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Shockwave Therapy Treatment for Erectile Dysfunction in Rockville

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What is Sexual Dysfunction?

Is a common problem both men and women have. Sexual dysfunction is defined as any problems that prevent a person or couple from experiencing satisfaction from sexual activity. It is estimated that 43% of women and 31% of men report some degree of sexual dysfunction.
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How do erections work?

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). During an erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection. When a man has an orgasm, the second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man’s circulation and the erection comes down (Cleveland Clinic)

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold, or worry; this is normal and reflects the balance of blood coming into and leaving the penis (Urology Health).

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What is ED?

Erectile dysfunction is a sexual disfunction that, is defined as a man’s inability to get or keep an erection firm enough for sexual intercourse. It is estimated that around 50% of males between the age of 40-70 experience ED. From extensive research we know, that If a male experiencing ED for a long period of time, it could be a cause for concern, presenting serious underlying health concerns, tissue damage, high levels of stress, serious illnesses and high-risk factors. Below is some more information on what a doctor might ask and test for in order to diagnose and treat ED.

  • Blood flow to the penis tissue or nerves are is harmed or have limited capabilities
  • A man is undergoing a large amount of stress and/or emotional tension
  • Serious illnesses: ED shows up when the male is experiencing potentially serious disease like atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure, or high blood sugar from Diabetes.
  • The male partakes in high-risk factors. These factors have the ability to physically alter the tissue, create health issues, or is a sign of more concerning emotional issues. These risk factors are alcoholism, drug use, alcohol consumption, tobacco use and long-term high intensity bicycling.

When should someone get treatments for ED?

ED can be a cause of concern if it is long-term, its affecting your sexual partner and/or the emotional impact of ED has become unhealthy. Once one of these factors become a hindrance to your life, we suggest seeking a medical professional opinion to diagnose and treat ED. Know that under most circumstances ED can be very treatable, eventually helping a man thrive sexually.
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FDA Approved therapies and treatments

There are several treatments on the market that are NOT FDA-approved, these treatments can be extensive and aren’t guaranteed to work, wasting your time and money. Here are treatments that have been tested, proven safe, and are FDA approved for the treatment of erectile dysfunction:

Oral medications

PDE inhibitors, such as Viagra, Cialis, Levitra and Stendra, that inhibit the enzyme that controls blood flow to the penis’ soft tissue.

Vacuum erection device

An external pump with a band that allows a man to get and maintain an erection.

Intraurethral suppository (MUSE):

Promotes blood flow to the penis.

Penile injections

An injected medication, such as Alprostadil, that increases blood flow to the penis.

Penile prosthetics

Malleable or inflatable implants.

Shockwave Therapy

Shockwave has been a common treatment the past 30 years for kidney stones, using sound waves strong enough to break up a stone. Some doctors have adapted a milder form of the technology — it’s known formally as low-intensity extracorporeal shockwave therapy — for patients with erectile dysfunction. The therapy increases blood flow to the penis (during a normal erection, blood fills the penis) and promotes new blood-vessel growth (Hartford Healthcare Medical Group). Some of the name brands that provide FDA approved Shockwave Therapy are: Eclipse, Storz and Zimmer.

More information on Shockwave Therapy

One of the treatments that Dr.Jennifer Miller recommends for ED is Shockwave Therapy. This is Extracorporeal shock wave therapy (ESWT); a non-invasive treatment that involves the delivery of shock waves to injured soft tissue to reduce pain and promote healing (Mayo Clinic). Specifically for ED, Shockwave Therapy applies low-intensity extracorporeal shock wave treatment to the penis (LI-ESWT). This FDA-approved therapy increases blood flow to the penis (during a normal erection, blood fills the penis) and promotes new blood vessel growth. Studies have found that the treatment is associated with the growth of new blood vessels and (in animal studies) recruitment of stem cells to the penis. This type of therapy should be administered by a trained medical professional. Some of the FDA approved

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The Shockwave Therapy process

During treatment ultrasound gel is applied to the treatment area. Most patients say it feels like a light tapping or tingling sensation, and 99% report they do not experience pain or discomfort. Should any pain or discomfort be felt a numbing gel can be used so that treatment can still be experienced. Most sessions are 10-15 minutes long, and treatment plans are determined during the initial consultation visit after a painless blood flow test.

