Peyronie’s disease is an acquired inflammatory disease of the tunica albuginea and adjacent erectile tissue of the penis, most commonly affecting men between the ages of 45 and 60 years old. In the acute inflammatory stage, the patient may experience pain during flaccidity and/or during erection or sexual intercourse. The pain usually resolves over several months as the acute inflammation subsides, and the condition evolves to a progressive fibrosis with development of a palpable plaque. The plaque may result in curvature of the penis, erectile dysfunction, or distal flaccidity. In some patients the plaque may resolve and disappear entirely. The etiology of Peyronie’s is unknown, but is thought to be related to subclinical trauma.
Patients may seek treatment for both relief of pain during the acute inflammatory phase, and sexual dysfunction and distortion characterizing the chronic phase. However, conservative treatment options are limited and there is currently no standard nonsurgical therapy. Nonsurgical therapies have included oral antioxidant agents (i.e., vitamin E, potassium aminobenzoate) or intralesional injections of corticosteroids, collagenase, or verapamil. Surgical treatment focuses on excision of the plaque. The “Nesbit” procedure involves excision of the plaque accompanied by patch grafting of the defect left by the excision. Recently, there has been interest in extracorporeal shock wave therapy (ESWT) as a treatment of Peyronie’s disease. While ESWT is a standard urologic therapy to disintegrate kidney stones, the mechanism of action is unknown in Peyronie’s disease, where the plaques may or may not be calcified. Similar to its proposed mechanisms of action in other soft tissue conditions, such as plantar fasciitis or lateral epicondylitis (tennis elbow), it has been proposed that ESWT may prompt increased vascularization and a healing response.