Combined Shockwave Therapy for Acute PD
August 28, 2025
Peyronie's disease is a challenging condition that affects many men, causing penile pain, deformity, and the formation of plaques. This condition can also lead to erectile dysfunction, creating both physical and emotional difficulties for men affected. While researchers do not fully understand what causes Peyronie's disease, we do know that it progresses in about 50% of cases. The initial phase of Peyronie's disease typically lasts between 6 to 18 months and is characterized by inflammation and significant pain during erections.
During this critical period, the primary focus should be on managing pain, preventing further injury, and supporting overall vascular health. Engaging in sexual activities carefully is essential for preventing additional trauma. Avoid vigorous sexual positions that could bend or twist the penis, and refrain from intercourse when erections are not rigid enough. If pain is severe, consider a temporary period of sexual abstinence to allow inflammation to subside. When sex is resumed, use plenty of lubrication to reduce friction.
Since Peyronie's disease often occurs alongside erectile dysfunction, your doctor may prescribe medications to improve erectile function, sometimes in combination with shockwave therapy. Extracorporeal shockwave treatment is generally safe with high patient satisfaction rates, though more controlled studies are needed to establish its long-term effectiveness for correcting curvature. Another lifestyle culprit related to poor penile blood flow is smoking and it can worsen PD symptoms by reducing circulation.
Two distinct phases of Peyronie’s disease...
Peyronie's disease develops in two clear stages. First comes an acute inflammatory phase, followed by a chronic stage where scar tissue forms into what doctors call penile plaque. When the plaque stops changing, the disease has reached a stable point. During the early inflammatory stage, patients typically experience penile pain that wasn't there before. This early phase might actually be the best time to start treatment, since the inflammation often responds to early interventions.
Extracorporeal shock wave therapy (ESWT) has found new applications in orthopedics for treating painful degenerative conditions, and results have been particularly promising for both pain management and wound healing. When ESWT targets specific organs, it triggers biological responses that encourage new blood vessel growth and tissue revascularization. Since Peyronie's disease continues to progress during its early stages, non-invasive therapies like ESWT could potentially slow the disease's development, which is an appealing option for many patients.
What ESWT Can Help with in the Acute Phase
Extracorporeal shock wave therapy offers a non-invasive option for men dealing with Peyronie’s disease in an early or acute phase. This innovative therapy works by delivering low-intensity sound waves to the affected area to stimulate growth of new blood vessels and improve circulation to the penile tissue. Additionally, EWST breaks down PD-related scar tissue, while also providing anti-inflammatory benefits that provide significant relief.
- Pain Reduction: ESWT is a valuable therapeutic option for patients experiencing penile pain during the early phases of Peyronie’s disease by offering improved comfort during PD’s acute stage.
- Plaque Modification: Clinical evidence points to potential benefits of ESWT in managing plaque reduction. But, some individuals reported positive outcomes while others express disappointment with their results.
- Stimulates Erectile Healing: This non-invasive therapy harnesses the power of acoustic waves to stimulate natural healing mechanisms by promoting healing to provide temporary improvements in erectile function.
Current evidence suggests that for carefully selected patients, ESWT is a safe option that can moderately improve penile curvature and reduce pain, with most men reporting high satisfaction with the treatment. The key challenge moving forward is identifying exactly which patients with Peyronie's disease are most likely to benefit from this therapy. While this minimally invasive treatment shows promise, clinical studies are still needed to confirm its long-term effectiveness.
Combined Shockwave Therapy
Many men actively seek combined treatment options for Peyronie’s because shockwave therapy helps preserve penile length, which is a major concern with surgical interventions that tend to result in a loss of length due to the invasive nature of the procedure. During the acute phase of PD treatment, some men’s health specialists recommend combining other treatment approaches with extracorporeal shockwave therapy for optimal results.
- COMBINED THERAPY: ESWT doesn’t have to work alone. Research shows combining shockwave therapy with other treatments can lead to better results. Paired with PDE5 inhibitors for treating ED, the combination approach has shown an overall boost in patient satisfaction.
- PENILE TRACTION: Penile traction therapy offers a non-invasive treatment approach that can be combined with ESWT during the early stages of Peyronie's disease. This method involves the use of devices designed to gently stretch penile tissue to reduce curvature while restoring length.
- ORAL AND INTRALESIONAL THERAPIES: If you're dealing with curvature issues, your doctor may start by prescribing oral anti-inflammatory meds to help manage pain. As the condition progresses, targeted intralesional injections deliver medications directly to the affected tissue.
- TREATING ERECTILE DYSFUNCTION: Treatment options for ED caused by Peyronie’s disease can vary based on severity of conditions. For milder cases, your men’s health specialists may prescribe PDE5 inhibitors combined with ESWT to improve blood flow to the penis.
- PLAQUE INCISION AND GRAFTING: There are surgical options available and each has distinct benefits. One approach involves cutting the plaque and placing a graft to fill the space for straightening of the penis. Another option is plication where sutures are placed on the opposite side of the curvature.
When treating acute Peyronie’s disease, the main goal is reduction of penile curvature and improvement of penile pain that can make sexual intercourse much more difficult. If you’ve had PD for a long time or have calcified plaques (chronic PD), improvement using ESWT is less likely. Typically, men who have had PD for less than twelve months are more responsive and studies suggest ESWT works best in younger patients with milder penile curvature. Combination shockwave therapy can include penile remodeling using a traction device or intralesional therapy.
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While surgical therapy remains as the most effective treatment option in men with PD, it is associated with significant risks such as penile length loss, sensory alteration and ED. Advances in diagnosis and treatment have made managing ED more effective. Today, we know that most men’s ED is caused by physical problems, particularly those affecting blood flow to the penis. Dr. Earl Eye is board certified in five medical specialties including Age Management Medicine and can help you take control of your sexual health. To schedule your appointment for a men’s health exam, call (904) 500-5500.
