Low-intensity shockwave therapy (LISWT) can be a safe, effective treatment for men with erectile dysfunction (ED) who don’t respond to oral ED medications, according to a recent Sexual Medicine report.
Used in medicine since the 1980s, shockwave therapy involves the aiming of shockwaves – energy waves that travel faster than the speed of sound – toward treatment areas from outside the body. The approach is sometimes used to break up kidney stones and treat conditions like joint pain, bursitis, and tendinitis. More recently, scientists have examined its use in the treatment of ED, with encouraging results.
The current study, conducted by researchers in Argentina, focused on 50 men with ED who did not have success with phosphodiesterase type 5 (PDE5) inhibitors. These drugs, which include sildenafil, vardenafil, and tadalafil, are often the first-line ED treatment. But the medications are not suitable for every man and some men don’t respond to them.
The participants also had vascular risk factors that could contribute to ED, such as diabetes, high lipid levels, high blood pressure, and coronary artery disease.
For four weeks, the men participated in weekly LISWT sessions lasting twenty minutes. At each appointment, shockwaves were applied to the penis and the perineum (the area between the anus and the scrotum). The men were then followed for twelve months. All of the men took PDE5 inhibitors throughout the study period.
Before treatment, and again at three-, six-, nine- and twelve-month points, the men’s erectile function was assessed using four different measurements, including a questionnaire called the International Index of Erectile Function (IIEF) which is often used in medical studies of ED.
The study authors pointed out that the device used to administer LISWT was an upgraded version of one used in previous studies on LISWT and ED. In the past, a clinician had to hold the device. In this study, the device could be attached to the penis itself.
Only forty of the men (average age: 65 years) completed the study through the follow-up period, so the researchers calculated their results based on data from this group. They found that 60% of the men had improved erections based on all of the measurement tools. At twelve months, those improvements were maintained for almost 92% of the responders. None of the men had side effects from treatment.
The men’s age and the length of time with ED did not affect the results, the authors noted.
They acknowledged several limitations, including the lack of a placebo group and the fact that ten participants dropped out of the study. If those men are considered in the calculations, the LISWT response rate would be 48%, not 60%.
The authors stressed the need for further research to determine how many LISWT sessions would be most effective and which men are the best candidates for this therapy. Also, the researchers were not certain exactly why LISWT worked well for some of the men and suggested more study in this area.
Experts caution that the true role for LISWT has yet to be determined, particularly given the increasing number of studies failing to show a benefit with the therapy. Given the contradictory evidence, experts urge further research in the area prior to routine implementation of the therapy as a standard of care for ED.
The authors similarly indicated, “Despite the enthusiasm over these results, it is necessary to have a larger number of long-term, multicentric placebo-controlled studies that can prove the efficacy and safety of this innovative treatment tool, thus avoiding false expectations and unnecessary medical expenses.”
Bechara, Amado, MD, PhD, et al.
“Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors”
(Full-text. Published online: July 18, 2016)