Erectile Dysfunction and Shock Wave Therapy

To get and maintain and erection, you need blood flow into the penis. If the arteries that supply blood to the penis are blocked or damaged, the blood does not get to the penis is sufficient quantities to create an erection.

Shockwave therapy, a non-surgical treatment that applies extracorporeal (generated externally) shock waves (waves that break down and repair tissue) to the shaft of the penis. The treatment targets the creation and repair of blood vessels and other tissue in the penis. Research has suggested that extracorporeal shock waves can provide vary degrees of improvement in erectile dysfunction. It is often used when other treatments have failed to increase penile blood flow.

Generally the treatment is given with a hand-held wand shaped device which is then placed at multiple sites along the penis. The treatment can vary from 10 – 20 minutes.

The core concept is to get blood flow into the penis by means of repairing and creating new blood vessels in the penis.

Research

A February 2024 paper (1) from Spanish researchers give the latest in summary overviews for using shock wave therapy for erectile dysfunction. They write: “Shock wave therapy has been used in various medical fields to treat different conditions such as tendinopathies, osteoarthritis, kidney stones, and Peyronie’s Disease, among others. In recent years, numerous studies have emerged evaluating the efficacy of Low-Intensity Extracorporeal Shock Wave Therapy in vascular-origin erectile dysfunction.”

In this paper, the researchers offer an umbrella review of previously published research of 3,908 patients with erectile dysfunction comparing the effectiveness of Low-Intensity extracorporeal shock wave therapy to that of a placebo in the treatment of vascular-origin ED, with the goal of evaluating erectile function and penile hardness at erection.

Notes:

  • In the examined patient data, patients observed within a one to 12 month time frame from onset of shock wave therapy treatment, improvement in erectile function as compared to patients receiving a placebo treatment.
  • The results suggest that shock waves could enhance erectile function in patients with erectile dysfunction, regardless of the severity of the dysfunction.
  • These findings appear to indicate that shock waves are also effective in enhancing penile hardness at erection and are promising, as they may enhance the quality of sexual life for men who suffer from this condition.
  • Shock wave generating devices, treatment duration, and patient characteristics are also important factors influencing the effectiveness of Low-Intensity extracorporeal shock wave therapy
  • This research “indicates that Low-Intensity extracorporeal shock wave therapy is a novel therapeutic alternative for vascular-origin ED, given its low risk, minimal side effects, and improvement in erectile function for men who have difficulty achieving and maintaining an erection during sexual intercourse.”

68% of men in this study improved to a score where their penis is completely hard and fully rigid at 6 months after treatment.

A November 2023 study in the journal Sexual Medicine (2) offers similar insights. In this paper the researchers  tested the effectiveness of low-intensity shockwave therapy in the treatment of erectile dysfunction against a sham procedure.

Notes:

  • Thirty-three patients with organic erectile dysfunction were divided into two groups, seventeen receiving shockwave therapy, sixteen receiving the sham or placebo treatment.  The sham group was allowed to cross over to receive shockwave therapy after 1 month.
  • At one month, self-reported sexual health assessment surveys showed significantly improvements in the shockwave therapy group as compared with the sham group.
  • Of the 25 men with an initial Erection Hardness Score of less than 3, (a 0 – 4 scoring system, having a score of 3 or less means: penis is larger but not hard enough for penetration, or is hard enough for penetration but not completely hard), 68% improved to a score where penis is completely hard and fully rigid at 6 months after treatment.
  • The entire treatment group “demonstrated significant increases in erectile function outcomes at 1, 3, and 6 months after treatment.”
  • In total, results showed that 54.6% of participants with organic erectile dysfunction met the minimal clinically important difference in self-reported sexual health assessment surveys scores after treatment with low-intensity shockwave therapy.

A June 2023 study in the Journal of Family and Reproductive Health (3) looked at thirty-one erectile dysfunction patients who received eight sessions of Low-Intensity extracorporeal shock wave therapy with a 2-3-day interval. The patient’s condition was assessed using the International Index of Electric Function (IIEF-5) questionnaire at baseline and one month after the last treatment session.

  • The average age of the patients was about 45 years old, ranging from 25 to 78 years.
  • The majority of them were married (83.9%)
  • Weight concerns: 51.6% overweight, 9.7% obese,
  • Other conditions: 48.4% diabetic, 45.2% hypertensive, 12.9% with enlarged prostate,
  • Poor lifestyle choices: 45.2% smoker, 25.8% alcoholic
  • Sleep problems in 71%

Grades of erectile dysfunction in this group:

  • 9.7% had severe erectile dysfunction and 51.6% had moderate erectile dysfunction.
  • After the treatment, patient improvement was seen as no patients were found with severe erectile dysfunction, and few of them had moderate erectile dysfunction (9.7%).
  • The mean difference in International Index of Electric Function (IIEF-5) questionnaire score during the pre-test and post-test was statistically significant.

