Lapeyronie’s disease is a urological pathology that affects many men around the world, often causing anxiety, pain and disruption to sexual life. As a urological surgeon based in Paris, I’m Dr. Sébastien Beley, and I’d like to enlighten you today on an innovative therapeutic approach that’s being used more and more: shockwave treatment. This method, while promising, still raises many questions as to its real effectiveness on disease-related deformities. In this article, I’ll explain in detail how shockwaves work, their impact on Lapeyronie’s disease, the benefits they bring, and their limitations.

What is Lapeyronie’s disease?

Lapeyronie’s disease is characterized by the formation of a fibrous plaque, called Lapeyronie’s plaque, inside the penis. This plaque is responsible for a deformity, often a curvature, which can cause pain and difficulty during intercourse. The disease generally progresses in two phases:

• Acute phase: This first phase is often painful and corresponds to active inflammation of the plaque. It may last several months, during which the curvature may worsen.
• Chronic phase: At this stage, pain generally diminishes, but the deformity becomes stable and sometimes permanent.

The plaque responsible for the deformity is made up of fibrous tissue, but it is important to note that it is generally not calcified in the early stages of the disease. This characteristic has important implications for the choice of treatment.

How do shockwaves work?

Shockwaves are high-energy acoustic pulses that can be used to treat a variety of medical conditions. They are well known for their use in the treatment of kidney stones, where they break up the stones into smaller pieces, facilitating their natural elimination.

In the context of Lapeyronie’s disease, shockwaves are not intended to fragment the plaque, as it is not calcified and does not have the hardness to be broken by this type of treatment. Instead, shockwaves have an anti-inflammatory and analgesic effect, making them particularly useful in the initial phase of the disease.

The benefits of shock waves in Lapeyronie’s disease

The main advantage of shockwaves in the treatment of Lapeyronie’s disease lies in their ability to reduce pain and slow the progression of inflammation. Here are the detailed benefits:

1. Pain relief

The pain associated with Lapeyronie’s disease, especially in the acute phase, can be intense and incapacitating. Shockwaves act by modulating inflammatory phenomena within the plaque, helping to considerably reduce the pain felt by the patient. This reduction in pain improves quality of life, and often allows patients to resume sexual activity more comfortably.

2. Limiting disease progression

By reducing inflammation, shockwaves can also slow or halt plaque progression. This means that the curvature of the penis, which results from the thickening and hardening of the plaque, is less likely to worsen. So, even if this treatment doesn’t directly correct the deformity, it can prevent it from worsening, which is a significant benefit for patients.

3. Indirect improvement in sexual function

By reducing pain and stabilizing the disease, shockwaves promote better sexual function. The fear of pain during intercourse, often responsible for a drop in libido or secondary erectile dysfunction, is thus alleviated.

The limits of shock waves in the treatment of Lapeyronie’s disease

It is essential to understand that shockwaves are not a miracle solution for Lapeyronie’s disease. They have significant limitations, particularly when it comes to correcting deformities:

1. No direct effect on curvature correction

Lapeyronie’s plaque is an area of fibrous tissue which, in the majority of cases, remains soft and uncalcified. As a result, shockwaves cannot fragment or destroy it, unlike in the treatment of kidney stones. This means that penile curvature or deformity will not be corrected by this treatment.

2. Effectiveness limited to initial phases

Shockwave treatment is particularly indicated during the acute phase of the disease, when plaque is still forming and inflammation is active. Once the disease has stabilized, with plaque formed and scar tissue mature, the anti-inflammatory effect of shockwaves is less marked and does not modify the deformity.

3. The need for comprehensive care

Shockwaves must be part of a comprehensive treatment strategy that may include other medical or surgical treatments, depending on the severity of the curvature and the impact on sexual function. In the case of severe deformity, surgical interventions such as plication, grafting orpenile implant placement may be necessary.

When and how should shock waves be used in Lapeyronie’s disease?

The success of shockwave treatment depends to a large extent on when it is initiated. Here are some practical recommendations:

• Start early: Treatment is most effective when initiated in the first few months after the onset of symptoms, i.e. during the active inflammatory phase.
• Frequency and duration: Protocols vary, but treatment generally consists of several sessions spaced a few days to a few weeks apart, enabling inflammation to be modulated progressively.
• Medical follow-up: Regular follow-up is essential to assess response to treatment, adjust sessions and decide on the need for any further interventions.

Other complementary treatments to consider

Lapeyronie’s disease often requires a multidisciplinary approach. Here are some other frequently used treatment options:

Anti-inflammatory and analgesic drugs

They can be prescribed to relieve pain and reduce inflammation, in addition to shock waves.

Intra-platelet injections

Injections of corticoids, collagenase or other agents can be made directly into the plaque to improve deformity or reduce pain.

Surgical treatments

In cases of severe or disabling deformity, surgery remains the most effective solution for correcting the curvature. Techniques include plication, grafting or penile implant placement, depending on the clinical situation.

Physical therapies and rehabilitation

Specific exercises or stretching devices can be suggested to improve penile flexibility and limit the progression of the disease.

Conclusion: Shock waves, a valuable but limited tool

Shockwave treatment represents an interesting advance in the management of Lapeyronie’s disease, thanks in particular to its action on pain and inflammation. It is a non-invasive option that can improve patient comfort and slow the worsening of deformity, especially when applied early.

However, it is important to have realistic expectations: shockwaves neither correct curvature nor destroy plaque. They must therefore be integrated into an overall strategy tailored to each patient, depending on the severity of symptoms and the progression of the disease.

If you suffer from Lapeyronie’s disease, I invite you to consult a specialist in order to establish a precise diagnosis and discuss treatment options adapted to your situation. Personalized care is the key to regaining a fulfilling sex life and limiting the complications associated with this pathology.

For more information on male sexual health, Lapeyronie’s disease and other urological disorders, feel free to explore the resources available on my site and follow my regular publications.