A Systematic Review Of The Long-term Efficacy Of Low-intensity Shockwave Therapy For Vasculogenic Erectile Dysfunction

There are numerous scientific studies that show shockwave therapy can potentially improve local revascularization (regeneration of blood vessels and enhanced blood flow) on a variety of body parts, including the penis.

Moreover, with the International Index of Erectile Function (IIEF) of ED, we have the possibility to evaluate the clinically minimal change in the IIEF, which is much more related to a real success rate. The significant improvement in MCID is much more related to the improvement of LI-ESWT effect on ED, rather than simple improvement of IIEF. 2) Vasectomy 79 (11. An initial decrease in the percentage of patients with low values (zero to two) and an increase for those with high values were observed in the first examination, with a partial reversal in the second examination. Unfortunately, many articles do not provide detail for the shockwave device characteristics and parameters. Yet, while Dr. Of the 18 men enrolled in the study, all completed the follow-up of 3 months.

The present study aims to determine the impact and efficacy of Li-EWST in male patients with ED. The process has been well tolerated by patients. Optimization of PDE-5i treatment entails applying sexual stimulation for appropriate nitric oxide release, reducing food intake (which may impair drug absorption), dose escalation as necessary, and repeated attempts.

However, that does not mean that shock wave therapy will be found to be an effective treatment for erectile dysfunction.

Nevertheless, however there isn’t a consensus about the efficacy of this tool in the ED setting, the type of schedule nor in which patients the benefit could be maximized (4). In the first examination, the EHS improved in 43. I envisioned myself rolling around my Holiday Inn Express hotel room bed in some kind of a raging sexual spasm, trying to keep my balls from exploding before my flight home. World J Urol 2020;35: 8% (14/18) showed significant improvement in virtue of Li-ESWT treatment (p=0. )(9% of patients with EHS >2), however the study failed to prove an increase in the IIEF-5 score. “Our own experience has been very similar to the published literature.

“Through shockwave therapy, we are introducing a new paradigm of ED treatment that appears effective in changing the health of the penile tissue. (3) Second examination (n = 412) % patients with EHS ≥ 3 36. But this treatment is now being offered for men with erectile dysfunction (ED) caused by inadequate blood flow to the penis, called vasculogenic ED. Is shockwave therapy right for me?

; Persiani, M.

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But thanks to the overcrowding of the sexual performance industry by pharmaceutical and supplement companies, there were no standardized protocols, machines, or training programs until dear Dr. But the efficacy and credibility of low-intensity extracorporeal shock wave therapy for ED has come under criticism, according to Dr. (31), respectively. It therefore calls for a multidisciplinary approach to every patient who suffers from ED [7–9].

Image by Direx Medical Systems Ltd. Acknowledging that the reduction in the blood flow in the cavernosal arteries and the endothelial dysfunction are the hallmarks of ED, Vardi and colleagues (3) were the first to study this subject in 2020. Published by Elsevier Inc. For men with vasculogenic ED, Dr. It is therefore essential to consider baseline erectile function as well as patient expectations before treatment.

(4) Absolute difference 10. When you had erections with sexual stimulation, how often were your erections hard enough for penetration? The shorter wavelengths of focus shock waves also allow the waves to be used for more targeted treatments.

001), respectively, at the 7-week follow-up; 47.


The frequency of comorbidities and outcomes were expressed in absolute numbers and percentages, respectively. 7% of responders maintained their responses. Erectile dysfunction (ED) or impotence is the inability to get and keep an erection firm enough for sexual intercourse. To administer shockwave therapy, a clinician applies a probe to the penis, which is coated in a special gel. MCID at 6-month FU visit was achieved in 82. They received 3,000 impulses per session at 0. All rights reserved. They can also be used to determine how much of an improvement men report, if they see one.

When assessing studies with follow-ups of greater than 6 months, there appeared to be limited improvement in IIEF scores beyond this time period (change in IIEF-EF scores of between − 2 and 0. Do erectile dysfunction pills work?, also, the best natural supplements for ED obligatorily contain the ingredients able to improve the circulatory function in men. )Both types of extracorporeal shock wave therapy are effective, non-invasive treatments. To assess the effects of extracorporeal shockwave therapy (ESWT) as a treatment option for men with erectile dysfunction (ED). 2% in men between the ages of 30 and 80 with an age-related increase from 2. Based on this trendy breakthrough of kidney doctors blasting their gonads with sound waves, physicians were eventually able to treat erectile dysfunction at its root source:

1) Spinal surgery 17 (2. Soundwave therapy’s ability to break up scar tissue in other body parts has been documented for 40 years, and in penal tissue for the last 25. For future studies, we propose that the best design to evaluate the effectiveness of the therapy is the placebo-controlled clinical trial; in addition, the evaluated parameters should be broadened in questionnaires on sexual satisfaction, quality of life, and more specific and objective outcomes such as blood flow in the penile Doppler ultrasound. It’s also not clear which men would benefit the most; doctors can’t give percentages of real success yet, nor can they predict how long the treatment’s effects will last. Conflicts of interest: 44, 95% CI = 0. All four groups improved in mean IIEF-EF score, average SEP3 “Yes” response rates at 6-month FU visit compared with baseline (p < 0. )

[Crossref] [PubMed] Vardi Y, Appel B, Kilchevsky A, et al.

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Learn what’s in store for your sex life – you’re likely to find that the best is yet to come. “We keep all maintenance records in an FDA-required format,” he said. These include: I’ll be back in a few minutes. During these routine visits to Las Vegas Urology, one of our trained providers will utilize a machine that delivers controlled, focused treatments to the area. And he noticed a difference after just two treatments.

More recently, Fojecki and colleagues (29), in 2020, published an RCT where they found an average increase in the IIEF-EF score of 1. 1 (95% CI = 9. )Ramasamy said that his clinical trial was designed for 80 men and that he currently has 66 patients enrolled at their University of Miami site.

Ramasamy said that this current trial is being supported by private donors and philanthropic support, although two devices were given to him by the manufacturer, Direx Medical Systems Ltd. “There’s a lot of buzz. Two out of three studies assessing age specifically identified a reduced effectiveness of LISWT with increasing age [14, 17]. (9) Absolute difference in the percentage of patients able to penetrate, with a confidence interval of 95%, compared to baseline.

Long-term efficacy of LISWT

Li G Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Shoskes disagrees. Some groups have included data on cavernous artery triplex ultrasonographic parameters, and if some described a significant positive change (30,31), others failed to show any significant change (18). The extraordinary feature of LI-ESWT is that it is the first potential non-surgical curative treatment for ED. Low intensity extracorporeal shockwave therapy for erectile dysfunction: 10 mJ/mm2 regarding efficacy and safety of 12-treatment sessions when applied two or three times per week.

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The EHS for all patients was measured at three stages: Conflicts of Interest: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment. The treatment’s pulsating sound waves simultaneously remove micro-plaque, accelerate the growth of new blood vessels, and fix damaged blood vessels in the penis. This could skew results towards those receiving the treatment, generating false-positive results. I wonder if I can buy one of these wands for my coffee table.

Extracorporeal shock-wave therapy in the treatment of erectile dysfunction: Whilst higher attrition rates are expected due to the longer follow-up in our selected articles, unusually high dropout rates in some studies such as Srini and Fojecki et al. ’’ Minimal improvement in the anchor from baseline to week 12 is defined as a change from little or no satisfactory intercourse at baseline (either 1, ‘‘almost never,’’ or 2, ‘‘a few times’’) to satisfactory intercourse sometimes (3, ‘‘sometimes’’). Where low-intensity extracorporeal shock wave therapy for ED may offer the greatest patient benefit is in ED. This type of therapy has been used to help heart patients, people with kidney stones, and those with fractures and joint inflammation. Gruenwald et al [11x[11]Gruenwald, I. From numbing cream application to pulse waves per second, Dustin Wolff demonstrates how the shockwave device works during your 20 minute ER treatment sessions:

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“The protocol schedule that we are using now is 10 minutes a day for either five days in a row — Monday, Tuesday, Wednesday, Thursday, Friday — with a follow-up at one month, three months, and then again at six months. At a certain level, you may have a beneficial effect. This helps improve blood flow to the region. If you are a current subscriber with Society Membership or an Account Number, claim your access now. In fact, other groups revealed increases in IIEF-5 score from 2. The primary outcome measure was the change in IIEF-5 score from baseline to after 1 and 3 months. Drugs.com mobile apps, although ED can be distressing, it is very common—the most common sexual dysfunction there is. A linear shockwave device, Renova-ED incorporates a unique shockwave transducer to deliver short, incredibly fast bursts of energy to a targeted part of the body — in this case, the left and right corpora cavernosa and the crura, portions of penile tissue.

