Abstract Introduction Peyronie’s disease (PD) is a localized fibrotic disorder of the tunica albuginea often associated with penile curvature and erectile dysfunction (ED). The coexistence of cavernosal fibrosis and impaired penile hemodynamics significantly affects sexual function and quality of life. Conventional conservative therapies remain only partially effective. Low-intensity extracorporeal shockwave therapy (LiESWT) has shown potential as a non-invasive modality promoting neovascularization, antifibrotic activity, and endothelial repair. Objective This study evaluated a sequential LiESWT protocol alternating linear and focal applicators, combined with multimodal pharmacologic therapy, in men with stable PD and ED. Methods A prospective open-label study was conducted on 32 men aged 43–64 years (mean 51 ± 6.3) with stable-phase PD and curvature below 30°, all presenting with mild-to-moderate ED. Sixty-nine percent were responsive to phosphodiesterase type 5 inhibitors (PDE5i). Treatment was performed using the Morenova® shockwave system over 12 consecutive daily sessions, alternating between linear and focal applicators. The linear applicator was applied during six sessions delivering 3000 shocks/session at 0.09 mJ/mm2 and 2.5 Hz to the penile root and shaft. The focal applicator was used during alternate sessions targeting the fibrotic plaque (3000 shocks/session, 0.15 mJ/mm2, 2 Hz). Each patient received adjunctive therapy for three months: tadalafil 5 mg daily, L-arginine with Pycnogenol, and potassium para-aminobenzoate (POTABA). Patients with biochemical hypogonadism used testosterone gel 40.4 mg daily. Clinical evaluations were performed at baseline, 3, and 6 months. Results All patients completed the protocol without adverse events. Erectile function improved in 91% of cases, with mean IIEF-EF increasing from 15.9 ± 3.3 to 22.8 ± 3.7 (p 0.001) and EHS from 2.4 ± 0.5 to 3.5 ± 0.6 (p 0.01). At 6 months, 36% of patients demonstrated measurable curvature reduction (8–12°), while 56% reported subjective plaque softening and better penile elasticity. Thirty-eight percent discontinued PDE5i therapy due to restored spontaneous erections. A mild subjective increase in curvature occurred in 13% without pain recurrence or functional decline. Plaque consistency decreased in most cases, and men receiving testosterone supplementation showed greater adherence and functional improvement. Conclusions Sequential LiESWT alternating linear and focal applicators, integrated with multimodal medical therapy, produced significant structural and functional benefits in stable PD with ED. Combining shockwave-induced vascular regeneration with antifibrotic and hormonal modulation enhanced erectile performance, plaque remodeling, and satisfaction. The observation that over one-third of participants discontinued PDE5i due to spontaneous erectile recovery highlights the restorative potential of this approach. The method proved safe, well tolerated, and clinically effective, warranting further evaluation in larger controlled trials. Disclosure No
Arian et al. (Mon,) studied this question.
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