Hypothesis / aims of study
Previous studies investigating the correction of Peyronie’s disease (PD) using extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) have demonstrated variable therapeutic outcomes. According to the European Association of Urology (EAU) guidelines, ESWT is currently recommended mainly for pain reduction.
The objective of this study was to evaluate the delayed clinical effects of ESWT and PRP in patients with PD.
Study design, materials and methods
A total of 70 men with PD were enrolled and randomly assigned into two equal groups. Group 1 received ESWT (Dornier Aries) twice weekly for 6 weeks (mean age 46.3 years [21–71]; mean PD duration 1.4 years [0.5–5]). Group 2 underwent two treatment sessions per week for 6 weeks: Session 1 included ESWT followed by PRP injections into the penis with subsequent PRP activation using ESWT; Session 2 consisted of ESWT alone (mean age 44.1 years [24–71]; PD duration 1.9 years [0.5–6]). At day 180, evaluations were performed using the PDQ (Q6), VAS during erection and intercourse, curvature angle, plaque and calcification size, and local fibrosis assessed by ultrasound. The study was approved by the Ethics Committee of the RUDN University Medical Institute.
Results
Earlier evaluations were conducted at baseline and day 60. In the ESWT group, by day 60, there was a reduction of pain, penile curvature, and fibrosis (p < 0.05). At 60 days, Group 2 showed significant improvement in PDQ, VAS, curvature angle, and plaque size compared with Group 1 (p < 0.05). At 180 days, pain (VAS = 0) did not recur in either group. PDQ in Group 1 increased from 3.8 (0.7–5.1) to 4.7 (1–6.2) (p < 0.05), while in Group 2 it decreased from 5 (1–7.6) to 3 (0–6.1) (p < 0.05). The curvature angle remained unchanged in Group 1 (p > 0.05), but decreased from 15° (7.2–25.5) to 11° (0–20) in Group 2 (p < 0.05). Calcification and fibrosis size did not change in Group 1 (p > 0.05). In Group 2, calcification size decreased from 2.4 mm (1–4.1) to 2.0 mm (0–4) (p > 0.05), while local fibrosis area reduced from 30.7 mm² (20.6–70.5) to 15 mm² (0–35) (p < 0.05). Complete resolution of fibrosis was observed in 17 patients (48.5%) on ultrasound at 6 months.
Interpretation of results
Long-term assessment confirmed sustained pain relief in both groups. The combination of PRP and ESWT resulted in continued improvement in PDQ scores and a significant delayed reduction in penile curvature and fibrotic plaque size, suggesting a stable regenerative effect beyond the early treatment period.