What does this research mean for the field?

Low intensity shock wave therapy (LISWT) is feasible, well-tolerated, and shows potential clinical utility for novel urological indications, including preventing penile shortening after implant removal, easing implant insertion in fibrotic corpora, improving genitoperineal sensory loss, and preserving erectile function after penile fracture. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

What question did this study set out to answer?

To evaluate the safety, feasibility, and preliminary outcomes of low intensity shock wave therapy for four new clinical applications in patients with specific penile conditions.

June 6, 2026

(884) Novel Indications for Low Intensity Shock Wave Therapy

Key Points

To evaluate the safety, feasibility, and preliminary outcomes of low intensity shock wave therapy for four new clinical applications in patients with specific penile conditions.
Four patients aged 34-67 received individualized LISWT treatments using the PiezoWave2 device.
Different treatment regimens were employed based on individual conditions, with a total of 6,000 shocks per session.
Outcomes were assessed through measurements of penile length, rigidity, sensory recovery, and erection quality.
Case 1 showed an increase in stretched penile length from 11.5 cm to 12.0 cm, with inadequate rigidity for intercourse.
Case 2 achieved Erection Hardness Score improvement from 0 to 1, enabling successful prosthesis placement.
Case 3 reported an increase in IIEF-5 score from 14 to 18, with a sensory recovery rate of approximately 87% of baseline.

Abstract

Abstract Introduction Low intensity shock wave therapy (LISWT) has demonstrable regenerative effects (neovascularization, nerve repair) and is increasingly used for vasculogenic erectile dysfunction. Leveraging the same biologic mechanisms, we explored four novel out of the box clinical applications of LISWT in four individual patients with challenging penile conditions. Objective To describe safety, feasibility, and preliminary outcomes of LISWT applied for four novel indications: (1) prevention of penile shortening after infected penile implant removal, (2) facilitation of implant insertion in severe corporal fibrosis, (3) improvement of chronic genitoperineal (GP) sensory loss, and (4) prevention of erectile dysfunction after surgical repair of penile fracture. Methods Four patients (ages 34–67) with distinct indications (Fig. 1-4) received targeted LISWT using the PiezoWave2 device (energy flux density 0.16 mJ/mm2; frequency 6–8 Hz; penetration ≈10 mm). Each treatment session delivered 6,000 shocks distributed across the perineum, dorsal and lateral penile surfaces. Regimens were individualized: Case 1: four weekly sessions begun one month after implant removal; Case 2: four monthly cycles with four weekly sessions per cycle to treat severe corporal fibrosis; Case 3: six weekly sessions for genitoperineal numbness; Case 4: six weekly sessions starting one week after surgical repair of albugineal rupture. Outcomes assessed included penile stretched length and rigidity (Case 1), Erection Hardness Score (EHS) and ability to receive prosthesis (Case 2), IIEF-5 and patient-reported sensory recovery (Case 3), and serial IIEF-5 and curvature/rigidity checks (Case 4). Follow-up ranged from 1 to 8 months. Results Case 1: Stretched penile length increased from 11.5 cm to 12.5 cm by the fourth session and measured 12.0 cm at 8 months; rigidity remained inadequate for intercourse despite adjunctive intracavernosal alprostadil. Case 2: Following LISWT, EHS improved from 0 to 1 with alprostadil; subsequent cavernosal dilation permitted successful placement of a malleable penile prosthesis (Tactra, 17 cm length, 9.5 cm girth) via a penoscrotal approach. Case 3: IIEF-5 rose from 14 to 18 after therapy; patient-reported genitoperineal sensation improved progressively to ~87% of baseline by 1 month and remained stable through 8 months. Case 4: No postoperative ED or deformity developed; IIEF-5 scores were 22, 24, and 24 at 1.5, 3, and 6 months, respectively. Conclusions In these four cases, LISWT was feasible and well tolerated and showed potential utility in preventing penile shortening after implant removal, easing implant insertion in severely fibrotic corpora, improving chronic genitoperineal sensory loss, and preserving erectile function after penile fracture. These preliminary observations warrant controlled studies with standardized protocols and larger cohorts to validate efficacy and define optimal treatment parameters. Disclosure No

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