Erectile Dysfunction

Shockwave Therapy For Erectile Dysfunction And Penis Rejuvenation

Shockwave therapy is the latest treatment modality for patients suffering from erectile dysfunction and it is one of the few treatments options that improves natural erections and can potentially rejuvenate the erection mechanism. In addition, shockwave therapy has the following advantages:

• Non-invasive treatment lasting 20 minutes in a treatment room – walk in and walk out within 30 minutes
• No medication required
• Fewer complications than other treatment modalities
• Significant clinical benefit often experienced 6-8 weeks after treatment

The results of our patients to date are very encouraging and in our opinion, this treatment option completely changes the landscape of erectile dysfunction management.

To find out more about this novel treatment option, then please contact our Patient Co-ordination team on 02030513060 or read our Frequently Asked Questions below.

 

Shock Wave Therapy FAQs

 

How does it work?

Extracorporeal Shock Wave Therapy (EWST) works by passing shock waves, an intense but short energy wave that travels faster than the speed of sounds into the tissues. Originally used to treat kidney stones in the 1970’s known as lithotripsy, using acoustic shock waves to break up the stones without the need for surgery. Clinicians soon discovered that whilst patients were being treated for kidney stones they reported that other non-related medical conditions either improved or had disappeared entirely. This, in turn, leads to the discovery that shockwaves had a healing impact on pain and chronic conditions in the musculoskeletal system. Devices were then developed to treat a range of tissue injury on all different parts of the body. Today Shockwave therapy is widely used to treat all kinds of indications from soft tissue injuries (tendinopathies) in humans and horses to diabetic foot ulcers to erectile dysfunction and even cellulite.

Shockwave treatment initiates a proflamatory response in the tissue where the shockwaves have been applied. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes.

In the specific case of Erectile Dysfunction, shockwave improves erections via two mechanisms:

1. Promotes angio-genesis (development of new blood vessels) in the penis which means that the blood flow to the penis increases and hence stronger erections are achieved; and
2. Rejuvenation of penis smooth muscle – the majority of patients suffering from ED do so because the smooth muscle in their penile arteries has been damaged thus inhibiting the functioning of the so-called veno-occlusive mechanism. Shockwave therapy has been shown to induce the body to repair the smooth muscle in the penis and thus improve the function of the veno-occlusive mechanism.

 

Am I a candidate for Shockwave Therapy?

Theoretically, shockwave therapy can help all patients suffering from ED and even improve erections in men with no issues or in order to prevent erectile dysfunction. However, given that it is a new treatment modality, scientific evidence is still being gathered and we only recommend the treatment to patients that actually suffer from erectile dysfunction.

As explained in our Treatment Protocols  section, we apply shockwave therapy together with on-demand first line and second line treatments.

Patients that do not respond to an intra-cavernosal injection test, are NOT good candidates for shockwave therapy since this will generally mean that their erection mechanism is significantly damaged and it is unlikely that they will benefit from this treatment modality.

A full pre-treatment diagnostic evaluation is always advised before a patient proceeds with this option in order to establish if it is appropriate and also determine the optimum treatment protocol.

 

What are the expected benefits?

There is a growing body of scientific evidence that shockwave therapy for ED can help in the following ways:

• Patients with mild to moderate ED that respond well to PDE-5 inhibitors might be able to regain their natural erections and no longer need – or reduce their dependence on medication.
• Patients with moderate to severe ED that do not respond to PDE-5 medication and rely on injections or other topical treatments may become more respondent to PDE-5 medication after shockwave therapy.
• Shockwave therapy will in most cases improve the outcomes of any other treatment modality.

 

What should I expect during my treatment session?

Each treatment session lasts around 20 minutes. When you arrive at the clinic a nurse will take you to the room with the shockwave machine where you will get undressed and lie on the treatment bed. The medical practitioner will then apply the treatment using a special probe on different parts of your penis and perineum. Most patients experience very little discomfort or pain during the session. It is important that if you do not feel comfortable you let your medical practitioner know and the shockwave intensity will be adjusted accordingly.

What is the best Shockwave Therapy treatment protocol?

This is an area of very active research. A number of treatment protocols have been suggested, some lasting only 4 sessions and some as long as 12 sessions. Unfortunately, the clinical trials investigating these protocols are quite different in a number of ways (energy of the shockwaves applied, number of shockwaves, number of sessions, duration of treatment and time between sessions and the technology of the shockwave machines).