Low-Intensity Extracorporeal Shock Wave Therapy and Sildenafil

In March 2023, (4) researchers published their comparative findings of patient satisfaction in low-intensity extracorporeal shockwave therapy versus sildenafil for erectile dysfunction.

Patients with erectile dysfunction chose between two active treatment groups according to their treatment intention. Either a 9-week low-intensity extracorporeal shockwave therapy regimen or 100 mg on-demand sildenafil. Self-reported questionnaires on erectile dysfunction and treatment satisfaction were followed and evaluated.

Notes:

  • 72 participants in the study (42 in the low-intensity extracorporeal shockwave therapy group and 30 in the sildenafil group).
  • Patients in both groups were young men.
  • Four weeks after the last session, self-reported patient questionnaires suggested that low-intensity extracorporeal shockwave therapy may have better satisfaction than on-demand sildenafil for young erectile dysfunction patients.

An August 2023 paper in the International journal of impotence research (5) assessed the long-term effects of combining low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction.

Notes:

  • 116 patients received low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months.
  • Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained and meaningful outcomes. This treatment is optimal for mild illnesses.

Low-intensity extracorporeal shock wave therapy therapy in diabetic patients with erectile dysfunction

An October 2021 paper in the journal Sexual medicine reviews (6) studied the effect of low-intensity extracorporeal shock wave therapy therapy on a subgroup of diabetic patients with erectile dysfunction who responded positively to PDE5 inhibitors [sildenafil (Viagra), vardenafil (Levitra and Staxyn), tadalafil (Cialis), avanafil (Stendra) and those who did not respond to PDE5 inhibitors.

Notes:

  • A review of pooled data from 5 double-blind, sham-controlled trials was performed. In 350 patients who responded positively to PDE5 inhibitors and with vasculogenic erectile dysfunction, the researchers found 61 patients with diabetes mellitus who underwent low-intensity extracorporeal shock wave therapy. Another 48 patients who did not respond to PDE5 inhibitors also underwent low-intensity extracorporeal shock wave therapy.
  • Self-reported questionnaires on erectile dysfunction and treatment satisfaction were followed and evaluated.

Results:

  • Low-intensity extracorporeal shock wave therapy was found to be effective in both subgroups of diabetic patients.  The researchers found improvements in erectile dysfunction and treatment satisfaction specifically after the sixth shockwave (SW) treatment evaluation and at 1 month, 6 months, and 12 months after the last shock wave therapy.

A March 2024 paper (x) however, found that while shock therapy helped many patients, including those who smoked, had previous pelvic surgery, and use of Phosphodiesterase 5 Inhibitors (PDE5Is), diabetic patients, in many cases, did not benefit from the treatment.

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If you are suffering from erectile dysfunction and would like to discuss your options, please call our office 310-231-7000 or use the contact form below to email us.

Related articles:

PRP Penile Injection for erectile dysfunction

References

1 Medrano-Sánchez EM, Peña-Cantonero B, Candón-Ballester P, Blanco-Díaz M, Díaz-Mohedo E. Effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy in Erectile Dysfunction: An Analysis of Sexual Function and Penile Hardness at Erection: An Umbrella Review. Journal of Personalized Medicine. 2024 Feb 4;14(2):177.
2 Kennady EH, Bryk DJ, Ali MM, Ratcliffe SJ, Mallawaarachchi IV, Ostad BJ, Beano HM, Ballantyne CC, Krzastek SC, Clements MB, Gray ML. Low-intensity shockwave therapy improves baseline erectile function: a randomized sham-controlled crossover trial. Sexual Medicine. 2023 Oct 1;11(5):qfad053.
3 Islam R, Rahaman KS, Hawlader MD. Efficacy of Low-Intensity Extra Corporal Shockwave Therapy (LI-ESWT) In Patients With Erectile Dysfunction. Journal of Family & Reproductive Health. 2023 Jun;17(2):93.
4 Wang D, Wang SJ, Li YJ, Liu CH, Li YQ, Zhang YS, Yan S. The Treatment Satisfaction in Patients and Their Partners Treated with Low-Intensity Extracorporeal Shock Wave Therapy and Sildenafil: A Prospective Non-Randomized Controlled Study. Patient preference and adherence. 2023 Dec 31:583-9.
5 Kaynak Y, Gruenwald I. Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study. International Journal of Impotence Research. 2023 Aug 29:1-6.
6 Spivak L, Shultz T, Appel B, Verze P, Yagudaev D, Vinarov A. Low-intensity extracorporeal shockwave therapy for erectile dysfunction in diabetic patients. Sexual Medicine Reviews. 2021 Oct;9(4):619-27.
7 Rubino M, Ricapito A, Finati M, Falagario U, Annese P, Busetto GM, Cormio L, Bettocchi C. Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction.

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