Medical devices have become an integral part of the diagnosis, management and treatment in all fields of medicine. The use of these devices did not skip the field of urology, and, during the past 20 years, many technologies have been applied throughout urological sub-disciplines, including functional urology and sexual dysfunction. Previously their development was aimed for diagnostic purposes (i.e., the NPT, Rigiscan, Doppler ultrasound, biothesiometer, the genital sensory analyzer, sensory evoked potentials, smooth muscle EMG and even clitoral MRI), but nowadays we have reached a point in which medical devices are increasingly being aimed for treatment purposes, such as the Viberect® for males, battery-operated vacuum constriction devices, penile traction devices, semi-rigid and inflatable penile prostheses, etc. Finally, technological knowhow, progress and innovative ideas have, among other devices, led to the introduction of the low-intensity shockwave device, a solid scientifically based medical tool for the treatment of ED. This therapeutic modality, along with its pros and cons, is gradually paving its way among the armamentarium of therapies for ED, taking a larger role in routine practice.
As mirrored by the valuable information from the contemporary articles in this special issue, many pending questions await to be resolved with regard to the mechanisms of action of shockwave therapy, the optimal treatment protocol, optimal anatomical areas of the corporal coverage, number of sessions, amount of energy to apply and many more uncertainties which remain unanswered.
Although controversial results from clinical studies and immaturity of available data present a justified debate with regard to efficacy, the mere concept that a medical device that delivers wave energy is able to have an effect on biochemical pathways, to manipulate molecular reactions and to affect the physiology of the erectile mechanism has been widely accepted. The term “mechanical transduction”, the process by which the body converts mechanical loading into cellular responses, is becoming progressively more familiar to those dealing with shockwave therapy.
When it comes to dealing with a functional disorder such as ED, the resulting outcome of treatment is very apparent. Therefore, any achievement of erection in a once dysfunctional penis, or any improvement in quality of erection, whether duration, tumescence or rigidity- is considered a measure of success. If not long ago, the mere achievement of an erection by taking a pill (i.e. a chemical intervention done before sexual activity) was considered success, today a treatment that would be considered successful requires much higher standards; achieving a spontaneous erectile response and reaching high quality erections without any pharmaceutical intervention is probably the current expected efficacious outcome. At least in selected patients, the now available shockwave therapy can potentially attain such expectations.
The future in the field of ED therapeutics is no less than exciting since the shift towards the search for reversing ED, or even curing ED has already begun. Shockwaves, gene or stem cell therapy have one goal in common- to restore erections back to the way they were before the pathologic process began, and to reinstate the achieved erectile function for years to come. We hope that with reaching an optimized treatment protocol with shockwave therapy – this goal will be reached.
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