Who is a candidate for Shockwave Therapy?

Generally, men with mild to moderate vasculogenic ED who have had some response to PDE5 inhibitors are ideal candidates for LISWT. Other men, such as those with nerve damage due to pelvic cancer surgery and those with ED resulting from psychological causes, typically don’t respond to the treatment (Cleveland Clinic)

How much does wave therapy cost for ED?

The cost of the treatment will vary between each patient. Most insurance companies determine these treatments to be an elective procedure like lasik eye surgery or cosmetic surgery ad subsequently might not cover the cost. Dr. Jennifer Miller offers all patients a free consultation to determine the specific treatment for each patient.

Shockwave Therapy Research

International Journal of Impotence Research (2020)

“Low Intensity Shockwave Therapy in Combination with Phosphodiesterase-5 Inhibitors Is an Effective and Safe Treatment Option in Patients with Vasculogenic ED Who Are PDE5i Non-Responders: A Multicenter Single-Arm Clinical Trial – Beyond the Abstract” (URO Today 2020) – Results: a clinically significant improvement of IIEF-EF was achieved in 75 patients (70.7%) and Erection Hardness Score ≥ 3, sufficient for full intercourse, was reported by 72 patients (67.9%) at the follow-up visit. 37 (34.9%) patients reported a full rigid penis (EHS=4) after treatment.4 Moreover, Li-ESWT treatment was also able to improve quality of life (SQOL-M: 45.56 ±8.00 vs. 55.31 ± 9.56; p < 0.0001) and significantly increased mean PSV (27.79 ± 5.50 vs. 41.66 ± 8.59; p < 0.0001) and decreased mean EDV (5.66 ± 2.03 vs. 1.93 ± 2.11; p < 0.0001) in penile doppler ultrasound.4 On the basis of our findings, we consider that the combination of Li-ESWT and PDE5-i represents an effective and safe treatment for patients affected from ED who do not respond to first line oral therapy.

Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction (2021)

Therapeutic Advances in Urology Since the usage of Li-ESWT in treating ED is relatively new and most studies are short-term in nature, there is insufficient data on whether Li-ESWT treatment of ED produces any long-term adverse effects. Furthermore, there is insufficient data on whether those adverse effects are affected by various treatment protocols. With that being noted, to date, no significant short- or long-term side effects from the usage of Li-ESWT in ED have been identified (Sage Journals, 2021).

The Impact of Extracorporeal Shock Wave Therapy (ESWT) for the Treatment of Young Patients with Vasculogenic Mild‐Erectile Dysfunction (ED): A Prospective Randomized Single‐Blind, Sham Controlled Study (2021)

The Impact of Extracorporeal Shock Wave Therapy (ESWT) for the Treatment of Young Patients with Vasculogenic Mild‐Erectile Dysfunction (ED): A Prospective Randomized Single‐Blind, Sham Controlled Study (Wiley Online Library, 2021)

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction: correlation with the severity of cavernous artery disease (2021)

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction: correlation with the severity of cavernous artery disease (Aisan Journal of Andrology,2021)

Combination Therapies for Erectile Dysfunction—A Synergy of Modalities Holds the Key (2021)

Combination Therapies for Erectile Dysfunction—A Synergy of Modalities Holds the Key (JAMA Network, 2021)

Shockwave Therapy (fSWT) vs. or Radial Wave Therapy (rWT) for ED

  • Radial wave therapy (rWT) is an alternative method of creating acoustic waves that is commonly utilized in orthopedics, physical therapy, and dermatology, but have not been evaluated for use in men with ED (NCBI)
  • LI-ESWT for ED works by applying low-intensity shock waves to the penis.

