A meta-analysis of extracorporeal shock wave therapy for Peyronie’s disease

Abstract

The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency of ESWT for PD and provide possible evidence on the basis of a meta-analysis of existing comparative studies. All controlled studies, including randomized controlled trials (RCTs), cohort studies and case-control studies, that focused on the efficiency of ESWT for PD, were prospectively identified through comprehensive searches of PubMed, the Cochrane Library and Embase databases. We conducted a meta-analysis of these studies. Six studies including 443 patients were selected for the meta-analysis. Pooling data of these studies showed that ESWT could significantly increase the percentage of men with lessening of penile plaques (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.11-3.85, P=0.02), relief of pain (OR 4.46, 95% CI 2.29-8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI 2.66-12.92, P<0.0001). However, insignificant differences were found in improvement of penile curvature (OR 1.88, 95% CI 0.97-3.65, P=0.06) and sexual function (OR 2.22, 95% CI 0.69-7.11, P=0.18) between ESWT and placebo groups. Further, similar results were shown for sensitivity and publication bias analysis when only RCTs were included. However, sporadic complications caused by ESWT were reported, but no patient needed additional treatment aside from conservative observation. ESWT may be an effective and safe treatment for lessening of penile plaques and relieving pain for men with PD, but not for improving of penile curvature and sexual function.

Laser Therapy for Peyronie’s Disease: A Randomized Control Double-Blind Pilot Study

“…1,[24][25][26][27] Recently, new therapeutic advances in the management of PD have been presented as ESWT. Data from a metaanalysis by Hauck et al 28 and Gao et al, 29 systematic review by Fojecki et al, 30 and also more recent prospective trials [31][32][33] Assessed for eligibility (n=63)…”

“…However, the efficiency of ESWT for PD has been controversial. 29 After this innovation, laser therapy was introduced as one of the newest modalities for PD treatment. PD is considered as an aberrant wound-healing process in response to inflammation.…”

Reduction in Peyronie's-like plaque size using a vacuum erection device in a rat model of Peyronie's disease via the TGF-β/SMAD signalling pathway

“…Moreover, intralesional CCH injections do not promote a significant improvement in erectile function (Anaissie, Yafi, DeLay et al., ). Extracorporeal shock wave therapy, which is a type of topical regimen, has been demonstrated to be an effective treatment for decreasing penile plaque size (Gao, Qian, Tang, Li, & Yuan, ), but whether it is effective in restoring erectile function in PD patients is unknown. Therefore, therapy aimed at reducing penile plaque size and improving erectile function is needed.…”

Nonsurgical Interventions for Peyronie's Disease: Update as of 2016

“…In addition, the authors pointed out that while ESWT may improve pain, this is the one symptom of PD that often resolves over time without intervention [56]. A recent meta-analysis agreed with these findings, suggesting that ESWT was most effective for pain reduction, but did not lead to appreciable improvements in penile curvature [57]. In this study, ESWT was well tolerated overall, despite the incidence of a few complications that did not require intervention, including penile bruising and urethral bleeding.…”