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Peyonie's Disease

Posted by J. P. (Sunny) Jacob on 3/06/04 at 07:31 (146196)

Painfree ESWT Clinic in Canada is performing ESWT for Peyronie's Disease since October 2003 on a regular basis. The initial assessment and the first treatment session are done by an urologist. The 2nd and 3rd session is performed by a therapist under the supervision of an urologist. The treatment includes inline ultrasound imaging which is crucial for this low energy treatment.
PainFree intends to publish a report of treatment outcome which will be posted on the PainFree website (www.painfree-eswt.com) in the near future. Following are some of our observations to date (12 weeks post ESWT for Peyronie's Disease). Please note that the information provided here is based solely on the clinic's records to date and is not a published scientific study at this point.
Less than 40% of the patients reported pain prior to ESWT.
From those who reported pain as part of the problem, 80% had a satisfactory reduction in their pain level, and the rest reported complete elimination of pain.
Plaque Size:
54% of patients reported reduction in plaque size. Comments ranged from 'smaller, narrower to '10%, 20%, 30% less and a few patients reported complete disappearance of plaque.
Improvements in curvature have been achieved with results ranging from 5 to 10 degrees, and one patient to 30 degrees. If we assume that the patients who did not respond to this question (12 weeks post treatment) had no improvement in curvature, it can be concluded that 45% of the patients had some sort of curvature improvement.

As with tendonitis and ESWT, my question regarding Peyronie's Disease is the same: What is the 'recommended primary treatment option ? Prior to ESWT, all patients of PainFree clinic had used Verapramil, Vitamin E, etc., and their only option left was surgery. Prior to surgery, they appreciate the opportunity of receiving ESWT treatment and many (not all) are satisfied with the result from ESWT, a non-invasive procedure without side effects.

Re: Peyonie's Disease

Ed Davis,DPM on 3/06/04 at 12:59 (146228)

Thank you for your response. What exactly is the 'plaque' you refer to consist of, scar tissue/fibrosis?

Re: Peyonie's Disease

Dr. Z on 3/06/04 at 15:29 (146249)


What is your clinic's success with low energy three session tennis elbow treatments? What is your treatment protocol? One more question are you using ESWT low energy for patellar tendonitis? How sucessful is this treatment

Re: Peyronie's Disease

Donald Iain Scott on 3/07/04 at 01:01 (146320)

Peyronie's Disease (1700 Scientist/Surgeon Dr. F. Peyronie)
The reference to plaque, it is hard benign lump/s inside the penis. Small blood vessels rupture and the resulting scarring of the elastic penile fibres. The restriction my cause Erectile Dysfunction (ED) - leading to the pain
It causes pain to a small percentage of men around the world. (1% of the male population over 30 years of age)
It may have some genetic predisposition. Grandfather - Father - Son
It is similar to that of Dupuytren's Contracture (DC) of the hand.

In all Cases, patients with PD,ED and DC should contact their appropriate clinical specialist.
ESWT for Peyronie's in Australia carried out by Urologists and ESWT Therapists

Donald Iain Scott
ESWT Therapist

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

J. P. (Sunny) Jacob on 3/07/04 at 09:13 (146339)

Dr. Zuckerman
Nice to hear form you.
Tennis elbow:
Treatment protocol: Low energy, 3 sessions x 2000 shocks each. ESWT sessions on alternate days and 2 sessions of low intensity photon therapy to speed up the healing process of the micro injury from ESWT. After these sessions, patient should continue light physiotherapy of the joint or light movement of the joint as instructed by the clinic. The clinic's success rate is over 85%.
Please note: Success rate for Golfer's elbow is only between 50-60% and patients are informed of this prior to booking.

