Shockwave Therapy as an Alternative Treatment for Erectile Dysfunction

Erectile dysfunction (ED) is a medical condition when a man is unable to achieve or sustain an erection that is satisfactory for sexual intercourse. It is an alarming health condition that affects up to half of the men aged 30 and above in Singapore. It is slightly common in those with concurrent cardiovascular health risk factors.

Conventional treatment for erectile dysfunction involves lifestyle changes to improve underlying medical conditions and oral medication treatment with phosphodiesterase-5 inhibitors (PDE5i) such as sildenafil or tadalafil. In those who are unable to consume oral treatment or have poor improvement with oral treatment, more drastic and invasive options such as vacuum devices, injections, and penile prostheses may be considered. Patients with erectile dysfunction may also be susceptible to the exploitation of non-clinically proven medication or treatment options that are available in the market, leading to further waste of money with unsatisfactory outcomes.

Over the years, low-intensity shockwave therapy has slowly gained popularity among both patients and clinicians as one of the treatment options for ED. In this article, we want to understand and explore the efficacy and sustainability of this option in erectile dysfunction.

What is the science behind shockwave therapy in treating erectile dysfunction?

The effect of shockwave therapy relies on incorporating the theory of basic physics onto biologically targeted human tissue to achieve the desired outcome.

In physics, a shockwave is produced when:

• There is a sound disturbance in a medium that delivers energy.
• This wave travels through the medium.

As the name ‘shockwave’ suggests, the shock allows forward propagation of disturbance that moves faster than the speed of sound in the medium. The sudden delivery and discontinuity of the ‘disturbances’ in the medium allow shockwave to achieve an abrupt high-pressure level onto the targeted region. When the shockwave forces are applied to a localised area of the body, it leads to repeated and sudden sheer pressure, compression and expansion of the tissues.    

What are the clinical benefits of shockwave therapy in treating erectile dysfunction?

In erectile dysfunction, the repetitive sheer pressure delivered by shockwave therapy stimulates the regrowth of blood vessels (neo-angiogenesis), improves micro-blood circulation, regenerates localised nerve (neurogenesis), activates progenitor cells to remodel, and restores erectile tissue from local inflammation and stress.

Is shockwave therapy clinically proven?

We now know that in most patients with erectile dysfunction, there is abnormal or reduced blood circulation through the erectile tissues. The idea of tissue regeneration with shockwave therapy changes the conventional treatment paradigm of erectile dysfunction.

Over the years, there have been increasingly promising clinical studies showing that shockwave therapy can be used beneficially and safely in ED. Shockwave therapy is also seen to work as an adjunct to improve patients' responses to oral medications such as PDE5i.

Currently, the EAU (European Association of Urology) recommends shockwave therapy as a first-line alternative treatment for patients who are unable to tolerate oral medications such as PDE5i. The Asia-Pacific Society for Sexual Medicine (APSSM) also recommends shockwave therapy to patients with mild or moderate vasculogenic (blood-circulatory related) ED who do not respond to oral medications.

What are the benefits of shockwave therapy, aside from being clinically useful?

• It is safe.
• It is painless, and no local or general anaesthesia is required.
• No preparation or fasting is required for treatment.
• It is non-invasive and needle-free.
• It has no downtime.

How is the shockwave therapy delivered?

Shockwave therapy is a convenient and relatively quick treatment therapy that can be offered in an outpatient setting. You are not required to fast for preparation prior to the procedure.

Your doctor will place a hand-held shockwave device onto your penis. The device will release gentle shock pulses to trigger the regeneration of the erectile tissues. There will be no needle involvement, and no anaesthesia is required. The entire procedure takes about 30 minutes. As there is generally no downtime, you are expected to be able to drive home, go to work, continue sports activities, and go about your usual everyday routine.

Who is likely to benefit from shockwave therapy?

Patients with erectile dysfunction who:

• Are not responding to oral medication or other treatment options of ED.
• Are not keen and not suitable to take oral medication such as PDE5i.
• Wish to reverse the underlying blood-circulatory cause of ED by aiding regenerative therapy.

Who is not suitable for shockwave therapy?

If you are taking blood thinner medications such as anticoagulants or antiplatelets, you should inform your healthcare providers before treatment. Depending on your circumstances and health risks, your doctor can advise you further on the suitability of shockwave therapy.

What other medical conditions can be treated with shockwave therapy?

Shockwave therapy is not a completely new medical technology and treatment option. In fact, this therapy has been available for over 40 years in the medical field. It is used to manage health conditions, including kidney stones, pelvic pain, and musculoskeletal injuries such as frozen shoulder and plantar fasciitis.

Should I, as a patient or consumer, consider shockwave therapy for the treatment of ED?

• There are increasing clinical studies highlighting the efficacy of shockwave therapy in improving ED symptoms.
• Shockwave therapy has also been shown to improve the response to oral ED medications such as PDE5i.
• Shockwave therapy can be considered a safe and beneficial alternative treatment for ED.
• Shockwave therapy can be used as a combination treatment option in the management of ED on top of conventional medication treatment.

References

1. Tan JK, Hong CY, Png DJC, et al. Erectile dysfunction in Singapore: Prevalence and its associated factors – A population-based study. Singapore Med J 2003;44:20-6.
2. Lau W, Shum CF, Lua HCA, Teo, CPC. Low-intensity shockwave therapy in the management of erectile dysfunction in Singapore. Annals Official Journal of the Academy of Medicine, Singapore 2021;50:8.
3. de Oliveira PS, Ziegelmann MJ. Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes. Transl Androl Urol. 2021 Jun;10(6):2617-2628.
4. Raul I. Clavijo, Taylor P. Kohn, Jaden R. Kohn, Ranjith Ramasamy, Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis, The Journal of Sexual Medicine. 2017 Jan;14(1): 27-35.