Although low intensity shock wave therapy has been used for the treatment of erectile dysfunction for decades, there is still confusion in the literature regarding nomenclature and forms of energy. This confusion makes it challenging to compare outcomes. There is still controversy regarding which type of equipment and treatment protocol is best. The potential addition of alternative treatments including platelet rich plasma (PRP) is another confounding variable.
LSWT is believed to work through regenerative processes. It is widely believed that the cells convert mechanical energy into a biochemical signal. The cells actually temporarily bend during this process. It is believed that there is a release of growth factors that result in angiogenesis (acquisition of new blood vessels) and also new nerves.
Not only do the shock waves promulgate regenerative changes, they also may directly breakup plaque in the small blood vessels, further enhancing blood flow. This is the reason that shock waves are thought to help cure vascular insufficiency, the most common cause of erectile dysfunction.
There is wide variance reported in the literature regarding this hot topic. According to a recently published article appearing in Translational Urology and Andrology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261418/ one investigator found no difference in outcomes between .05mJ/mm2 and .10mJ/mm2. The article also referenced studies using up to .25mJ/mm2.
Who Should Be Treated With LSWT?
According to the American Urology Association LSWT should be reserved exclusively for investigation, and not offered to the general public. As such, Medicare, Medicaid, and private insurance companies do not feel obligated to reimburse patients who desire this treatment. On the other hand, shock wave therapy has gained widespread approval in Europe.
For instance, the esteemed European Association of Urology recommends LSWT as first-line treatment for men who are uninterested or unable to take pde5-inhibitors. There is general consensus that patients with milder forms of ED are more likely to respond. Patients who are non-responders to pde5-inhibitors may find that they do respond after a course of treatment.
What Is The Most Current Treatment Protocol?
1) There is a range reported in the literature from 1,500 shocks per session to 5,000 shocks per session. The most common protocol is at 3,000 shocks per session.
2) A common protocol is 2 sessions/week x 3 weeks
3 weeks off
Resume treatment with 2 sessions/week x 3 weeks
Other protocols include 1 session/week X 4-6 weeks
How severe are the side effects?
LSWT is generally very well tolerated. In the studies reviewed, patients were not required to discontinue the use of anti-coagulants, and there were very few if any patients who dropped out of the studies because of side effects. At Uroshock, out of an abundance of caution, we recommend that patients who have bleeding disorders or who are on anti-coagulation therapy do not use our device. Never stop anti-coagulation therapy without the permission of your physician.
Are the benefits of LSWT permanent? Will I require additional treatments in the future?
The literature is clear that the benefits of LSWT are not permanent. They may be durable for 6 months, or even longer, but eventually most patients will require additional treatment. The biggest advantage of owning your own acoustic wave machine is that you can perform a touch-up whenever you like. Even if you have previously had a successful outcome from prior treatments in a physician’s office, you can still enhance the results with your own device.