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Controversies in low intensity extracorporeal shockwave therapy for erectile dysfunction

International Journal of Impotence Research volume 31, pages 239–242 (2019)Cite this article

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Despite major advances in the field of erectile dysfunction (ED) in the past decades, the current treatment paradigm is far from perfect and all available treatments have significant limitations. Oral PDE-5 inhibitors are commonly offered as initial treatment. Although highly effective in many patients, they do not alter the underlying pathophysiology of the erectile mechanism, which may continue on its downward spiral [1]. In addition, select PDE-5 inhibitors may still be costly. Furthermore, PDE-5 inhibitors may have undesirable adverse effects such as dyspepsia, headache, flushing, and dizziness [1, 2]. Another effective treatment for ED is intra-cavernosal injections (ICI) which includes monotherapy or a combination of prostaglandin E1, papaverine, and phentolamine. Despite a response rate of up to 90%, the thought of inserting a needle to the penis is undesirable to many patients. Furthermore, ICI can lead to penile pain, priapism, and fibrosis [2], further leading to treatment discontinuation. Intraurethral suppository is another non-invasive alternative with a moderate 43–60% success rate [2]. However, this option is often expensive and difficult to apply. Vacuum constriction devices are the least expensive option, incurring only a one-time cost of $150–$450 for unlimited short-term erections of ~20–30 min [2]. Vacuum constriction devices are typically cumbersome to use and have numerous unpleasant side effects such as transient penile petechiae, ejaculatory difficulties, and numbness [2]. Finally, surgical insertion of a penile prosthesis is a very viable option for men with any stage of ED. While a penile prosthesis provides a high rate of patient satisfaction, it is an invasive surgical procedure [2]. Penile prostheses have multiple potential complications as well that are beyond the scope of this article. In summary, all current treatment options for vasculogenic ED have multiple limitations, including decreased sexual spontaneity, local side effects, risk of priapism, compliance difficulties, and inability to reverse the underlying pathophysiology.

Low intensity extracorporeal shockwave therapy (Li-ESWT) is a novel treatment for ED that aims to reverse the pathophysiology of ED at the cellular level to provide long-term improvement and return of spontaneous erectile function [3]. Because Li-ESWT is minimally invasive, it is touted to be readily accepted and have minimal side effects.

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Acknowledgements

Special thanks to Ahmed Abdelhady for his help with literature search for the manuscript.

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  1. Division of Urology, Cooper University Hospital, 3 Cooper Plaza Suite 411, Camden, NJ, 08103, USA

    Hailiu Yang & Allen D. Seftel

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  1. Hailiu Yang
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Correspondence to Hailiu Yang.

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Yang, H., Seftel, A.D. Controversies in low intensity extracorporeal shockwave therapy for erectile dysfunction. Int J Impot Res 31, 239–242 (2019). https://doi.org/10.1038/s41443-019-0124-0

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