Patellar tendonitis:
To date only 6 to 7 patients, all young athletes (basket ball and football players) were treated with good results. The use of ultrasound imaging during treatment is a must. Unfortunately, after a few months these patients return for additional treatment. They do usually do not comply with the instructions for rest period, etc. To date we never had a non-athletic patient for Patellar tendonitis.
If you require any additional information, you may contact me at my personal email (email removed)

Re: Peyonie's Disease

J. P. (Sunny) Jacob on 3/07/04 at 09:15 (146341)

Dr. Davis,
The plaque referred to can be either calcification or deposit of collagen. Plaques can be in more than one location and each one has to be treated separately. The size of the plaque is measured prior to treatment and after the final treatment session. Immediately after treatment, many patients also feel that the plaque has become smoother. The reduction in plaque size continues for several weeks after the treatment. It is assumed that the re-absorption continues due to increased vascularization.
In some cases there could be corporeal-fibrosis with or without plaque formation. It is doubtful that ESWT has an effect on corporeal-fibrosis.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Dr. Z on 3/07/04 at 09:29 (146347)

Hi Sunny

Always nice to see your postings,

Thanks for the information. That is a great tennis elbow report. I am doing research for high energy one session treatment for tennis elbow and can't seen to find any literature. I know the ossatron uses high energy in the USA for tennis elbow but I can't determine exactly what the level of energy is at their 18kv setting or the total amount of energy for one treatment session.

I have used high energy on just a very few patients with Patellar Tendonosis. The results were very good. They were adult runners.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Ed Davis, DPM on 3/08/04 at 22:19 (146494)

We have been speculating as to the lower success rate for golfers elbow:
aiming a bit wide to avoid the ulnar nerve, the nature of the attachment at the medial epicondlyle is broader and flatter. Any thoughts on this?

What is your success rate with achilles tendonitis? My numbers are small but so far things are looking exceptionally good for the achilles.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

J. P. (Sunny) Jacob on 3/09/04 at 09:57 (146523)

Dr. Davis,
Your reasoning for the lower success rate in treating medical epicondylitis may stimulate an interest to do further studies by researchers at teaching institutions, such as Prof. Rompe.
Our success rate in treating Achilles tendonitis is around 80%. One interesting observation: Contrary to Plantar fasciitis (3 months chronic), the earlier one can treat Achilles tendonitis, the better the result will be.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Ed Davis, DPM on 3/13/04 at 16:11 (146887)

I would love to hear Dr. Rompe's reasoning on this. I may email him on the issue if we don't hear from him here soon. I don't know if he has the patience to deal with some of the 'discourse' on the site.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Dr. Z on 3/13/04 at 16:24 (146888)

Jan Rompe is in San Franciso lecturing at the Academy of Orthpedic Surgeons yearly convention. He did invite us ( you, me ) to joint him to discuss ESWT but I couldn't fly this weekend. Just to far. I can't wait to get the abstracts from the convention . They should be their web site soon.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Ed Davis, DPM on 3/14/04 at 19:08 (147003)

This weekend? San Fran is less than 2 hours by plane but not enough notice. I wish I knew as he could have come up to Seattle if his trip was long enough.

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Dr. Z on 3/14/04 at 19:25 (147008)

Sorry. I should have told you. I though he posted this on this site. I guess it was in an e-mail. I have been asking him about tennis elbows and he then told me that there are going to be lectures on this subject. He is giving one of them.
I can't believe you are only two hours away from SF. The last time I was there was in 1989 during the big earthquake. Do you go there alot.?

Re: Dr. Zuckerman: Re Tennis Elbow / Patellar Tendonitis

Ed Davis, DPM on 3/14/04 at 21:47 (147017)

No, it is about that far by plane. It is hard to get away due to my practice and family but, while San Francisco is a fascinating city, there are a lot of other places to go that are closer like Vancouver, BC which is an incredible city. We are going to take a few days off in April to go to Victoria, BC by ferry, another terrific destination. The Canadian border is only about 2 1/2 hours to the north and British Columbia is a beautiful province that I cannot stop saying nice things about. It is not as well known to folks on the east coast of the US but definitely worth a trip.