Con: does shockwave therapy have a place in the treatment of Peyronie’s disease?

Extracorporeal Shockwave Therapy (ESWT) has been used to treat various urological conditions such as nephrolithiasis and erectile dysfunction. The use of ESWT for Peyronie’s disease (PD) has been a subject of debate since Bellorofobate et al. published the first report on the use of ESWT on a PD patient in 1989 (1). The mechanism of action of ESWT in PD patients is still unknown mainly due to the lack of an animal model truly resembling PD. Multiple theories had been hypothesized with regards to its mechanism of action. Levine hypothesized that EWST causes destruction and lysis of the plaque by inducing an inflammatory response that attracts macrophages to the plaque site, leading to changes in vascularity and plaque resorption (2). In addition, direct trauma caused by ESWT may produce scar formation on the contralateral side of the penile shaft and, thus, correct the curvature. The other possible theory is that ESWT causes degradation of the plaque leading to an increase of the surface area in contact with the drugs introduced either locally or systemically (3). None of these theories have, however, yet to be scientifically proven.