The past two decades have been witness to almost miraculous advances in technology, from the internet, to the tablet, to communication by texting and wearable extensions of our smart phones. Advances in our options to improve men’s ability to achieve erections have been no less profound. The inflatable penile prosthesis is decades old but has stood the test of time. It offers men who cannot achieve an erection an ability to have an erection, whenever and for as long as they want, even if other options are not adequate.
Subsequent to the development and refinement of the implant came penile injections with pharmaco-active medicines. The most common medicine given is prostaglandin E2. This therapy has allowed many men to forgo implants and has continued to be an option for the past three decades. Non-invasive methods include vacuum erection devices; these devices use negative pressure or suction to bring blood into the penis and cause and erection, and then trap the blood using and elastic band and are still used today as a conservative form of therapy. They have also been available for about three decades.
A revolution in treatment for erectile function came with the development of pharmaceutical agents that inhibited an enzyme called phosphodiesterase type 5. These PDE5 inhibitors enable a spontaneous erection to happen more easily. They include viagra, levitra, cialis, staxyn and stendra. PDE5 inhibitors have been available for over fifteen years. Since that time, few developments have had significant impact, until perhaps now. There is a new therapy for erectile dysfunction which essentially improves blood flow into the penis through the use of pulses of energy or shockwaves into the erectile tissue and may restore ability to have erections. .
LI-SWT or low intensity shockwave therapy uses acoustic waves that generate a pressure impulse which carries energy through a medium or tissue to encourage better blood flow by a process called neo-vascularization. Neo-vascularization literally means new blood vessels form and improve circulation in the target organ..
A more powerful or high intensity shockwave therapy has been used to help patients with kidney stones, but the newer, low intensity form, has a role in rehabilitation including use on patients with joint and or extremity inflammation. Recently, researchers have investigated the use of LI-SWT as therapy for erectile dysfunction (ED).
The ability to have erections is dependent on adequate blood flow. When a man is sexually stimulated, cavernous arteries dilate and allow blood to flow into and fill the erectile bodies of the penis. Adequate blood inflow is necessary for the penis to achieve the rigidity necessary for sex. If blood flow is inadequate, a man may experience weaker erections or may be unable to have erections at all.
Shockwave therapy is a potentially revolutionary type of treatment as it actually plays a role in repairing vascular damage the penis may have sustained, damage that has contributed to erectile dysfunction. Potentially, this could possibly give men who are dependent on PDE5’s the ability to once again have spontaneous erections, or make patients who are beyond oral medications, once again responsive to PDE5’s.
LI-SWT is administered in an office setting with the patient awake. Trials have most commonly employed five or six weekly treatments which last about fifteen to twenty minutes. The probe that administers the energy is hand held and applied directly to different areas of the penis and its root (or crus).
Results of clinical trials have been encouraging. Almost no complications have been reported and the treatment is well tolerated. There are few restrictions; however, patients who are receiving anticoagulation are not currently candidates for this treatment. This new shockwave therapy has created a lot of “buzz” and excitement and will likely be coming soon to New Jersey.