(88), respectively, indicating that shock wave therapy increases the likelihood that the patient regain their ability to penetrate regardless of other therapies received. In animal studies, shock wave therapy has been shown to both improve the growth of blood vessels and to stimulate growth and differentiation of penile tissue. 3) Sexually transmitted diseases 4 (0. We always start with a clinical history and a physical examination to make sure there’s not an obvious deformity. The aim of the present study was to evaluate the efficacy and safety of the electromagnetic-type low-intensity extracorporeal shock wave therapy (Li-ESWT) in patients with erectile dysfunction (ED). Participants were asked to complete the international index of erectile function-erectile function (IIEF-EF) domain questionnaire, erection hardness scale (EHS), and sexual encounter profile questionnaire (SEPQ 2 and 3). ” She looked excited. Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients.

I really hope I don’t have a boner. A prospective, randomized, double-blind, placebo-controlled study. Two studies assessed the effect of vascular risk factors on LISWT effectiveness.

3%), while Ruffo et al [14x[14]Ruffo, A.

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Fortunately, there are many treatment options available to men with ED, including Low-Intensity Extracorporeal Pulsewaves Therapy. He never played for the NBA, but this Michael Jordan also loves basketball, although depression had him sitting on the sidelines. Let’s back up. There are still limited number of studies assessing long-term follow-up after LISWT with predominantly non-randomised trials present.

It’s an acoustic wave therapy, similar to ultrasound. Gupta, nevertheless, expects that shockwave therapy will be a game-changer in the treatment of ED over the next decade, but only if scientists manage to design rigorous treatment protocols, and perhaps only for a restricted number of men. After treatment, pituitary or hypothalamic causes - treat the underlying causes; for example, pituitary tumours causing hyperprolactinaemia. It may be that it is too soft for penetration or too brief for penetration. Treatment sessions may last for fifteen to twenty minutes. The IIEF-5 scores at baseline and at 1- and 3-month follow-up were compared using the McNemar’s test for a matched pairs analysis. But here’s the catch:

This oversight may contribute to the inconsistent results reported by various authors using different devices. Now, a new treatment using shockwave therapy is helping patients get back in the game. It occurs in association with aging, chronic illnesses and various modifiable risk factors. The main objective of the study was to investigate and prove the effectiveness and safety of extracorporeal shock wave therapy (ESWT) in treatment of erectile dysfunction (ED) caused by vascular disorders.

Supplementary material 2 (PDF 63 KB)

Scientists have been working relentlessly to restore patients’ ability to get it up on their own, without the need to plan each sexual encounter. The good news is that erectile dysfunction is treatable. Therefore, the effect on PD/CPPS-associated ED patients is limited owing to their nonvasculogenic origin. Originally developed as a treatment for wounds and injuries, shock wave therapy is thought to stimulate increased blood flow in order to promote healing. 2) Acute myocardial infarction 19 (2.

You could try accomplishing this through PDE5 inhibitor medications like Viagra or penis artery reconstruction surgery – but you’d have to be willing to accept some pretty high risks and costs. These men should look at other therapies – the vacuum device, penile injections, or penile prosthesis surgery. It therefore has a significant negative impact on the quality of life of sufferers and their partners [3–5]. My crotch was numb.

Thanking myself for pulling on my tight jeans before heading to the restaurant, I sat it out for a moment, then excused myself to the restroom, ducked into a stall and pulled down my pants to take a glance at what was happening down there. The numbing stuff. Typically, treatment sessions will last between 15 to 20 minutes. But my dick was flaccid. Those groups have shown improvement in the IIEF-EF ranging from 2 to 9 (17,19,20,28), however the absolute value of variation is not comparable taking into account the different scale of both questionnaires.

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“We wanted to do this trial first to make sure it works — and it does,” he said. In the last years, some innovative options appeared in order to face this problem, and some studies have shown good results with the use of low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie‘s disease. Shock wave therapy induces neovascularization at the tendon–bone junction. Impact of aging and comorbidity on the efficacy of low-intensity shock wave therapy for erectile dysfunction.

J Sex Med 2020;10: Any device must be specifically approved for the condition being treated. Around 30% of male patients above 40 years suffer from this condition, with increasing rates in older ages (1). 4% were able to have penetrative intercourse (EHS ≥3) [11x[11]Gruenwald, I. This could explain why it has been studied mainly in men with vasculogenic ED but not in men with neurogenic ED. Most ED cases are of vascular origin.

6% of the patients were PDE5-I non-responders. J Urol 2020;187: In the future, rigorous RCTs will better show whether this therapeutic approach is truly effective and in which subset of patients. Statistical analysis was performed by the program Statistical Package for Social Sciences, version 22. “It affects the libido as much as it affects performance,” he says.

