In a study of men who used drugs such as Viagra and Cialis to treat erectile dysfunction, 57% of men treated with shockwave therapy were able to get erections without the need for medication, compared to just 9% in the placebo group. In the present study, Li-SWT was a safe and effective treatment in 63.5% of men with erectile dysfunction who did not respond to oral PDE5i. After 18 months, the beneficial response declined to some extent in 50% of the responding patients, but they were still able to successfully use PDE5i. Shockwave therapy is often recommended for patients who do not respond well to medication or who do not want more invasive treatments.
Low-intensity shock waves have also been shown to grow new blood vessels and improve blood flow to the penis, which is essential for erections. Low-intensity shock wave therapy (Li-SWT) induces cellular microtrauma, which in turn stimulates the release of angiogenic factors with the subsequent neovascularization of the treated tissue. A shockwave therapy regimen usually includes six different treatments, but treatment protocols may change as more research becomes available. This led us to evaluate the long-term prognosis (at 18 months) of Li-SWT in men with vasculogenic erectile dysfunction who did not respond to PDE5i, and to evaluate factors that could influence or predict the success of Li-SWT in these patients.
In general, men with mild to moderate vasculogenic erectile dysfunction and who have had a response to PDE5 inhibitors are ideal candidates for LISWT. While the literature on the positive effects of low-intensity extracorporeal shock wave therapy on the penis is considerable, there are substantial differences in both energy sources and extracorporeal shock wave therapy (ESWT) devices. Review of the current status of low intensity extracorporeal shock wave therapy (Li-ESWT) in erectile dysfunction (ED), Peyronie's disease (PE) and sexual rehabilitation after radical prostatectomy, with special attention to the technical aspects of the different ESWT devices marketed, including personal experiences in 350 patients. The main outcome measures were success rates in erectile dysfunction (international rate of change in erectile function, conversion of unresponsive phosphodiesterase type 5 inhibitors) and PE (change in deviation and plate size), differences between energy sources used and energy flow densities (EFD).
Shockwave therapy seems to be most effective for people with vasculogenic erectile dysfunction, which is a blood vessel disorder that affects blood flow to penile tissue. When Li-SWT is applied to an organ, shock waves interact with the affected tissues and induce a cascade of biological reactions, which stimulate the release of growth factors, which in turn triggers tissue neovascularization, with a subsequent improvement in blood supply. However, to our knowledge, no study has been conducted to evaluate factors that could affect or predict the success of erectile dysfunction treatment with Li-SWT in men who respond poorly to PDE5i. I define success as going from not having erections to having erections capable of penetrating, or having PDE5 inhibitors that have stopped working and now work very well, he explains, and points out that the benefits of treatment usually last at least a year.
We evaluated patients at 18 months to determine long-term outcomes of Li-SWT; treatment success at 18 months was defined as an EHS ≥ 3 with or without the use of oral PDE5i. Some doctors may still offer shockwave therapy for erectile dysfunction, but its use outside of a research setting is not considered to be indicated on the label.