Breaking up gravel and Peyronie's disease

Peyronie’s disease treatment has been done in recent past times with ESWT, although after just a few years of promotion and use it has rapidly fallen out of favor.

ESWT or Extracorporeal Shock Wave Therapy is a standard medical procedure that involves the use of shockwave lithotripsy (high pressure and low frequency sound wave) technology to treat Peyronie's disease.  The machine that actually creates the extracorporeal shockwaves is a device located outside the body, that is applied over the affected tissue of the Peyronies plaque. In Peyronie's disease, the fibrous plaque or scar is the target of these shockwaves that are identified with an ultrasound scanner.  The ESWT shockwaves per session range from 2000-3000, applied over several minutes, with the average patient receiving 4-6 treatments and a maximum number of sessions of 12. This procedure can be performed with or without sedation, although most men prefer sedation after their first actual encounter with ESWT.

Although ESWT is primarily used as a treatment for kidney stones, this shock wave therapy or lithotripsy, has also been attempted for Peyronie's treatment since the early 1990s. However, more recent studies re-evaluating the effectiveness of ESWT for Peyronie's disease have only shown mixed results. Some studies have found ESWT restores normal erections and reduces pain associated with Peyronie's disease.  However, additional studies could not reproduce those same findings, and have not found any clinical benefit. Further research is needed to fully evaluate what role, if any, shock wave therapy should play as a treatment for Peyronie's disease.

The current evidence concerning the safety of ESWT for Peyronie’s disease appears adequate, using accepted medical standards.  However, keep in mind that accepted medical standards also suggests that Peyronies surgery that leaves many men impotent or totally numb or more distorted after the surgery is also thought to be safe.  Even so, the evidence for the effectiveness of ESWT does not appear adequate to support the continued use of this procedure without special arrangements and for audit or research; this means that if you want to use ESWT, you will have to agree to use it on a research basis because it has not proven to be effective.  Doctors who use ESWT must therefore tell their patients that the outcomes of this procedure are uncertain and there is unclear effectiveness in relation to the risks involved.

ESWT safety

Safety is always an issue in any healthcare matter.  In the several studies of ESWT safety that have been conducted since the late 1990s, according to medical review, “relatively few complications were reported. Complications were mostly of a transient nature and included urethral bleeding, bruising, skin discoloration due to petechiae (small dot-sized bruises), and hematoma (large bruises). The relationship between the energy level used in the treatment and the reported complications is unclear…The Specialist Advisors did not note any particular safety concerns about this procedure. Superficial bruising and moderate local pain were noted as potential adverse events.”

This disconnected thinking seems to be typical of many medical reviews of Peyronie’s disease treatment options.  On one hand, the report of ESWT safety casually mentions urethral bleeding, along with large and small bruising of the penile tissue. On the other hand, it does not consider that small trauma is often sufficient to trigger the onset of Peyronie’s disease.  Perhaps a trauma large enough to cause bleeding and bruise marks is no big deal to a medical researcher, but ask a man whose PD started from a small and one-time injury during sexual relations.

Think of what a jack-hammer does to concrete

It seems unbelievable that medical researchers, who the public rely upon for approval or disapproval of Peyronie’s disease treatment options, can be this ignorant of the situation concerning Peyronie’s disease.  Perhaps this entire body of researchers did not consider that a trauma large enough to cause penile bleeding and bruising might just be sufficient to cause or aggravate Peyronie’s disease.

In fact, no medial explanation has been offered how beating on a Peyronie’s disease  plaque 2000-3000 times with a high pressure and low frequency sound wave is going to help the problem.  Recall that this technology was intended to break up kidney stones.  A Peyronies plaque is not a kidney stone.  The fact that the scar or plaque is sometimes calcified in latter stages is perhaps where the connection started between kidney stone and Peyronie’s disease.  Yet, it must be considered that the tunica albuginea of a man susceptible to Peyronie’s disease is unlike other tissue.  When irritated it develops plaque material, especially when subjected to something as strong as 2000-3000 sound waves strong enough to break up a kidney stone.

It just never made sense to me when I first heard of the ESWT concept several years back, and I was the only one saying that kind of direct and repeated trauma capable to break kidney stones could not be beneficial to the tunica of a man who already has Peyronie’s disease.  Over time I heard less and less of ESWT and how even the Canadian clinic that promoted it so heavily has stopped doing the procedure.

It seems that common sense is not that common, especially when it comes to Peyronie’s disease treatment.