Scientists have shown that low-intensity extracorporeal shockwave therapy (LI-ESWT) can benefit men with vasculogenic erectile dysfunction (ED) and that improved erections may last for up to a year.
Their study, recently published in the Journal of Sexual Medicine, used penile hemodynamics as an objective evaluative tool.
LI-ESWT is sometimes used to treat heart conditions, kidney stones, and joint inflammation. But its use for men with ED is still experimental.
The approach uses energy from acoustic waves to promote the formation of new blood vessels (neovascularization). Since erections depend on good blood flow to the penis, the process may help men whose blood flow is obstructed. LI-ESWT may also be a viable alternative to ED medications, which are not safe for all patients.
Forty-six men with vasculogenic ED participated in the study. They ranged in age from 31 to 72, with an average age of 54 years. The men had had ED for at least six months.
The men were randomly assigned to receive either LI-ESWT (30 men) or a sham treatment (16 men). Twelve treatments were given over a period of nine weeks, with each 20-minute session including 300 shocks to five separate locations on the penis. (Sham treatments followed a similar protocol, but a device was used to block shockwave delivery.) No pain or side effects were reported for either group.
At baseline, and again three months after treatment, the researchers used penile ultrasonography to measure changes in peak systolic velocity (PSV) and resistance index (RI). In addition, the men completed the International Index of Erectile Function (IIEF) questionnaire at baseline and at one-, three-, six-, nine-, and twelve-month points after treatment.
PSV increased by a mean of 4.5 cm/s for the treatment group between baseline and the three-month follow up, which is indicative of improved erectile function. The sham group saw a mean increase of 0.6 cm/s.
The treatment group also had better IIEF scores than the sham group throughout the follow-up period, with a minimal clinically important difference observed in 57% of the participants at 3 months and 75% at 12 months, compared to 13% (3 months) and 25% (12 months) for the sham group.
“An important finding of our study is that IIEF score and PSV increased significantly at 3 months in a linear fashion,” the authors wrote. “Patients with no improvement in IIEF score had no improvement in PSV.”
The scientists were not certain why LI-ESWT worked well for patients with ED and called for more research “to gain insight into the mechanism of action of LI-ESWT on cavernosal structures.”
LI-ESWT could be a feasible treatment for ED, the authors said, but more research is needed to determine the best treatment protocols for specific patients. For example, men with mild ED might need fewer sessions than those with severe ED. Age and health conditions (such as diabetes) might also influence treatment protocols.
“Such research will identify those who could really benefit from this revolutionary therapy and make the indications of this novel treatment modality more accurate,” the authors wrote.
International Society for Sexual Medicine
“What is shockwave therapy and how might it help men with erectile dysfunction?”
The Journal of Sexual Medicine
Kalyvianakis, Dimitrios MD, FECSM and Dimitrios Hatzichristou MD, PhD, FECSM
“Low-Intensity Shockwave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial”
(Full-text. July 2017)