Whereas all these trials have proved the treatment benefits, there is no clear protocol that applies to all patients. Our own experience and the studies so far indicate that the there is no one size fits all protocol and the number of sessions will depend on the severity of ED, the presence of comorbidities and the response to treatment. At our clinic as a minimum, we recommend 6 twenty-minute sessions over a three-week period.

Regarding the number of pulses, the range should be between 3000 and 5000 shock waves per session and there is evidence that administering more shock waves leads to greater improvements. It also seems beneficial to deliver treatment to multiple sites to reach the vascular bed of the erection mechanism.

 

Can I repeat the treatment on a regular basis?

As the method seems to have a physiologic effect on the erection mechanism, repeating the treatment after a certain period of time seems logical; however, the question regarding a possible saturation effect remains unanswered and requires further investigation.

 

Are the results permanent?

The biological effects of shockwave therapy are permanent and have been established on a basic science level. However, erectile dysfunction depends on the lifestyle of patients and is usually a symptom of underlying health issues which lead to ED. Because ED usually gets worse in patients with comorbidities, this means that the improvements after the treatment might be reversed over time if the underlying conditions are not addressed.

Given that the treatment is relatively new, the longest period that patients have been followed up after treatment in a systematic way as part of a clinical trial was 12 months. The results of this study indicate that the treatment benefits were preserved after one year from the treatment but further studies are required to investigate the efficacy after a longer period of time.

 

Is the Shockwave Therapy treatment itself painful?

 

Sometimes the treatment is a bit painful, but most people can stand these few intense minutes without medication. If patients are in pain during the treatment, they are to notify the medical practitioner as there are some adjustments that can be made to reduce the discomfort, however, having some pain during the treatment illustrates that shockwaves are having a positive effect.

 

Will there be any pain after the treatment?

 

Normally patients experience a reduced level of pain or no pain at all immediately after the treatment, but a mild and diffused pain may occur a few hours later. This dull pain can last for a day or so.

 

What if there is pain experienced after the treatment?

 

Shockwave therapy treatment initiates a pro-flammatory response in the tissue that is being treated. If necessary patients may use ordinary prescription-free painkillers. Do not use anti-inflammatory medication or ice in the treated area as both may interfere with the body’s self-healing abilities.

 

What if the shockwave therapy treatment doesn’t work?

 

Usually, the response to shockwave therapy treatment is good however it may take several months before the maximum effect is achieved. If after 3-4 months the patient still does not experience a pronounced improvement, then other treatment modalities will need to be considered.

 

List of references

Fojecki GL, Tiessen S, Osther PJ. Extracorporeal shock wave therapy (ESWT) in urology: a systematic review of outcome in Peyronie’s disease, erectile dysfunction and chronic pelvic pain. World J Urol. In press. http://dx.doi.org/10.1007/s00345-016-1834-2.

 

1. Vardi, B. Appel, G. Jacob, O. Massarwi, I. Gruenwald, Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile   dysfunction, Eur Urol, Volume 58, 2010, pp. 243–248

 

1. Abu-Ghanem, N.D. Kitrey, I. Gruenwald, B. Appel, Y. Vardi, Penile low-intensity shock wave therapy: a promising novel modality for erectile dysfunction, Korean J Urol, Volume 55, 2014, pp. 295–299

 

N.D. Kitrey, I. Gruenwald, B. Appel, A. Shechter, O. Massarwa, Y. Vardi, Penile low-intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham-controlled study, J Urol, Volume 195, 2016, pp. 1550–1555

 

Lu Z, Lin G, Reed-Maldonado A, Wang C, Lue TF. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. In press.   http://dx.doi.org/10.1016/j.eururo.2016.05.050.

 

R.O. Cleveland, J.A. McAteer, The physics of shockwave lithotripsy, Smith’s Textbook of Endourology, A.D. Smith, 2007, Blackwell Publishing Ltd, Hoboken, NJ, pp. 317–332

 

I am suffering from Erectile Dysfunction, what should I do next?

We advise you to book a consultation with our highly experienced doctors. The first step towards an accurate diagnosis is an investigation of possible causes by our specialists.

After this, our doctors will aim to do two things:

• design a treatment plan that will allow you to immediately achieve a strong erection to continue normal sexual activities.
• design a treatment plan to address the underlying causes of your ED, this means that each treatment we offer in our clinic is highly personalised.