It’s hard to argue against an erectile dysfunction treatment that can reverse the cause of ED, is noninvasive, and is harmless.
The treatment called “Extracorporeal Shockwave Therapy (ECSW)” has yet to earn the FDA’s approval but is widely used in the US and in other countries. Early results from ongoing U.S. trials are promising. A shock wave is a wave of acoustic energy, that travels faster than the speed of sound. Think of a sonic boom or the loud clap after a lightning strike.
Similar acoustic energy is used during lithotripsy to break up kidney stones. But when directed at a penis, the therapy is different. Linear shock waves used for erectile dysfunction use about one-tenth of the energy of traditional shock wave machines for kidney stones. And rather than break something down, as is the case with stones, shock waves make the penis healthier by improving blood flow.
In a systematic review and meta-analysis published in 2017, Dr. Ramasamy and colleagues analyzed extracorporeal shock wave therapy in seven randomized controlled trials in 602 patients. They found among men with an average age of 60.7 years and an average follow-up of 19.8 weeks, the International Index of Erectile Function score significantly improved an average 6.40 points from baseline in men receiving shock wave treatment, compared to an average 1.65 points in those receiving sham therapy (J Sex Med 2017; 14:27-35). This is significant!
How does it work?
Currently, there are two theories about how shock waves work to treat ED. As a vascular neurologist, I offer a third: One relates to angiogenesis (new blood vessel formation) in penile tissue. The second theory is that shock wave therapy improves ED by recruiting stem cells, which helps grow new corporal and penile tissue. Dr. Irwin Goldstein, a urologist and researcher in the field of ED said he thinks low-intensity shock wave therapy works by activating stem cells. “The shock wave provides energy to the stem cells, and the stem cells get activated and grow—growing muscle, blood vessels.” Thirdly, I believe it is possible that the energy produced by ECSW could potentially break up existing plaque in the vascular bed which could result in improved vascular flow to the penis. For the latter reason, I often perform penile Doppler ultrasound in my office to evaluate for vascular flow insufficiency.
Are all Shockwave Devices equal?
In general, three variants of devices are used in treating ED with ECSW. There is radial (The energy lessens further from the tip of the device); focal (Energy maximizes at a focus point); and the latest advance, linear which the energy is focused in a straight line throughout the tissue. In a recently published meta-analysis of low-intensity extracorporeal shock wave therapy for ED, researchers analyzed multiple studies using radial or focused devices. It was concluded that radial devices lack effectiveness. Despite this, most clinics and home devices use a radial form of treatment.
The University of Miami published data using the new FDA-approved MoreNova linear ECSW device for ED. They showed the device offers significant improvement in ED outcomes while being painless and quick (each session lasts 15 minutes) while offering a private treatment session as a technician is not required to perform the procedure.
The only two clinically proven devices currently available and FDA-approved for ED.
- Storz DUOLITH® SD1
- MoreNova