Review of the Current Status of Low Intensity Extracorporeal Shockwave Therapy (Li-ESWT) in Erectile Dysfunction (ED), Peyronie’s Disease (PD), and Sexual Rehabilitation After Radical Prostatectomy With Special Focus on Technical Aspects of the Different Marketed ESWT Devices Including Personal Experiences in 350 Patients
Introduction:
Although the literature on the positive effects of penile low-intensity extracorporeal shockwave therapy is substantial, there are significant differences regarding both the sources of energy and the extracorporeal shockwave therapy (ESWT) devices.
Objectives:
To provide an overview of the energy range and differences of the 6 currently marketed ESWT devices along with personal ESWT experiences in 350 patients.
Methods:
This review includes all published preclinical and clinical penile ESWT studies with an evaluation of the technical differences of the 6 ESWT devices and personal experiences with these devices in treating erectile dysfunction (ED) and Peyronie’s disease (PD). The main outcome measures were success rates in ED (International Index of Erectile Function – erectile function change, conversion of phosphodiesterase type 5 inhibitors non-responders) and PD (change in deviation and plaque size), differences in energy sources used, and energy flux densities (EFDs).
Results:
Three different sources of energy are used: electromagnetic, electrohydraulic, and piezoelectric. The devices vary considerably in the available spectrum of EFD, ranging between 0.09 and 0.55 mJ/mm². In terms of biological effects, the relevant energy parameters are 6 dB and the 5 MPa focus, which differ substantially between the ESWT devices. Furthermore, there is great variability in treatment protocols and applied energy. Preliminary personal experiences with low-intensity extracorporeal shockwave therapy in 160 ED non-responders and 190 patients with PD showed success rates of 45% and 47%, respectively.
Conclusion:
Positive results have been published with all 6 ESWT devices in patients with organic ED, but there are significant differences regarding the EFD and total energies applied. There is growing evidence that concentrated treatment protocols and increasing energies may yield better results. It may be argued that some published studies were underpowered due to small sample sizes. Because of the limited number of published studies, the literature on the effects of ESWT in PD and for penile rehabilitation after pelvic surgery is not yet conclusive.
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