Peyronie’s disease (PD) is an acquired penile deformity (curvature) as a result of fibrotic (scar) tissue in the penile shaft. This can cause lot of penile pain and discomfort, can reduce or diminish the quality of erections, can complicate sexual intercourse with your partner, and can cause significant psychological burden for affected men and their sexual partners.
Causes of Peyronie’s Disease
The actual cause of Peyronie’s disease is still not fully understood. Many believe that Peyronie’s disease is the result of a traumatic injury at the level of penile shaft that initiates an inflammatory response which in turn results in a build-up of scar tissue at the site of injury. In addition, there are other non-traumatic conditions and risk factors that have been linked to Peyronie’s disease such as smoking, metabolic syndrome, gout, and family or personal history of Dupuytren’s contracture.
Acute & Chronic Phases
Peyronie’s disease occurs in 2 phases: acute and chronic. During the acute phase of Peyronie’s disease, affected men tend to develop a curvature in their penis, and often penile pain. Once the disease is stable, the penile pain tends to resolve but the curvature may last forever. By this time, Peyronie’s disease has entered chronic phase.
Options for treatment have historically included drug injections into the plaque using Verapamil and Xiaflex, mechanical traction (stretching the penis), and surgical options. Verapamil gel, a topical version of the drug, has also been effective in “eliminating pain upon erection, decreasing the size of plaque, decreasing curvature, and improving erection quality in patients with Peyronie’s Disease” (1). At this point in time, none of the existing oral agents (pills) are recommended by Canadian Urological Association (2).
Non-Invasive Treatment – Shockwave Therapy
In recent years, non-invasive innovative treatment options have been used in dealing with Peyronie’s disease. One of these options is Low Intensity Shock Wave Therapy (LiSWT) which has also been shown to be an effective treatment modality for the vasculogenic erectile dysfunction (i.e. erectile dysfunction due to compromised blood flow to the penis. For more information please visit the erectile dysfunction section of our website).
The actual mechanism of LiSWT for Peyronie’s disease is not fully understood. However, electron microscopy studies have “demonstrated actual histological changes within the Peyronie’s plaque following LiESWT” (3). Additional studies also reported “an improvement in penile curvature by more than 15° in 33% of men [who received LiSWT] with a corresponding decrease in penile plaque hardness in 60% of men, and a reduction in penile plaque by 2 cm in 27% of men” (4). LiSWT is believed to reduce the pain associated with Peyronie’s disease and to improve the quality of erection by promoting the generation of new and stronger blood vessels at the level of penile shaft. The Canadian Urological Association 2018 guideline states that “contemporary guidelines have clearly demarcated ESWT’s role in Peyronie’s disease management and the Committee concurs with this approach, supporting ESWT for potential penile pain improvement” (2).
Peyronie’s Disease Treatment at Pollock Clinics
At Pollock Clinics, our aim is to provide the least invasive but effective treatment modalities for Peyronie’s disease. Our Peyronie’s disease protocol involves Low intensity Shockwave Therapy (LiSWT) and a daily regimen of topical Verapamil gel. The LiSWT sessions occur once weekly for 6 consecutive weeks. The number of shocks applied to the plaque per session depends on the severity and duration of the disease and will be determined by the treating physician at the time of treatment.
(1) Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie’s disease–a placebo-controlled pilot study. J Sex Med. 2007.
(2) Canadian Urological Association guideline for Peyronie’s disease and congenital penile curvature. 2018.
(3) A new biopsy technique to investigate Peyronie’s disease associated histologic alterations: results with two different forms of therapy. Eur Urol 2002;42:239-44; discussion 244.
(4) Peyronie’s disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men. Korean J Urol 2015;56:775-80.