Table 3: External energy therapies

From: Review of non-surgical treatment options for Peyronie's Disease

Treatment (dose)MechanismClinical benefitsSide effectsICSM guidelines14
Penile ESWT (2000 shocks weekly × 4)75Local inflammatory reaction leading to plaque lysis, improved vascularity, plaque resorption and contralateral scarringPain resolved in 53%,75 no benefit with regard to curvature or deformity.Bruising, skin hemorrhage, hematoma, urethral bleedingEvidence that ESWT does not improve PD-related deformity
     
Electromotive Drug Administration (EMDA)–Iontophoresis (5–10 mg verapamil±8 mg dexamethasone at 2.4 mA for 20 min)70,72Decreased expression of bFGF mRNA and bFGF protein expression in excised Peyronie's plaques, verapamil same mechanism as intralesional45% had at least 50% reduction of curvature, 88% with complete resolution of pain72Mild erythemaSeveral controlled trials had evidence of reduced deformity following iontophoresis treatment using verapamil and dexamethasone
     
Penile traction (2–9 h per day)82,83Tension-induced cellular proliferation, reorientation collagen fibrils, upregulation of ‘antifibrotic’ genesDecreased curvature of 33%82Local irritationEarly evidence from two small non-controlled prospective trials have reported a reduction of deformity and increased penile length
  1. Abbreviations: bFGF, basic fibroblast growth factor; ESWT, electroshock wave therapy; PD, Peyronie's disease.