Have you guys heard of shock waves for erectile dysfunction?
Well, finally I am making the video you have all been asking me for
about shock waves for erectile dysfunction. I'm Dr. Rena Malik, urologist and pelvic surgeon,
and if you're new here we talk all about urology here, sexual health, bladder health
and much much more make sure you subscribe so you can see my new videos each and every week!
so what exactly is shock waves for erectile dysfunction and how does it work well shockwave
therapy's long form is actually low intensity extracorporeal shockwave therapy and in this
video we're going to go through a few things we're going to go through one exactly how this works to
improve erections what is the data about shockwave therapy and who does it work best for and number
three what do the american and european guidelines say about shockwave therapy and lastly how to know
if you're getting the right treatment so how does it actually work well shock wave therapy actually
produces these acoustic waves two parts of the penis that create mechanical stress and then that
area heals and it's during that healing process where you're actually going to see the improvement
in erectile function and the theory of this is that it actually creates more blood vessels
and even potentially some nerve regrowth in the penis so it can actually potentially reverse some
of the damage to the penis so what happens is the cells that get traumatized through the shock waves
release things called vascular endothelial growth factor and fibroblast growth factor and these
factors are really important in the formation of blood vessels and clinically if you're making
more blood vessels you should be getting more blood flow and you're getting more blood flow
well then you're getting better erections there's actually some data that suggests in animal models
that healing from shockwave therapy releases neutrophilic growth factors which means that it
can potentially cause some nerve regeneration and may be useful for patients who have nerve injury
however we don't have enough data on this yet so what data do we know about shockwave therapy
well we have what's called meta-analyses and meta-analyses are studies that look at all the
data that's been done and looked at for shockwave therapy and it combines all the data together
to see does shockwave therapy actually work so let's get into it there's two meta-analyses that
I'm going to go over the first one looked at only randomized controlled trials and what does
that mean that means that you have patients who either get the shockwave therapy or patients who
don't get the shockwave therapy but think they're getting it or a placebo and then they're compared
and this is kind of the best or gold standard of investigations for trials in patients because we
can really see the difference is it placebo effect do you think you're going to get better erections
so maybe that helps with some of your function versus is it because of the actual treatment
itself these specific studies looked at people who had organic erectile dysfunction
specifically due to most often vascular causes and that's for the large majority of people
due to high blood pressure diabetes and other sort of medical problems that can affect
blood flow to the penis it did not include people who got radiation that caused erectile dysfunction
or people who had chronic pelvic pain that was associated with their erectile function so in
this meta-analysis they included seven studies over five different countries and they didn't
have a uniform protocol so they vary the type of shock wave generator they vary the number of shock
waves that were given and how many locations they included on the penis itself to target during the
shock wave so shockwave generators come in three different flavors they can come in electromagnetic
electro hydraulic or piezoelectric and so they all create these focused shock waves which can
get into a certain depth of penetration that is deep enough to penetrate the deep tissues of the
penis that can create new vessels and potentially new nerves in the penis the most common protocol
was getting six weeks of treatments with 12 treatments usually it was three weeks
where you got six treatments then a three week break and then another three weeks of treatments
however that wasn't consistent across all studies and basically how they evaluated erectile function
was by using specific questionnaires that are given to patients that are used as a
validated questionnaire to identify the degree of erectile dysfunction and what they found was that
there was a statistically significant improvement in erectile function at one month after getting
treatment with shockwave therapy so one month is not a really long time what have other studies
shown us well another meta-analysis looked at a wider number of trials so they included both
the randomized controlled trials as well as cohort studies where they took a bunch of people and they
gave them shockwave therapy and they followed them over time and the difference between this
meta-analysis and the other one was not just that but they also included patients who had peyronie's
disease or curvature of the penis if you want to learn more about that make sure you check out my
last video on peyronie's disease and they also included patients with pain disorders that can
also impact erectile function so based on this data what are the urologic associations that kind
of govern our clinical care saying so the american urological association updates guidelines in 2018
and what they say is that shockwave therapy should be considered investigation and not be given as a
routine treatment for erectile function based on the limitations that we see in the data and some
of which i've discussed previously interestingly the european association guidelines were just
updated in september of 2021 and what they recommend is that it may be offered to men who
have vasculogenic erectile dysfunction but these men should be fully counseled before treatment
where does this counseling come in so who is shockwave therapy best for well shockwave therapy
is best for men who have mild erectile dysfunction and mild erectile dysfunction is men who
either don't require oral medications yet or are doing well with oral medications or maybe they've
been on oral medications they've just recently stopped responding to those medications so those
people are really a great candidate for shockwave lithotripsy based on the data that we have there's
some possibility that perhaps people who have more severe erectile dysfunction may have benefit when
you're combining this with other therapies however the data doesn't tell us yet exactly what that
might be and I think again to know that this may be limited it's only a 50 to 60 success rate at
one year however the data shows that it's pretty safe there's very few adverse events with it
so the things to consider are really how much time it takes to get the treatments and the
cost so when we're talking about cost how do you know that you're getting the right treatment well
so as I mentioned earlier the things that you want to look for the shock waves that actually help are
focused shock waves and when you're thinking about shock waves there are different types of
shock waves there's the focus shock waves which have the right depth of penetration and the right
waveform that will create this neogenesis of blood vessels compared to the other type of shock wave
that we see often which is a radial shock wave and radial shock waves are actually more superficial
and don't result in any of those changes that we see with focus shockwaves but interestingly radial
shock wave generators are much cheaper to purchase and so a lot of the men's health clinics that
suggest they're giving shockwave may be giving you radial shockwave therapy rather than focus
shock waves and that radial therapy will not help so the best way is to find out what exact machine
they're using and does it produce focused shock waves or not also because it's still considered
investigational in the united states you can find investigators who are doing clinical trials
on shockwave therapy and that's the best way get involved in a clinical trial one you can see if
it's gonna work for you and two you can be part of the solution let's find out if this is a great
therapy for many many men coming down the pipeline in the future I think there's still a lot more
that we need to find out about shockwaves we need to find out exactly what is the best treatment
protocol what about people who have erectile dysfunction from other problems like prostate
surgery or nerve problems what about those patients and how about the long-term outcome is
there any benefit to getting repeated treatments later down the line and lastly what about having
individualized treatment protocol so if someone has mild ed maybe a less rigorous protocol
would work best for them but some if someone has really severe erectile dysfunction maybe a more
aggressive or more frequent protocol may be best for them and I think all of that is being studied
and we will know much much more in the next years to come and hopefully this will become a great
treatment option for men with erectile function but for now if you're thinking about shockwave
therapy one make sure that you know you're getting focused shockwave therapy and two that you realize
your success rate may be variable depending on how bad your erectile dysfunction is to start
and while you may see some improvement we don't know the long-term data at this time thanks so
much for watching as always we're gonna take care of yourself because you're worth it