Low-intensity shock wave therapy to the penis is a new alternative for the treatment of erectile dysfunction or difficulty with erections. It has been shown to help men with erectile dysfunction (ED) that is unresponsive to conventional medications: phosphodiesterase type 5 (PDE-5) inhibitor treatments such as viagra, levitra, cialis, stendra,or staxyn. It is also been shown to improve function in patients who are partially responsive to medication.
The key to LISWT appears to be its effect on blood flow. Previously, Low-energy shock wave therapy had been shown to induce the regeneration of small coronary vessels in patients with angina who were not suitable for coronary surgery or angioplasty. Based on the finding that therapy can improve the blood flow of vessels in the heart, the potential for use in erectile dysfunction was explored.
Normal erections require adequate blood flow. When sexual stimulation causes tumescence what is actually happening is that arteries widen so that the penis can fill with blood. The ability to fill with and then hold blood is what gives the penis the firmness needed for vaginal penetration. A decrease in blood flow can cause weaker erections or failure to have erections.
When LISWT is applied, shock waves interact with the targeted tissue where they cause mechanical stress and microtrauma. This then triggers a chain of events that cause the release of angiogenic factors inducing “neovascularization” of the affected tissues, enhancing blood flow.
Animal studies show that LISWT stimulates the expression of angiogenesis-related growth factors such as vascular endothelial growth factor (VEGF), and endothelial cell proliferation factors such as proliferating cell nuclear antigen (PCNA).
The current shock wave therapy treatment protocol involves 2 treatment sessions per week for 3 weeks. During each treatment session, low-energy shock wave therapy is applied to the penile shaft and crus (root of the penis) for about fifteen to twenty minutes. Pre-treatment application of a topical anesthetic is required.
Exclusion criteria includes use of anticoagulation. Patients cannot take blood thinners such as coumadin, xarelto or pradaxa.
Although approved for certain orthopedic applications, shockwave therapy is not yet “FDA approved” for the treatment of erectile dysfunction, and as a result, it is typically not covered by insurance.
The appeal of shock wave therapy is that, unlike current ED treatments, the use of which is essentially based on symptoms, shock wave therapy aims to provide improvement of the erectile function through regenerative means. In other words, although medications allow improved function despite pathological changes, it does not fix those changes. It appears that LISWT actually improves blood flow in the setting of vascular based erectile dysfunction.
LISWT is currently available at UGNJ, Millburn Office, 225 Millburn Avenue, Millburn, NJ.