Olivia
Erectile dysfunction (ED) is a widespread condition that often remains a “man’s secret” due to various factors such as social stigma, psychological barriers, and familial influences. Consequently, many patients do not seek medical diagnosis and treatment, resulting in a lower cure rate.
Despite not being life-threatening, ED significantly affects a patient’s quality of life, family dynamics, and psychological well-being. Moreover, it can serve as an early warning sign for underlying physical conditions like coronary heart disease and diabetes. Thus, the diagnosis and treatment of erectile dysfunction have long been a focal point and a clinical challenge in the field of andrology.
Oral PDE5 inhibitors are currently the preferred approach for treating erectile dysfunction due to their convenience, rapid onset, and widespread patient acceptance. However, in recent years, low-energy extracorporeal shock wave therapy (ESWT) has gained increasing attention from both medical professionals and patients due to its notable safety and effectiveness.
Low-intensity Extracorporeal Shock Wave Therapy
Extracorporeal shock wave therapy (ESWT) is a physical therapy method recommended by guidelines for the diagnosis and treatment of erectile dysfunction. It represents a new treatment modality in clinical practice. This therapy employs low-intensity shock waves to stimulate angiogenesis uniformly and increase the content of smooth muscle, endothelial cells, and key factors like neural nitric oxide synthase (nNOS) and vascular endothelial growth factor (VEGF) in the penile cavernous body.
Consequently, it helps repair pathological damage to smooth muscle cells, vascular endothelial cells, and nerves in the penile cavernous body. This approach aims to improve the patient’s erectile function index, erection hardness, duration, and penile cavernous endothelial function, ultimately achieving the desired outcome of treating erectile dysfunction.
The history of shockwave therapy dates back to 1980 when the German company DORNIER developed the world’s first extracorporeal shock wave lithotripsy system HM1. Professor Chaussy, a renowned urologist from Munich, Germany, successfully performed the first extracorporeal shock wave lithotripsy procedure, marking the application of shock waves in the medical field.
Subsequently, in the 1990s, shockwave therapy found utility in orthopedics, exhibiting anti-inflammatory and analgesic effects. In the early 2000s, it was employed for the treatment of cardiovascular diseases as it displayed the ability to promote angiogenesis. Finally, shockwave therapy entered the realm of erectile dysfunction treatment in 2010.
Shockwave Therapy to Different ED Types
Low-intensity extracorporeal shock wave therapy offers physiological improvement for vascular defects in the penis, making it a primary consideration for the treatment of vascular ED. It is suitable for patients who have not responded to oral PDE5 inhibitors, particularly individuals with vascular ED caused by diabetes. Additionally, shockwave therapy can effectively treat Peyronie’s disease and chronic prostatitis (CPPS), achieving a total success rate of 70% to 80%. The specific indications for shockwave therapy include:
- Patients with vascular ED, such as those with diabetes, obesity, hypertension, metabolic diseases, and smokers.
- Patients with vasogenic ED who do not respond to oral PDE5 inhibitors, regardless of the duration of their medical history.
- Patients with Peyronie’s sclerosis and ED.
- Shockwave therapy may prove effective in patients with ED following nerve-preserving radical prostatectomy.
Effects of Low-intensity Extracorporeal Shock Wave Therapy
In the first randomized double-blind controlled study, shockwave therapy showed positive effects on both short-term clinical and physiological outcomes for patients who responded well to PDE5 inhibitors. Rosen et al. reported a treatment efficacy rate of 70% in ED patients who exhibited a positive response. Kitrey et al. found that shockwave therapy was beneficial even for ED patients who did not respond to PDE5 inhibitors. After treatment, 60.8% of these patients showed a response to PDE5 inhibitors. Additionally, Gruenwald et al.’s research revealed a 56% success rate for low-energy shockwave therapy in diabetic ED patients.
A 2017 systematic review and meta-analysis of 9 studies including 637 patients found that LI-ESWT could significantly improve the International Index of Erectile Function (IIEF) and Erection Hardness Score (EHS) of patients with ED. The therapeutic efficacy could last at least 3 months.
Sources:
[1]Giuliano F, Assaly-Kaddoum R, Laurin M, Bernabe J, Behr-Roussel D.”981 – Low-intensity shockwave therapy (Li-ESWT) delivered by Aries improves erectile function and decreases cavernosal fibrosis of spontaneously hypertensive rats (SHR).”Eur Urol Suppl. 2018 Mar 1;17(2):e1384.
[2]Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D.”Low-Intensity Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment.” J Sex Med. 2018 Mar;15(3):334-45.
[3]Zewin T, El-Assmy A, Harraz A, Elsherbini A, Musa Z, Bayoumi A, et al.”1115 Low-intensity extracorporeal shock wave therapy for severe erectile dysfunction in poor responders to phosphodiesterase type-5 inhibitors: A short-term prospective study.” Eur Urol Suppl. 2016 Mar 1;15(3):e1115.
