Low Intensity Shock Wave Therapy
Erectile Dysfunction (ED)
Erectile dysfunction is the inability to obtain or maintain an erection sufficient for sexual activity. It becomes increasingly common from the age of 40 years such that by the age of mid 50s up to 50% of men are experiencing some level of erectile dysfunction. At one point this was thought to be a psychological issue but over the last several decades it has been realized that it is primarily a blood vessel issue within the penis. There are other causes of ED which may be more related to nerve damage such as after prostate surgery. Erectile Dysfunction has an association with cardiovascular disease and is often used as an indicator that men need to be screened for cardiovascular disease and it has some of the same risk factors such as smoking, high blood pressure, obesity and diabetes.
Management of ED
Vacuum pump devices have been available for many decades and are able to produce a temporary erection although it usually requires the use of rings or bands to restrict the out-flow of blood from the penis. Vacuum pumps have a place in the management for a few men with ED but not most.
Everybody has of course heard of Viagra (Sildenafil) which was approved by the American FDA in March 1998, so we have just had the 20 year history of a specific medication to treat erectile dysfunction. Five years later, Cilias was approved. It’s advantage was having a longer duration of effect and did not need to be taken immediately before it was needed. However, some men failed to respond to either of these medications and require injection therapy with Caverject (prostaglandin E1- PGE1) which rapidly results in an erection.
The final step beyond using injectable therapy is to have an implantable device of which there are multiple kinds. The most common involving inflatable cylinders and a pumping device that can pump fluid in, expand and create an artificial erection.
Shockwave therapy sounds intense but is actually painless, quick and simple. More correctly called Low Intensity Shock Wave Therapy – LISWT to distinguish it from its high intensity forerunner used to break up kidney stones, also known as lithotripsy. It essentially uses short bursts of sound waves. The process has been well studied over the past 20 years and shown to increase the production of and opening up of existing blood vessels. It has been accepted as a viable treatment by the American and European Urological Associations.
The significant difference between LISWT for ED and all other treatments is that it is the only treatment aimed at the cause of impotence and erectile dysfunction and effectively is a lasting ‘cure’ vs an on demand medically produce erection.
The treatment itself only take 5 – 10 minutes, is noninvasive, requires no anaesthetic, is a simple walk in, walk out session with no down time. Usually done twice a week for 3 weeks for a total of 6 treatments. Some men need up to 12 treatments. Maximum results are usually seen after 8 weeks. About 75% of me will have significant improvement resulting in stronger, harder, longer lasting erections.
We have had men in their 60’s with diabetes no longer responsive to Viagra/Cialia who are able to obtain spontaneous erection and have sex (this patient also had PRP Shot). Some men will go from not having an erection with Viagra before to being able to have an erection with Viagra after – this is still counted as success.
Benefits have been observed out to 2 years – most studies don’t go out that long to find out. The good news is that if the results begin to diminish the treatment can be repeated.
It is important for men to look at other lifestyle issues that relate to ED. If you need another reason to stop smoking then this is the best. Smoking leads to impotence – STOP! Get your weight and blood pressure under control, they are strongly related to vascular disease causing ED, heart attacks and stokes. Diabetes both type 1 and 2 cause ED. For type 2 diabetes, diet and exercise keep it in control and prevent ED. In fact exercise in general is good for improving erectile function.
LISWT has also been demonstrated to be efficacious in the treatment of Peyronies Disease (curvature of the penis).
Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis
– 2016 European Association of Urology. Published by Elsevier B.V.
Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie’s disease and erectile dysfunction: results from a prospective randomized trial
– International Journal of Andrology, 2012
Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population
The Canadian Journal of Urology; 22(1); February 2015
Impact of aging and comorbidity on the efficacy of low-intensity shock wave therapy for erectile dysfunction
– International Journal of Urology (2016)
Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study
THE JOURNAL OF UROLOGY® – 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal
shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial
– 2015 The Authors – BJU International © 2015 BJU International
Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors
– 2016 International Society for Sexual Medicine
Low-Intensity Shock Wave Therapy and Its Application to Erectile Dysfunction
– World J Men’s Health 2013 December 31
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