Credit: © Oystein Sando |

Extracorporeal shock wave therapy (ESWT), best known for its role in the destruction of urinary calculi, has now demonstrated efficacy in the treatment of erectile dysfunction (ED). A research group from Israel report this novel use for ESWT in The Journal of Sexual Medicine.

Shocking the penis might seem extreme, but the therapy used in this study was of a lower intensity than that used to break up stones. Previous experiments with low intensity ESWT (LI-ESWT) revealed its ability to induce blood vessel growth and thus improve blood flow.

Up to 35% of men with ED fail to respond to conventional treatment with phosphodiesterase type 5 (PDE5) inhibitors, and are left with the options of intracavernosal injections or penile implant surgery. Researchers identified 29 men with severe ED (mean IIEF-ED score 8.8) who were unresponsive to PDE5 inhibitors; the key inclusion criterion was a low erection hardness score (EHS) of 0–2 during PDE5 inhibitor therapy.

LI-ESWT involved 12 shock treatments over 9 weeks—two sessions per week in weeks 1–3 and 7–9, with 3 weeks of no treatment inbetween. During each session, 300 shocks were administered over 3 min to five sites on the penile shaft and crus.

Significant improvements were reported 1 month after treatment, in both penile hemodynamics and erectile function (mean IIEF-ED 12.3). 2 months after treatment, patients were restarted on PDE5 inhibitor therapy, resulting in further improvement—mean IIEF-ED score increased to 18.8 (P <0.0001) and 72.4% of patients reached an EHS of ≥3. In other words, men previously unable to have sexual intercourse could achieve vaginal penetration.

A randomized sham-controlled study of LI-ESWT is to follow, but whether men will be keen to try this new approach remains to be seen.