What does Shockwave Therapy for ED feel like?

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. National hearing test, during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner? If you’ve already invested in over-the-counter erectile dysfunction treatments or tried doing erectile dysfunction exercises every night you’re likely still searching for an ED treatment that really works. Also, it can be used in any man without ED who wishes to improve the quality of his erections. However, he notes, “there is a lack of clinical trial evidence to support its effectiveness and long-term safety” in men with ED. The potential of Li-ESWT remains appealing, since the possibility of having a disease-modifying treatment for ED would be unique. I am no longer a poster-child for the mutant Avenger with gonadal superpowers, but Dr. The technique has traditionally been used in the treatment of other conditions, in cardiovascular medicine in particular, but also to treat kidney stones or tendonitis. ” With that, she handed me a brochure for “GAINSWave”, cover adorned with the smiling face of Dr.

FEBS Lett 2020;520: I thought of my wife 3,000 miles away in Washington state. No treatment-related side‐effects were reported. The age and the EHS values were described using median and interquartile range. High-frequency sound waves are applied to the penis to stimulate the growth of new blood vessels and possibly break down plaque build-up in existing vessels. But board-certified urologists are urging men seeking help for ED to do their homework before jumping into novel treatments that aren’t yet FDA approved. 5 points, and success in treatment in 38% of patients. Encore standard battery system, stress and anxiety is also one reason for ED and a lubricating jelly can help prevent stress and anxiety associated with sex. Furthermore, it has been reported that low-intensity extracorporeal shock wave therapy (LI-ESWT), applied to the corpora cavernosa of patients with vascular ED, improves the quality of the erection by inducing angiogenesis mediated by intra- and extracellular mechanisms such as increased levels of nitric oxide synthase, nitric oxide, and vascular endothelial growth factors [12–15].

  • The authors have nothing to disclose.
  • In 2020, scientists from the European Society of Sexual Medicine reviewed the evidence for the use of shock wave therapy in sexual health.
  • His center has nine trials ongoing in various areas of sexuality, and it has already completed a pilot study on men with ED in open-label context with the shockwave device, the Dornier Aries, made by Dornier MedTech Systems out of Germany.
  • ED severity appears to have contrasting effects on efficacy.
  • The aim of ED shockwave therapy (EDSWT) is to trigger regeneration of blood vessel in the penile shaft to support stronger, longer, and more satisfying erection.
  •  None of the studies have reported any adverse events from undergoing shock wave therapy.
  • 10 mJ/mm2 was noticed, although it did not reach statistical significance.

Shockwave Therapy for Erectile Dysfunction

Erectile dysfunction: Araujo AB Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. 5% of men in the LI-ESWT group and 0% in the sham group responded to therapy (p < 0. )

Although shockwave therapy for treating ED has not received approval from the U. The personal ED issues he discussed — to the chagrin of those watching television with their parents or grandparents — was a result of the surgery. Related videos, with significant health and lifestyle changes, erectile dysfunction can be significantly improved. The hertz speed of your shockwave pulses will always be adjusted for your comfort. (8 years) completed the 12-month follow-up. Furthermore, even those meta-analyses that have found a significant improvement in men's IIEF scores have only found them to go up by 2 to 3 points. In an animal model of severe injury to cavernous and pudendal nerves and internal pudendal arteries, LI-ESWT improved intracavernous pressure by enhancing angiogenesis, tissue restoration, and nerve regeneration with activation of Schwann cells and endothelial cells [2x[2]Li, H.

J Sex Med 2020;14: Without answers, offering the ED treatment outside research settings is questionable medicine, some urologists say. Until such trials become available, we are unable to recommend LI-ESWT as a standard treatment option for men who are PDE-5i nonresponders. Forgot your password? “The most disappointing issue my patients face is, of course, the price”, Dr. ” The best candidates for this type of new therapy are men who have not tried any therapy medications, or those who have already tried Viagra or Cialis.

Innovative, Non-surgical, Painless, Curative

(0001) [15x[15]Kitrey, N. A prospective, randomized, double-blind, placebo-controlled study, Scandinavian journal of urology, Informa Healthcare Stockholm, 2020, 1-5. Shockwave therapy is different, as it targets the erectile mechanism so that men are more likely to have erections on their own. Despite what the enthusiastic commercials say, it’s not clear how well shockwave therapy works for ED. ” and the Global Assessment Question (GAQ) by answering the yes/no question:

The good news: