Erectile dysfunction continues to be a primary issue in the bedroom for men (and women). Erectile dysfunction (ED) is defined as the inability to obtain and/or maintain an erection sufficient enough or long enough for normal sexual intercourse. It affects on average 15-30 million men in the US alone. It can be caused by a number of complex underlying disorders that affect the mechanisms for penile erections. Some of the underlying disorders may include hormonal imbalance, neurological disease, prior surgeries such as prostatectomies, and damage to cavernous arteries. Vasculogenic ED, a disorder of the arteries and veins, is found in 70% of all cases. This occurs when the arteries and/or veins that bring blood to and from the penis are not functioning correctly due to blockages, narrowing of the vessels or other physiological causes.

Treatment options for ED have remained relatively unchanged for over 15 years. Some of these treatments include non-surgical options such as pills (ex: Viagra and Cialis); intraurethral suppositories (ex: urethral alprostadil); intracavernous injections (ex: trimix); vacuum erection devices used with a penile constriction device; and surgical options include penile prosthesis (ex: inflatable penile implants). Recently though, there have been many studies demonstrating benefits in using low-intensity shock wave treatment (LiSWT) as a potentially new treatment option in patients without severe ED. Treatment with LiSWT for ED is currently considered to be “investigational” as of 2018 based on American Urological Association (AUA) guidelines. Nonetheless, LiSWT is becoming more prevalent in clinics across the country.

LiSWT is similar to extracorporeal shock wave therapy (ESWL). ESWL is used to treat other medical issues like kidney stones or gallbladder stones for example. It uses acoustic waves to target tissues and cause mechanical stress. In kidney stones the acoustic waves of ESWL are focused on the stones in the urinary tract and break them up into smaller stones that are easier to pass. LiSWT utilizes lower levels of energy that are spread over a larger area, and early studies have shown that LiSWT helps to treat mild to moderate vasculogenic ED via regenerative mechanisms including neo-angiogenesis, stem cell stimulation, and corporal remodeling. Devices that are used for LiSWT are classified as FDA class II and require medical supervision to be operated. 

A different type of shock wave technology that is frequently advertised by many direct to consumer (DTC) men’s clinics is called radial shock wave technology. It utilizes dispersive pressure waves with significantly lower energy levels when compared to LiSWT. This results in decreased tissue penetration and is therefore classified as class I by the FDA and does not require medical supervision to be operated. There is also fewer supporting data that demonstrate its therapeutic benefit in treating ED. Despite this, many DTC clinics frequently advertise it as treatment for ED and some clinics did not specify the type of treatment they were offering – LiSWT vs radial shock wave technology.

 A recent study by Kalyviansakis et al compared LiSWT to radial shock wave treatment in a group of 70 men with moderate ED. After 3 months, 79% of patients that received LiSWT achieved a minimal clinically important difference defined as at least a 5-point increase in the International Index of Erectile Function score compared to 0 patients undergoing sham treatment. There were also no adverse events noted. The body of evidence supporting LiSWT as a safe treatment option for men with mild to moderate ED continues to grow. 

Here at The Y Factor, we can thoroughly evaluate you for underlying causes of ED. We are aware that ED is multifactorial and we have multiple treatment options available for you depending on your underlying condition, including LiSWT. As urologists, we specialize in treatments for ED. Although LiSWT is not for everyone, approximately 80% of patients that are candidates for LiSWT and undergo treatment experience stronger erections, better response to ED medications, and better sexual intercourse. 

Schedule an appointment with one of your providers to get you started on an evaluation to determine the best treatment option for you. 

References:

Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802–13.

National Institutes of Health. Impotence: NIH consensus development panel on impotence. JAMA. 1993 Jul 7;270(1):83-90.

Juan J. Andino, MD, MBA; Jeffrey C. Morrison, MD; Sriram Eleswarapu, MD; Jesse N. Mills, MD. Shock Wave Therapy for Erectile Dysfunction: Patterns of Care and Efficacy. Posted on: 01 Nov 2022.

Benancio Martinez Jr is a certified Family Nurse Practitioner and one of the newest integral parts of the Y Factor team. Benancio is the medical provider in charge of the Northpointe location and brings to the Y Factor 10 years of nursing experience obtained through the emergency departments of the VA and Kingwood medical centers, as well as clinical experience in family practice, hematology, and oncology.