Peyronie’s
disease }

Pathology

Peyronie's disease, or induratio penis plastica, is an acquired curvature of the penis that can cause erectile dysfunction. When present, pain occurs early in the disease process and lessens with time.

Diagnosis is based on the clinical features of the disease. At the microscopic level the disease is characterized by the deposition of collagen and fibrin and a reduction in elastic fibers, resulting in plaque formation in the tunica albuginea. This scarring of the penis leads to its bending during erection.

It has been proposed that Peyronie's disease results from abnormal wound healing, and the deposition of collagen and fibrin might be the result of a microtrauma. This is supported by the finding that soft tissue trauma can cause increased levels of transforming growth factor β1 (TGF-β1), potentially leading to a proinflammatory and profibrotic cascade with subsequent deposition of collagen. However, a unifying pathophysiological understanding of the disease process has not become available.

The population incidence is approximately 1-3% among male individuals, with peak incidence occurring between 40 and 70 years of age. 20–40% of men with Peyronie's disease report erectile dysfunction, and it has been estimated that the disease has significant psychological effects on up to 77% of all affected men. Notably the number of patients suffering from Peyronie's disease has apparently increased since the advent of oral sildenafil ("Viagra").

Because of the missing unifying pathophysiological understanding, no therapeutic modalities have provided patients with reliable results and resolution of their symptoms. All therapeutic modalities that are nowadays in use aim at manipulating some components of wound healing. Among them are oral supplementation with vitamin E, omega-3 fatty acid and antioxidant coenzyme Q10, as well as pentoxifylline (a nonspecific phosphodiesterase inhibitor with antifibrotic and anti-inflammatory properties). Other therapeutic strategies involve topical application of verapamil, trifluoperazine or magnesium sulfate, iontophoresis, intralesional injections of corticosteroids, collagenase, verapamil and interferon alpha, radiation therapy and penile traction therapy.

Recently, radial shock wave therapy (RSWT) has been demonstrated as being efficient for Peyronie's disease. The specific molecular and cellular mechanisms of action of RSWT in Peyronie's disease are still unknown, but it is reasonable to hypothesize that they are linked to RSWT's proven beneficial effects in wound healing.

Treatment Procedure

1. PALPATE
Locate the area of pain through palpation and biofeedback.

2. MARK
Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment
Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ Not recommended
Impulses 2000 impulses
Frequency 8 Hz to 12Hz
Applicator 15mm
Skin pressure Light

Clinical Proof

Palmieri A, Imbimbo C, Longo n, 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: 363-369
http://www.ncbi.nlm.nih.gov/pubmed/19473751

Risks

Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®

When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36 hours after the treatment.

Accordingly the following contraindications of RSWT® using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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