Hypothesis / aims of study
Conservative management of Peyronie’s disease (PD) often shows no advantage over placebo, while surgical correction may yield unsatisfactory outcomes. The objective of this study was to evaluate the effects of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in patients with PD.
Study design, materials and methods
A total of 110 men with PD were included and randomly assigned to two groups.
Group 1 (n = 50) received ESWT (Dornier Aries) applied to the penis twice weekly for 6 weeks. The mean age was 40.9 years (25–72), and the mean duration of PD was 1.6 years (0.5–6). Group 2 (n = 60) underwent two treatment sessions per week for 6 weeks. In Session 1, ESWT was performed followed by PRP injections into the penis, and PRP was subsequently activated with ESWT; Session 2 consisted of ESWT alone. The mean age in Group 2 was 39.4 years (23–70), and disease duration was 1.1 years (0.5–5). Assessments were performed at baseline and 2 months post-treatment using the following parameters (median [IQR]): Peyronie’s Disease Questionnaire (PDQ, item Q6), visual analog scale (VAS) scores during erection and vaginal intercourse, penile curvature angle, plaque size, and calcification area on ultrasound. The study protocol was approved by the Ethics Committee of the RUDN University Medical Institute.
Results
In Group 1, VAS during erection decreased from 2.9 (0–5) to 0 (0–1) (p < 0.001), and VAS during vaginal intercourse decreased from 2 (0–3.5) to 0 (0–1) (p < 0.05). PDQ scores improved from 13 (6–18) to 6 (1–8) (p < 0.001). The mean curvature angle reduced from 40.8° (20–68) to 31.8° (18.0–46.9) (p < 0.05). Calcification size decreased from 5 mm (2–9) to 4 mm (1–6) (p > 0.05), and fibrosis area decreased from 183.8 mm² (106.8–400.1) to 151.2 mm² (68.9–385) (p < 0.05).
In Group 2, VAS during erection decreased from 3 (1–4) to 0 (0–1) (p < 0.001), and VAS during vaginal intercourse decreased from 4 (2.4–5) to 0 (0–1) (p < 0.001). PDQ scores improved from 16 (8–24) to 5 (0–7) (p < 0.001). The curvature angle decreased from 36.9° (17.1–57.7) to 18.2° (10.6–30.4) (p < 0.05). Calcification size reduced from 6.2 mm (2–16) to 2 mm (0–6) (p < 0.05). Local fibrosis area decreased from 171.5 mm² (80.6–384.9) to 74.9 mm² (35–138.4) (p < 0.05), with complete resolution observed in 17 cases (28.3%) according to ultrasound findings.
Interpretation of results
After 2 months of therapy, combined PRP + ESWT treatment produced significantly greater reductions in plaque size, penile curvature, and pain (VAS scores) during erection and intercourse compared to ESWT alone (p < 0.05). This combination therapy demonstrated a superior regenerative and antifibrotic effect in patients with Peyronie’s disease.