Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction

Abstract

Erectile dysfunction (ED) is a common and disabling impairment in ability to attain and maintain erections for sexual activity. Currently approved medical treatments for ED mitigate the organic elements of the disease on a short-term basis but do not address the underlying physiological issues; ergo, they do not “cure” so much as “manage” ED. Shockwave therapy (SWT) has recently attracted a great deal of interest as a potential means to resolve the physiological circumstances that lead to organic ED. In this review, we investigate the mechanisms by which SWT may help resolve ED and explore the existing evidence on this modality for management of ED. Recent studies have revealed membrane receptors capable of converting mechanical deformation into molecular signaling in cells. Subsequent signal transduction via these pathways may explain the beneficial effects of SWT including (but not limited to) vasodilation, enhanced nitric oxide synthase (NOS) activity, angiogenesis, neuro-regeneration, activation of progenitor cells, tissue remodeling, and anti-inflammatory effects. A limited body of evidence supports a role for SWT in restoration of erectile function in men with ED. These data are hampered by short-term follow-up and ambiguity about optimal administration protocols. Pulse wave and SWT may be conflated by patients and some providers; however, these modalities are not equivalent in terms of energy transfer nor evidence basis for efficacy in ED. Shockwave therapy is an intriguing and counterintuitive approach to the problem of ED. Evidence from other organ systems and a limited body of direct evidence from animal models and human men with ED suggest that this modality may improve erectile function without the need for supplemental or adjuvant treatments. Additional mechanistic data will be informative. Optimal treatment protocols remain unclear. The long-term durability of erection improvement and potential need for repeat treatment with SWT remains unknown.