Counselling erectile dysfunction patients for low intensity shock wave therapy: what pitfalls? – Professor Dimitrios Hatzichristou

Key takeaway points

	#1 ESWT for ED should not be considered experimental 10 Randomized sham-controlled trials [1-10] 3 Randomized trials [11-13] 8 meta-analyses [14-21] and 1 systematic review [22]
	#2 Dornier Aries 2 ED treatment protocol (5000 shock waves, 2 sessions/week, EFD 0.09mJ/mm2) Evidence based, safety, efficacy backed by clinical data. [23-25]
	#3 No major side effects related to treatment. A few patients reported mild tenderness or numbness in certain parts of the penis that goes away in a couple of days. There is clinical evidence to show that ESWT is safe for ED patients on anti-coagulant/anti-platelet therapy. [23-25]
	#4 ESWT is the only ED therapy that reverses the pathology, with clinical evidence showing that 50% of treated patients experience beneficial effects up to 2 years after treatment. Vasculogenic ED is caused by the lack of blood flow to the penis. ESWT reverses the pathology by promoting the formation of new blood vessels in the cavernosal tissues of the penis, thereby improving blood flow to the region. [26]

Conclusion

There is a gradual paradigm shift in ED treatment:

From: Doctor’s visit ⇒ ED diagnosis ⇒ Oral medication

To: Doctor’s visit ⇒ Identify the type of ED ⇒ Vasculogenic ED ⇒ Treating the root cause with ESWT

References

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Effect of Low-Energy Linear Shock Wave Therapy on Erectile Dysfunction-A Double-Blinded, Sham-Controlled, Randomized Clinical Trial.
Fojecki GL, Tiessen S, Osther PJ.
https://www.ncbi.nlm.nih.gov/pubmed/27938990

[2] J Sex Med. 2017 Jul;14(7):891-897. doi: 10.1016/j.jsxm.2017.05.012.
Low-Intensity Shock Wave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial.
Kalyvianakis D, Hatzichristou D.
https://www.ncbi.nlm.nih.gov/pubmed/28673433

[3] Scand J Urol. 2015;49(4):329-33. doi: 10.3109/21681805.2014.984326. Epub 2014 Dec 3.
Can low-intensity extracorporeal shock wave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study.
Olsen AB, Persiani M, Boie S, Hanna M, Lund L.
https://www.ncbi.nlm.nih.gov/pubmed/25470423

[4] Sex Med. 2018 Mar;6(1):1-7. doi: 10.1016/j.esxm.2017.09.002. Epub 2017 Dec 21.
Effect of Linear Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study.
Fojecki GL, Tiessen S, Osther PJS.
https://www.ncbi.nlm.nih.gov/pubmed/29275957

[5] Int J Impot Res. 2019 May;31(3):195-203. doi: 10.1038/s41443-018-0062-2. Epub 2018 Aug 14.
Low-intensity shock wave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography.
Yamaçake KGR, Carneiro F2, Cury J, Lourenço R, Françolin PC, Piovesan AC, Srougi M, Nahas WC, Antonopoulos IM.
https://www.ncbi.nlm.nih.gov/pubmed/30108337

[6] Int Urol Nephrol. 2018 Nov;50(11):2007-2014. doi: 10.1007/s11255-018-1987-6. Epub 2018 Sep 19.
Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial.
Zewin TS, El-Assmy A, Harraz AM, Bazeed M, Shokeir AA, Sheir K, Mosbah A.
https://www.ncbi.nlm.nih.gov/pubmed/30232721

[7] J Urol. 2016 May;195(5):1550-1555. doi: 10.1016/j.juro.2015.12.049. Epub 2015 Dec 13.
Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study.
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https://www.ncbi.nlm.nih.gov/pubmed/26694904

[8] Int J Urol. 2014 Oct;21(10):1041-5. doi: 10.1111/iju.12506. Epub 2014 Jun 17.
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https://www.ncbi.nlm.nih.gov/pubmed/24942563

[9] Can J Urol. 2015 Feb;22(1):7614-22.
Low intensity extracorporeal shock wave therapy for erectile dysfunction: a study in an Indian population.
Srini VS1, Reddy RK, Shultz T, Denes B.
https://www.ncbi.nlm.nih.gov/pubmed/25694008