Shockwave Devices and technology

A certain amount of energy is required to effectively treat ED by Shockwave devices so the device matters. Dr. Jennifer Miller recommends using energy-focused products used by medical professionals and not at-home devices. Patients might have heard of some of the technologies below but these devices might not have the “energy”, FDA approvals or the guaranteed results.

GAINSwave Shockwave Devices

These devices are less focused on energy and more focused on training, marketing, and education-based concepts. GAINSwave do not sell devices and there’s no such thing as a “GAINSWave device.” Because of the prevalence and popularity of the GAINSWave have gained support, many exclusive GAINSWave clinics are using underpowered (not as effective) devices. As a result, protocols and results at clinics using the “GAINSWave” name can vary dramatically. Medical devices with negligible capacities, devices that generate less than .22 mj/mm2 are unable of delivering a sufficient amount of energy to address the root causes and subsequent treatment of ED.

The Phoenix

This an “FDA, Patented” at-home “Acoustic Wave Therapy” device used to treat ED. It is not known about their energy input nor are there studies that specifically support their claims. We do know that at-home devices like the Phoenix are typically self-guided, therefore the user isn’t granted the benefits of working with a trained experienced medical professional. Since there is a lack of medical supervision, these devices tend to have specific limitations, making it difficult for the user to have consistent, effective results compared to clinic-based therapies.

“Wave” technologies

Some devices claim different wave technologies like: Acoustic Wave to Sound Wave and Swiss Wave. Many of these technologies, lack medical evidence, research and are not capable of offering quantifiable, demonstrable results.

Penile injections

An injected medication, such as Alprostadil, that increases blood flow to the penis.

GAINSwave vs Shockwave vs Acoustic Wave vs Sound Wave vs Swiss Wave

What’s the difference between all these brands?

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GAINSwave

This brand uses high frequency, 2.5 waves per second a low intensity Radial sound waves

Shockwave

the generic name used in medical research

Acoustic Wave

These specific waves only travel 10 meters per second — compared to the 1,500 meters per second seen with focused shockwaves

Sound Wave

Mechanically, low energy sound waves break up micro plaque in the arteries and induce neovascularization, so more blood can be directed to the penis.(Academic Urology and Urogynecology of Arizona)

Swiss Wave

Which is a class 1 medical device that’s offered throughout the country by chiropractors and the like with claims that it improves erectile dysfunction. Because it’s a class 1 medical device, they can offer this to patients and administer it without a worry from the FDA. (Urology Times)

What can patients expect once they get Shockwave Therapy?

Since this specific ED therapy stimulates inflammation in the penis area, the body will produce specific side effects, due to the healing process. Patients can expect to drive home with minimal discomfort (if any). Patients might experience tingling, tenderness, and mild temporary swelling up to a few days after treatment.
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What can someone expect after receiving Shockwave Therapy?

In the trial that “DR. Georgios Hatzichristodoulou, MD (and team), have completed, 60% of men appear to respond to shock wave therapy by achieving the minimal clinically important difference in International Index of Erectile Function scores at the end of 6 months without taking any kind of PDE-5 inhibitors. Some of the trials have demonstrated a benefit up to 12 months, but that’s probably the longest time that we know that shock wave therapy can provide a benefit for.” (Urology Times, 2019)

Statistics

50-80% of patients will report an improvement in their erections 30 days after they have completed the full treatment cycle (Urology San Antonio)
53% of men that have diabetes also have ED (Reuters, 2017)
“Li-ESWT is a safe, harmless and repeatable treatment tool for ED with outcomes: 20.59% patients answered positively to GAQ-Q1 at 6 week and 61.76% at 3 months.” (Bangladesh Journal of Urology, 2020)

Summary

For patients that have ED and are struggling to find a solution. It is important to recognize there are many effective and ineffective treatments. A patient to consult a medical professional in the diagnosis and treatment of ED to effectively resolve their ED.

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