Low‐Intensity Extracorporeal Shock Wave Therapy in Vascular Disease and Erectile Dysfunction: Theory and Outcomes

INTRODUCTION: Low-intensity extracorporeal shock wave therapy (LI-ESWT) to the penis has recently emerged as a new and promising modality in the treatment of erectile dysfunction (ED). AIM: To review the published literature on the mechanism of action of LI-ESWT; and to report our clinical data on its efficacy in men with vasculogenic ED. METHODS: A Medline search using the relevant keywords on this topic has been done. RESULTS: From the results of numerous preclinical and animal studies that have been done to date, sufficient evidence shows that the underlying mechanism of action of LI-ESWT is probably neovascularization. Therefore, local application of LI-ESWT to the corpora cavernosa may potentially act in the same mechanism and increase corporal blood flow. We found that the application of LI-ESWT to patients who responded to oral therapy (PDE5i) eliminated their dependence on PDE5i and they were able to successfully achieve erections and vaginal penetration (60-75%). Furthermore, PDE5i non-responders became responders and capable of vaginal penetration (72%). Additionally, LI-ESWT resulted in long-term improvement of the erectile mechanism. CONCLUSIONS: LI-ESWT has the potential to improve and permanently restore erectile function by reinstating the penile blood flow. Although these results on LI-ESWT are promising, further multi- centered studies with longer follow-up are needed to confirm these findings. Gruenwald I, Kitrey ND, Appel B, and Vardi Y. Stem low-intensity extracorporeal shock wave therapy in vascular disease and erectile dysfunction: Theory and outcomes. Sex Med Rev 2013;1:83-90.