[10] Advances in Sexual Medicine, 6, 15-18. (2016)
Treatment of Vasculogenic Erectile Dysfunction with Piezowave2 Device. Application of Low Intensity Shock Waves Using Novel Linear Shock Wave Tissue Coverage (LSTC-ED®) Technique. A Prospective, Multicentric, Placebo-Controlled Study.
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[11] J Sex Med. 2018 Mar;15(3):334-345. doi: 10.1016/j.jsxm.2018.01.003. Epub 2018 Feb 1.
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[12] International Journal of Impotence Research (02 September 2019)
Low-intensity shock wave therapy (LiST) for erectile dysfunction: a randomized clinical trial assessing the impact of energy flux density (EFD) and frequency of sessions
Dimitrios Kalyvianakis, Ioannis Mykoniatis, Evangelos Memmos, Paraskevi Kapoteli, Dimitrios Memmos & Dimitrios Hatzichristou
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[13] Eur Urol Focus. 2018 Apr;4(3):336-337. doi: 10.1016/j.euf.2018.07.011. Epub 2018 Jul 17.
A Phase 2 Randomized Trial To Evaluate Different Dose Regimens of Low-intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: Clinical Trial Update.
Katz JE, Molina ML, Clavijo R, Prakash NS, Ramasamy R.
https://www.ncbi.nlm.nih.gov/pubmed/30025713

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Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis.
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[16] Actas Urológicas Españolas, Vol. 41. Issue 8. Pages 479-542 (October 2017)
Eficacia de la terapia de ondas de choque de baja intensidad para la disfunción eréctil: revisión sistemática y metaanálisis
Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis
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[17] Am J Mens Health. 2019 Mar-Apr; 13(2):
Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis
Liang Dong, MM, Degui Chang, PhD, Xiaojin Zhang, MM, Junjun Li, MBBS, Fang yang, MM, Kun Tan, MM, Yali Yang, MBBS, Shanshan Yong, MBBS, and Xujun Yu, PhD
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[19] European Urology, Volume 71, Issue 2, 223 – 233
Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis
Zhihua Lua,, Guiting Lin, Amanda Reed-Maldonado, Chunxi Wang, Yung-Chin Lee, Tom F. Lue
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[20] Int Urol Nephrol. 2019; 51(5): 773–781.
A systematic review of the long-term efficacy of low-intensity shock wave therapy for vasculogenic erectile dysfunction
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[21] Ther Adv Urol. 2019 Jan-Dec
Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shock wave therapy for the treatment of erectile dysfunction
Jeffrey D. Campbell, Bruce J. Trock, Adam R. Oppenheim, Ifeanyichukwu Anusionwu, Ronak A. Gor, and Arthur L. Burnett
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[23] Int J Impot Res. 2019 Sep 2. doi: 10.1038/s41443-019-0185-0.
Low-intensity shock wave therapy (LiST) for erectile dysfunction: a randomized clinical trial assessing the impact of energy flux density (EFD) and frequency of sessions.
Kalyvianakis D, Mykoniatis I, Memmos E, Kapoteli P, Memmos D, Hatzichristou D.
https://www.ncbi.nlm.nih.gov/pubmed/31474753

[24] J Sex Med. 2019 Sep;16(9):1478-1480. doi: 10.1016/j.jsxm.2019.05.008. Epub 2019 Jun 14.
Low-Intensity Shock Wave Therapy (LiST) for Erectile Dysfunction: Is It Safe for Patients on Anticoagulant Medication?
Kalyvianakis D, Memmos D, Mykoniatis I, Kapoteli P, Hatzichristou D.
https://www.ncbi.nlm.nih.gov/pubmed/31204264

[25] J Sex Med. 2018 Mar;15(3):334-345.
Low-Intensity Shock Wave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment.
Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D.
https://www.ncbi.nlm.nih.gov/pubmed/29396020

[26] J Sex Med. 2019 Feb;16(2):168-194.
The Basic Science Behind Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies.
Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F.
https://www.ncbi.nlm.nih.gov/pubmed/30770067