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.