Ultrasound-Enhanced Combined Therapy: Low-Intensity Shockwave and Daily PDE5I for Pain Relief and Sexual Function in Acute Peyronie’s Disease

This study aimed to compare the efficacy and safety of daily phosphodiesterase type 5 inhibitors (PDE5i) alone and PDE5i combined with linear low-intensity shockwave therapy (Li-SWT) for treating the acute phase of Peyronie’s disease (PD). A total of 68 patients, aged 26 to 56 years (mean age 42.3 years), with acute PD symptoms within six months of onset were randomly assigned to two treatment groups. One group received 5 mg of tadalafil nightly for three months, while the other group underwent four sessions of Li-SWT alongside daily PDE5i. Li-SWT involved using the Renova device with a specific energy density, delivering 3200 pulses to the penile plaque and 900 to each penile shaft weekly over four weeks. Assessments included ultrasound or MRI, penile bending angle measurements, subjective symptom improvements, and International Index of Erectile Function (IIEF-5) scores before and after treatment. Results showed that 80% of patients in the PDE5i group experienced pain relief, compared to 90.9% in the combined therapy group. The IIEF-5 scores improved significantly in both groups, with the PDE5i group rising from 13.8 to 19.5, while the combined group increased from 13.4 to 21.3. Additionally, plaque size shrank in five patients in the PDE5i group and in twelve patients in the combined group. However, penile curvature remained unchanged in both groups. Mild side effects such as dizziness and back pain were reported but were not significant. Overall, both treatments were effective in alleviating symptoms and improving erectile function, with the combined therapy showing superior pain relief and sexual function enhancement while maintaining safety.