Active Peyronie's Disease with Penile Pain — What to Do When Oral Anti-inflammatory Treatment Has Not Relieved Symptoms
In active-phase Peyronie's disease, penile pain is the defining symptom. When initial oral anti-inflammatory therapy fails to achieve adequate pain relief, a structured next-line approach exists. This page outlines the clinical context and links to the full protocol.
Clinical Scenario
Active Peyronie's disease presenting with penile pain. Active disease is characterised by dynamic and changing symptoms; penile and/or glanular pain or discomfort — with or without erection — is the defining symptom of the active stage.
Previous Treatment — Inadequate Response
The prior step used oral non-steroidal anti-inflammatory medications for penile pain management. The target — resolution or improvement of penile pain on a visual analog scale — was not adequately reached. This protocol represents the recommended next step after that failure.
Next-Line Approach (Partial Overview)
A structured course of extracorporeal shock wave therapy (ESWT) may be offered to improve penile pain — the full protocol details are available via the link below.
Treatment Goal
Improvement of penile pain on visual analog scale at 24 weeks.
References
- Active disease is characterized by dynamic and changing symptoms.
- Penile and/or glanular pain or discomfort with or without erection is the defining symptom of the active stage.
- Clinicians may offer extracorporeal shock wave therapy (ESWT) to improve penile pain.
- Treatment durations ranged from 4 to 6 weeks with typically 1 session per week; the number of shock waves (SWs) ranged from 2000 to 3000 and the mJ per mm² ranged from 0.25 to 0.29.
- Palmieri (2009) also reported that mean pain scores on a visual analog scale decreased more in the ESWT group (from 5.5 at baseline to 0.46 at 24 weeks) than in the placebo/sham group (from 5.2 at baseline to 2.7 at follow-up).
- Hatzichristodoulou (2013) reported that mean pain scores on a visual analog scale decreased more among ESWT patients (from baseline value of 4 to post-treatment value of 1.5) than among placebo/sham patients (from baseline value of 4 to post-treatment value of 3).
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