What is Erectile Dysfunction?
1 in 5 men have reported ED. Many more have probably goes unreported
Erectile dysfunction often referred to as ED, is the inability to achieve and sustain an erection suitable for sexual intercourse. The prevalence of erectile dysfunction increases with age and whilst around 20% of adult men suffer from erectile dysfunction that increases to 50% for men aged 40 and above. Modern treatment protocols mean that majority of our patients are able to successfully achieve penetrative sex irrespective of the underlying causes.
Shockwave Therapy for Erectile Dysfunction
Shockwave therapy is the latest treatment modality for patients suffering from erectile dysfunction and it is one of the few treatment options that improve natural erections and can potentially rejuvenate the erection mechanism. 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. In addition, shockwave therapy has the following advantages:
Frequently Asked Questions on Shockwave Therapy for Erectile Dysfunction
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:
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
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 10-12 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 10 12-minute sessions over a 5 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.
If you are having any symptoms like urinary inconsistence, erectile dysfunction, pain in the lower back, frequent urination, waking up at night to urinate, pain in your urinary system, blood in the urine, or any other symptoms which you feel might require a urologist’s opinion, please feel free to leave a comment and send it to us.
Dr. Datesh Daneshwar
FRCS (Urology) (Glasgow) - Consultant Urologist & Robotic Surgeon
A man on a mission to fight against the social stigma against men’s sexual health for over 2 decades. "Imagine a successful man, a loving husband; a caring father, god forbid if he develops a heart condition, he immediately gets the full support and sympathy of his family and friends. However, if the same person develops urological issues, he has to deal with it completely by himself for the fear of being labeled an ‘impotent’ or ‘sexually-incompetent’ person. This is so unfair, especially in today’s day and age, when we are denouncing every social stigma and challenging them in every field. Nobody should suffer in SILENCE"
Dr. Datesh’s Profile at a Glance