28.8 degrees; p = 0.335). Mean penile pain improved significantly at 3 months (6.5 vs. 3.1 points; p < 0.001) and 12 months (3.1 vs. 1.0 points; p = 0.001), remaining stable over time (1.0 vs. 1.0 points; p = 0.074). The mean five-item version of the International Index of Erectile Function (IIEF-5) increased significantly at 3 months (14.5 vs. 17.9 points; p = 0.001), remaining stable at 12 months (17.9 vs. 18.5 points; p = 0.082), and deteriorating in the long-term (18.5 vs. 15.8 points; p = 0.003). A high satisfaction rate with ESWT was recorded at 3 months (92.3%), remaining similar at 12 months (91.2%) and over the long-term (90.2%). No new acute phase and low rate of PD surgery (4.1%) were recorded in the long-term analysis. In patients with acute PD, ESWT seems to be associated with early and persistent relief of penile pain, transient improvement in erectile function, no significant effect on penile curvature, and a high rate of patient satisfaction constant over time.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Change in ESWT outcomes over time.

Similar content being viewed by others

Data availability

Raw data is available if requested.

References

  1. Salonia A, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioglu A, et al. European Association of Urology Guidelines on sexual and reproductive health. Presented at the EAU Annual Congress Amsterdam. 2022. ISBN 978-94-92671-16-5.

  2. Di Maida F, Cito G, Lambertini L, Valastro F, Morelli G, Mari A, et al. The natural history of Peyronie’s disease. World J Mens Health. 2021;39:399–405.

    Article  PubMed  Google Scholar 

  3. Levine LA, Latchamsetty KC. Treatment of erectile dysfunction in patients with Peyronie’s disease using sildenafil citrate. Int J Impot Res. 2002;14:478–82.

    Article  CAS  PubMed  Google Scholar 

  4. Vardi Y, Levine LA, Chen J, Hatzimouratidis K, Sohn M. Is there a place for conservative treatment in Peyronie’s disease? J Sex Med. 2009;6:903–9.

    Article  PubMed  Google Scholar 

  5. Spirito L, Manfredi C, La Rocca R, Napolitano L, Di Girolamo A, Capece M, et al. Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s disease: a retrospective comparative analysis. Int J Impot Res. 2022. https://doi.org/10.1038/s41443-022-00651-8.

  6. Fernández-Pascual E, Manfredi C, Torremadé J, Ibarra FP, Geli JS, Romero-Otero J, et al. Multicenter prospective study of grafting with collagen fleece tachosil in patients with Peyronie’s disease. J Sex Med. 2020;17:2279–86.

    Article  PubMed  Google Scholar 

  7. Krishnappa P, Manfredi C, Sinha M, Arcaniolo D, Matippa P, Moncada I. Penile modeling in peyronie’s disease: a systematic review of the literature. Sex Med Rev. 2022;10:434–50.

    Article  PubMed  Google Scholar 

  8. Verze P, Sokolakis I, Manfredi C, Collà Ruvolo C, Hatzichristodoulou G, Romero-Otero J. Penile prosthesis implant in the management of Peyronies’ disease. Minerva Urol Nephrol. 2021;73:196–214.

    Article  PubMed  Google Scholar 

  9. Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N. The end of an era: withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European market. Eur Urol. 2020;77:660–1.

    Article  PubMed  Google Scholar 

  10. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2:1265–8.

    Article  CAS  PubMed  Google Scholar 

  11. Porst H. Review of the current status of low intensity extracorporeal shockwave therapy (Li-ESWT) in erectile dysfunction (ED), Peyronie’s disease (PD), and sexual rehabilitation after radical prostatectomy with special focus on technical aspects of the different marketed ESWT devices including personal experiences in 350 patients. Sex Med Rev. 2021;9:93–122.

    Article  PubMed  Google Scholar 

  12. Gao L, Qian S, Tang Z, Li J, Yuan J. A meta-analysis of extracorporeal shock wave therapy for Peyronie’s disease. Int J Impot Res. 2016;28:161–6.

    Article  CAS  PubMed  Google Scholar 

  13. Palmieri A, Imbimbo C, Longo N, Fusco F, Verze P, Mangiapia F, et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie’s disease. Eur Urol. 2009;56:363–9.

    Article  PubMed  Google Scholar 

  14. Manfredi C, Arcaniolo D, Amicuzi U, Spirito L, Napolitano L, Crocerossa F, et al. Impact of extracorporeal shockwave therapy for erectile dysfunction and Peyronie’s disease on reproductive and hormonal testicular function. Andrology. 2022;10:1368–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hayat S, Brunckhorst O, Alnajjar HM, Cakir OO, Muneer A, Ahmed K. A systematic review of non-surgical management in Peyronie’s disease. Int J Impot Res. 2022. https://doi.org/10.1038/s41443-022-00633-w.

  16. World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191-4.

  17. Ziegelmann MJ, Bajic P, Levine LA. Peyronie’s disease: Contemporary evaluation and management. Int J Urol. 2020;27:504–16.

    Article  PubMed  Google Scholar 

  18. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3:310–6.

    Article  Google Scholar 

  19. Ohebshalom M, Mulhall J, Guhring P, Parker M. Measurement of penile curvature in Peyronie’s disease patients: comparison of three methods. J Sex Med. 2007;4:199–203.

    Article  PubMed  Google Scholar 

  20. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    Article  CAS  PubMed  Google Scholar 

  21. Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab. 2012;10:486–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Xu M, Fralick D, Zheng JZ, Wang B, Tu XM, Feng C. The differences and similarities between two-sample t-test and paired t-test. Shanghai Arch Psychiatry. 2017;29:184–8.

    PubMed  Google Scholar 

  23. Kim HY. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor Dent Endod. 2017;42:152–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sokolakis I, Hatzichristodoulou G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31:177–94.

    Article  PubMed  Google Scholar 

  25. Srirangam SJ, Manikandan R, Hussain J, Collins GN, O’Reilly PH. Long-term results of extracorporeal shockwave therapy for Peyronie’s disease. J Endourol. 2006;20:880–4.

    Article  PubMed  Google Scholar 

  26. De Berardinis E, Busetto GM, Antonini G, Giovannone R, Gentile V. Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: long-term results. Arch Ital Urol Androl. 2010;82:128–33.

    PubMed  Google Scholar 

  27. Ziegelmann M, Bole R, Avant R, Yang D, Montgomery B, Trost L. Conservatively managed Peyronie’s disease-long-term survey results from patients undergoing nonsurgical and noninjection therapies. Urology. 2018;113:99–104.

    Article  PubMed  Google Scholar 

  28. Capoccia E, Ziegelmann M, Emmerson J, Lankford J, Ofori-Marfoh C, Levine L. Long-term patient-reported outcomes in men with Peyronie’s disease undergoing nonsurgical and nonintralesional injection management. Int J Impot Res. 2021;33:75–81.

    Article  PubMed  Google Scholar 

  29. Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F. The basic science behind low-intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic scoping review of pre-clinical studies. J Sex Med. 2019;16:168–94.

    Article  PubMed  Google Scholar 

  30. Mulhall JP, Luo X, Zou KH, Stecher V, Galaznik A. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA. Int J Clin Pract. 2016;70:1012–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131, Naples, Italy

    Lorenzo Spirito, Celeste Manfredi, Davide Arcaniolo & Marco De Sio

  2. Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of, Naples, “Federico II”, 80131Naples, Italy

    Roberto La Rocca, Luigi Napolitano, Massimiliano Creta & Nicola Longo

  3. Urology Clinic—A.O.U. “Città della Salute e della Scienza”—Molinette Hospital, University of Turin, 10126, Turin, Italy

    Mirko Preto

  4. Urology Unit, AORN Moscati, 83100, Avellino, Italy

    Antonio Di Girolamo

Authors
  1. Lorenzo Spirito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Celeste Manfredi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto La Rocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luigi Napolitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mirko Preto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Di Girolamo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Davide Arcaniolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marco De Sio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Massimiliano Creta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nicola Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: LS, CM; Data Collection: RLR, LN, ADG, DA, MC; Data analysis: MP, MC; Writing-original draft: LS, CM; Scientific review: MDS, LN; Supervision: NL.

Corresponding author

Correspondence to Luigi Napolitano.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spirito, L., Manfredi, C., La Rocca, R. et al. Long-term outcomes of extracorporeal shock wave therapy for acute Peyronie’s disease: a 10-year retrospective analysis. Int J Impot Res 36, 135–139 (2024). https://doi.org/10.1038/s41443-023-00673-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-023-00673-w

This article is cited by

Search

Advanced search

Quick links