November 7, 2019

When Is Low-intensity Shockwave Therapy a Good Option for Erectile Dysfunction?

LISWT may benefit certain men with ED

Doctor counseling male patient on showave therapy

Low-intensity shockwave therapy (LISWT) has been used for years to help with wound healing and improve healing of bone fractures and damaged or inflamed tendons and ligaments.

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But this treatment is now being offered for men with erectile dysfunction (ED) caused by inadequate blood flow to the penis, called vasculogenic ED.

Urologist Daniel Shoskes, MD, says LISWT may be an option — particularly for men with mild to moderate ED who’ve had success with medications known as phosphodiesterase-5 (PDE5) inhibitors.

“It has a very long track record as a device in terms of efficacy and safety,” explains Dr. Shoskes. “If someone, for instance, takes a PDE5 inhibitor and has a great response but wants to not have to take it, those are patients who typically do very well.”

How low-intensity shockwave therapy boosts blood flow

Erections require a sufficient blood supply, and anything that limits blood flow to the penis — such as cardiovascular disease and diabetes — can lead to ED.

With LISWT, a physician uses a wand-like device to deliver mild shockwaves to the penis. Studies have found that the treatment is associated with a growth of new blood vessels and (in animal studies) recruitment of stem cells to the penis.

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In a recent meta-analysis of 10 randomized controlled trials involving a total of nearly 900 men with vasculogenic ED, researchers reported that, compared with sham treatment, LISWT resulted in significant improvements in measures of erectile function and penile blood flow.

“It has been shown in studies that pretty much everyone gets an improvement in blood flow,” Dr. Shoskes says. “Over the years there have been a number of studies showing overall improvement in the ability to get erections, either alone or with a PDE5 inhibitor.”

What type of results can you expect from LISWT?

For men with vasculogenic ED, Dr. Shoskes and colleagues at Cleveland Clinic administer LISWT once a week for six weeks, although the ideal treatment protocol has yet to be determined. Each treatment session lasts about 15 minutes. No anesthesia is necessary, and for upwards of 95% of patients, the procedure is painless, Dr. Shoskes says.

“Our own experience has been very similar to the published literature. We find success about 62% of the time. I define success as going from no erections to having erections able to penetrate, or having PDE5 inhibitors no longer work and now they work great,” he explains, noting that the benefits of treatment tend to remain durable for at least a year.

Who is a good candidate for LISWT?

Generally, men with mild to moderate vasculogenic ED who have had some response to PDE5 inhibitors are ideal candidates for LISWT. Other men, such as those with nerve damage due to pelvic cancer surgery and those with ED resulting from psychological causes, typically don’t respond to the treatment, Dr. Shoskes advises.

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Although LISWT has a long track record in medicine, its use for treating ED in the United States is relatively new. The U.S. Food and Drug Administration hasn’t approved it specifically for ED, and guidelines from the American Urological Association note that LISWT shouldn’t be offered outside of a clinical trial — a position with which Dr. Shoskes disagrees.

Furthermore, for ED, insurance coverage of LISWT is lacking. In some practices, the treatments can cost thousands of dollars (Cleveland Clinic charges $300 per treatment session, Dr. Shoskes says).

“But it is a very reasonable option as part of an integrated treatment approach,” he adds. “For the right patient who’s counseled the right way, it’s a low- to zero-risk treatment that may have surprisingly good effects. If it doesn’t break the bank for you to have this therapy, it’s certainly worth considering.”

This article first appeared in Cleveland Clinic Men’s Health Advisor.

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