Sytenko A. The substantiation of the using the high level energy shock wave therapy for correction of the penile deviation in patients with Peyronie's disease

The dissertation is dedicated to the problem of increasing of efficacy of correction penile deviation in patients with Peyronie's disease (PD) by means of using shock waves of high energy level.Materials end methods: 120 patients with PD and 15 excised bioptates of fibrous plaques. Diagnostic procedures: plaque palpation with measurement dimensions of the plaque and its consistence, photography of erected penis with goniometry, ultrasound investigation of penis in B and duplex regimes, to find petrification and study penile homodynamic, detection of the collagen specific amino acid hydroxyproline level in urine by means of chromatography, light microscopy of preparates of fibroses plaques stained by hematoxiline-eozine and Van-Hizone. Shock waves were applicated with device "Compact" Dornier. All treatment session includes 3000 impulses/mm2, high energy level 5-6, one session per week . Statistic analysis includes: parametric and nonparametric test. Significance level was 0,05.It was found that in patients with Peyronie's disease the intensity of penile deviation statistically significantly correlates with penile hardness and dimensions and consistency of the plaque. Such correlation allows us to make assumption that correction effect of shock-wave therapy might be based on decreasing of penile rigidity and increasing of plaque elasticity.It was found a strong negative correlation between the penile rigidity and the parameters of plaque that points on pathogenic role of decreasing of tunica albuginea elasticity in genesis of veno-occlusive dysfunction in patients with Peyronie's disease.It was demonstrated that shock waves of high energy level do not induce inflammatory reaction in fibroses plaques. Its correction effect associated with increasing of the elasticity of the plaque. In turn the increasing of the elasticity of the plaque is caused by destruction transversal hydroxilysine junctions between collagen fibers and disintegration of calcium deposits. It was found that excretion level of hydroxyproline with urine in patient with Peyronie's disease is in normal interval. This allows us to consider Peyronie's disease as local fibromatosis.It was demonstrated that the using of the shocks waves of high energy level permits to increase the efficacy of 20% comparing with medium energy level. At the same time the combine using of shock wave therapy and Wobenzime® does not increase the efficacy of the correction.It was found that old age (over 60), disease duration over 12 month, plaque petrification, previous invasive therapy (intaplaque injection) are negative prognostic factors of efficacy of shock wave therapy in patients with Peyronie's disease.