[No abstract available] Dekalo et al., 2022: Shock Wave Therapy for Peyronie’s Disease—Learning From the Past and Looking Into the Future

This article is more or less an Expert`s Opinion based on the review of the current literature.
The authors conclude, that there is no indication of Li-SWT for Peyronie`s disease. This is in contrast to the EAU-guidelines, where Li-ESWT has been approved for management of pain.

The authors state, that creating in vitro and animal models for Peyronie's plaques that closely replicate the human condition has proven difficult. Obviously, there is no animal model for Induratio Penis Plastica (IPP). Unfortunately, the authors did not cite the important article of Mirone et al Eur Urol 2002; 42:239, where they were able to take biopsies before and after Li-ESWT verifying the effect of shock wave treatment. In addition, they did not include the recent follow-up publication of Sokolakis et al. in the Journal of Sexual Medicine 2021. The authors did again find a significant advantage with respect to pain.

Evidently, the impact of Low intensity shock wave treatment on penile deviation has not been significant. However, there are reports of significant improvement of the penile deviation when using High-energy settings. This would come back to the early idea of destroying the plaque. Unfortunately, there is no randomized trial with use of High energy ESWT.

It has to be emphasized, that there are basically no severe side-effects when using ESWT. This is in contrast to other approaches like the injection of collagenase chlostridium histolyticum, where 3 % of the patient developed a rupture of the corpora (Natale et al. Sex Med Rev 2021;9:340). This should be at least discussed in a review paper of 2022.

Nevertheless, I agree that there is a need of prospective well-designed trial to further evaluate the potential of ESWT in the management of IPP.

Jens Rassweiler