The results of conservative methods of Peyronie's disease (PD) treatment do not exceed the placebo, and surgical treatment does not always lead to satisfactory results. The objective was to investigate the effects of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in patients with PD.

70 patients with PD were included in our trial. Patients were randomly allocated to 2 groups. Group 1 received ESWT (Dornier Aries) twice weekly for 6 weeks; the average age was 46.3 years (21-71), and the duration of PD was 1.4 years (0.5-5). Group 2 received 2 therapy sessions per week for 6 weeks. Session 1 included ESWT per penile and PRP injections into the penile; finally, PRP was activated with ESWT. Session 2 included ESWT per penile. The age of group 2 patients was 44.1 years (24-71), and the duration of PD was 1.9 years (0.5-6). Follow-up evaluations were performed at baseline and 2 months after treatment using the following criteria in both groups (median (IQR%): PDQ (Q6), VAS score during vaginal intercourse and VAS score during erection, curvature angle, plaque size, and calcifications according to ultrasound data. The study was approved by the Ethics Committee of the RUDN Medical Institute

VAS during erection in group 1 decreased from 3.4 (0-5) to 0 (0-0) (p<0.001). VAS during erection in group 2 decreased from 3 (1-4) to 0 (0-1.5) (p<0.001). VAS during vaginal intercourse in group 1 decreased from 1.5 (0-3) to 0 (0-1) (p<0.05). VAS during vaginal intercourse in group 2 decreased from 3.5 (2.4-5) to 1 (0-1) (p<0.001). PDQ in group 1 changed from 9.5 (6-17) to 3.8 (0.7-5.1) (p<0.001). PDQ in group 2 changed from 13.6 (7.9-18.5) to 5 (1-7.6) (p<0.001). The curvature angle in group 1 decreased from 30.3° (17-49) to 20.9° (15.7-36.1) (p<0.05). The curvature angle in group 2 decreased from 28.4° (18.6-47) to 15° (7.2-25.5) (p<0.05). In group 1, calcification size decreased from 4.2 mm (2.6-8.6) to 2.4 mm (1-5.1) (p>0.05). In group 2, calcification size changed from 3.5 mm (2.1-8.7) to 2.4 mm (1-4.1) (p<0.05). In group 1, local fibrosis decreased from 268.2 mm2 (123-367.6) to 109.5 mm2 (56.2-176) (p<0.05). In group 2, local fibrosis decreased from 117.9 mm2 (71.9-295) to 30.7 mm2 (20.6-70.5) (p<0.05). In 15 cases (42.8%) of group 2, local fibrosis was completely resolved according to ultrasound data. After 2 months, intergroup analysis revealed significantly lower mean plaque size, VAS during erection, and VAS during vaginal intercourse in patients who received PRP plus ESWT (p<0.05).

These suggested treatments were well-tolerated in all patients.  Combined treatment is more effective in managing local fibrosis according to ultrasound data and pain, as indicated by VAS and PDQ.

PRP plus ESWT, as well as ESWT alone, may represent an effectiveness conservative strategy in the treatment of Peyronie's disease.