Gruenwald I et al, 2013: Shockwave treatment of erectile dysfunction
Gruenwald I, Appel B, Kitrey ND, Vardi Y
Neuro-Urology Unit, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa 34679, Israel
Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.
Ther Adv Urol. 2013 Apr;5(2):95-9. doi: 10.1177/1756287212470696
This article reviews briefly the background to a possible effect of LI-ESWT on erectile dysfunction and summarises the authors' experience from three different studies. The latest of these reports was a prospective randomized double-blind shame controlled trial in 60 men. It is, however, not easy to understand how the double-blind concept was fulfilled. Nevertheless the great advantage of the authors' different studies was that objective measurements with pletysmography were carried out. Those data supported the subjective information from the patients.
Interestingly, the reported sustained effect up to 2 years really seems promising and for patients in whom pharmacological treatment has been unsuccessful or impossible, LI-ESWT might be worthwhile to try.