Shockwave therapy for ED
Erection is a complex physiological phenomenon resulting from a precise interaction of psychological, nervous, hormonal and vascular aspects. The basis of erection is essentially an increase in blood flow within the corpora cavernosa of the penis. Thus, the integrity and correct functioning of the penile microcirculation are fundamental for this vasodilation process to occur.
The treatment of erectile dysfunction is mainly based on drugs capable of promoting dilation of the penile circulation. These include:
- Phosphodiesterase-5 inhibitors (PDE5i) — such as Viagra, Siler, Cialis, Levitra, or Spedra — which are taken orally.
- Prostaglandins - such as Caverject or Vitaros, which are administered directly to the penis by injection.
Low-intensity shock waves
Shock wave treatment is a novel approach to the treatment of erectile dysfunction offering a potential alternative to pharmacological treatment, which is able to act directly on the anatomy of the penile circulation and, therefore, on the direct causes of erectile dysfunction, rather than just the symptoms. Shockwave therapy would also be free of side effects and contraindications.
Shock waves ("shock-waves" in English) are mechanical waves similar to acoustic ones capable of propagating in a medium. When these waves meet an organ or a tissue, they can release mechanical energy, causing compression followed by an expansion of the tissues themselves (this physical effect is described as "cavitation").
The mechanical stimuli induced by low-intensity shock waves act on the endothelial cells that line the blood vessels and are transformed into biochemical signals to promote the formation of new capillaries. The mechanical interaction of the shockwaves with the vessel walls causes release of angiogenetic growth factors capable of inducing vascularization (neo-angiogenesis). At the level of the corpora cavernosa, the increase in the capillary network can favour blood flow during erection.
Thus, the shock waves can regenerate the erective mechanism rather than offering only symptomatic relief. This could actually treat the causes of the problem without requiring drug therapy or can be combined with medication to maximise the therapeutic response.
This type of neoangiogenic action is achieved using low-intensity linear shock waves (Low-Intensity Extracorporeal Shock Wave Therapy, LI-ESWT). High-intensity shock waves are used in other branches of medicine, such as treatment of kidney stones or tendon and muscle inflammation.
Shock waves in clinical practice: how are they applied? How many sessions? Are they painful?
Application of shockwaves
The treatment protocol includes >6 applications, typically every week. Each session lasts about 15–20 minutes and is performed in the clinic without special preparation, sedation, or anaesthesia, as the procedure is painless.
The shockwaves are applied to different parts of the penis using a special handpiece connected to the generator. Shockwaves are applied to 3 areas of each of the two corpora cavernosa as well as the distal part of the penis, the base and the roots (or crura penis).
Depending on the type of generator used, each of these zones receives several pulses ranging from 300–500 pulss for 1500–3000 total pulses per treatment. Generally, the results are observed after about one month from the beginning of the therapy. In severe erectile deficit and/or in case of incomplete resolution, the treatment can be repeated.
This treatment has been used for several years and the preliminary results are very encouraging. In particular, an analysis of the overall results obtained from 14 studies including over 1,200 patients with erectile dysfunction demonstrated clear benefits in the erection of treated patients compared with those of the control group, and this difference was statistically significant.
These findings are particularly noticeable when the degree of erectile dysfunction is mild or moderate.
Another study carried out in Italy by the Italian Society of Andrology showed a success rate of 70% of patients with medium-to-mild erectile dysfunction treated with shock waves. Complete recovery was observed in some of these patients, in whom the therapy was able to restore the physiological mechanism of erection without the need for drug therapy. This means that the intrinsic negative aspects of these drugs can also be avoided. These include:
- Their use "on-demand" (on request) and the need to plan sexual intercourse.
- The possibility of side effects and contraindications.
- The necessity for indefinite use and the costs associated with the continuous purchase.
In patients with severe erectile dysfunction, the complete success rates of shock waves — that is, complete recovery — are much more modes. However, shockwave therapy can sometimes induce responsiveness to drug therapy in patients who were previously unresponsive.
As evidence of the effectiveness of shock waves emerges from an increasing number of prospective randomized clinical trials, this type of treatment is now included in the guidelines of various urological societies as a possible therapeutic tool for patients with erectile dysfunction. Even so, definitive conclusions about the effectiveness of shockwave therapy cannot yet be drawn, as the patients treated are still too few. In order to confirm these positive data, further scientific studies are needed, carried out higher numbers of patients and with extensive follow-up protocols. It is also necessary to standardize and validate the shockwave application protocol, particularly regarding the number of sessions, the timing, the number of pulses per session and the exact energy applied.
Shockwave treatment is painless, fast, non-invasive, well-tolerated and safe. Side effects have not occurred in any of the patients in which it has been used and, therefore, no situations in which the application of shock waves to the penis have been reported as dangerous or contraindicated.
This type of treatment is not currently reimbursed by the NHS and is, therefore, entirely at the expense of the patient. A complete treatment cycle with six applications costs 2000 pounds at our clinic.
Treatment with low-intensity shock waves seems to have good efficacy in treating patients with erectile dysfunction. The putative neoangiogenic action of shockwaves can potentially restore the physiological mechanism of erection. In this way, the treatment could act directly on the cause of the problem and could, therefore, be curative. Thus, it differs from pharmacological treatments, which exclusively treat the symptom without the possibility of definitive recovery.
Overall, shockwave treatment is fast, safe, painless and free from side effects. The results of further scientific studies are needed to reach a definitive conclusion about its effectiveness.