Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction

Abstract

The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA.Materials and Methods:31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2).Results:At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2).Conclusion:In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified.

Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors

“…Reisman et al, 31 in a multicenter study with a larger number of patients and 6-month follow-up, reported 81% efficacy, whereas Ruffo et al 37 reported 76% efficacy in a group of 31 patients and 3-month follow up.…”

Phase II Randomized, Clinical Trial Evaluating 2 Schedules of Low-Intensity Shockwave Therapy for the Treatment of Erectile Dysfunction

“…Patients were equally randomized into the 2 treatment groups to receive a total of 3,600 shocks of Li-SWT with prior studies demonstrating clinically significant outcomes with the same number of shocks delivered. 7,8 Shocks were administered in 5 locations on the stretched penis, left and right cavernosa, and the parallel diverging segments of the crura. Patients in Group A received once a day treatment over 5 consecutive days (Monday to Friday), in which 720 shocks of Li-SWT were applied in every session, half to each treated region (left and right corpora cavernosa and crura).…”

“…The underlying mechanism of shock delivery of this device is equivalent to that published in previously studies. 7,8 Unlike other electromagnetic shockwave generators, this device does not apply a point-focuser, but instead uses the patented Large Area Shockwave Technology to simultaneously deliver shockwaves to whole segments of the corpora and crura. Compared to radial shockwaves, the focused shockwave has a much shorter pulse duration, deeper penetration depth, and has its effect at the cellular rather than superficial tissue level.…”

Should Low-intensity Extracorporeal Shockwave Therapy Be the First-line Erectile Dysfunction Treatment for Nonresponders to Phosphodiesterase Type 5 Inhibition?

“…After 12 mo, 91.7% of the responders maintained their response to treatment [12]. Likewise, Tsai et al [13] found an increased effect of PDE-5i after 12 weekly LI-ESWT sessions in 35/52 men (67.3%), while Ruffo et al [14] found positive effects after four LI-ESWT sessions among 31 PDE-5i nonresponders. In a randomized trial, Kitrey et al [15] evaluated LI-ESWT among men who had become PDE-5i nonresponders in the previous 12 mo, with 37 patients in the treatment arm and 16 in the sham group.…”

“…With respect to PDE-5i nonresponders, only a few trials have evaluated the effect of LI-ESWT specifically in this subpopulation [11][12][13][14][15]. Gruenwald et al [11] performed a prospective study among men who were poor responders to PDE-5i therapy and had a baseline erection hardness score (EHS) of 2 (inability to have penetrative intercourse).…”