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Extracorporeal Shock Wave Treatment (ESWT)

Extracorporeal shock wave treatment (ESWT) was introduced about 40 years ago to break down kidney stones (lithotripsy).

Recently this technology has been applied to various fields of medicine, including urology and andrology, for regenerative purposes. In fact, the low intensity shock waves, through a biological mechanism only partially known, are able to increase the vascularization of the treated area and this consequently promotes its regeneration.

Extracorporeal Shock Wave Treatment (ESWT) in Urology

The main fields of use in uro-andrology are erectile dysfunction, induratio penis Plastica (IPP, also called Peyronie's disease) and chronic prostatitis (also called chronic pelvic pain syndrome - CPPS).

Shock waves have two main characteristics: they can propagate in a liquid medium (1500m / sec in water) or gaseous (in air) or solid, compact (the tissues of the human body) and they carry energy.

These waves are produced by a handpiece that is placed on the body and can be transmitted to a well localized point or region of the body. Wave energy is discharged only in the targeted area without involving nearby tissues. The biological mechanism of action is not yet well understood. It is thought that the cells of the tissue, affected by the shock waves, are first compressed, due to the positive pressure deriving from the energy carried by the shock wave, and then expand due to the intrinsic properties of tension, almost like a balloon. swollen, creating microscopic bubbles, which induce a stress, an opening, of the cell membrane with the release of angiogenic factors. These substances would induce the creation of new vascular structures (blood vessels).

Erectile dysfunction - shockwave therapy and penile rejuvenation

Low intensity shock wave therapy is the latest therapeutic modality for patients suffering from erectile dysfunction. Its therapeutic action improves spontaneous erections and also has the ability to invigorate and rejuvenate the erection mechanism.

Advantages

The treatment is not invasive, and is practiced in the doctor's office with a duration of about 20 minutes
It does not require any medication
It has fewer complications than the other methods
The benefits are significant and visible within 6-8 weeks of treatment

How does it work?

Extracorporeal Low Intensity Shock Wave Therapy (LI-ESWT) works by means of acoustic waves that generate a pressure pulse and carry energy as they propagate through an element. When shockwaves are applied to an organ, the focused waves interact with the chosen deep tissues and act as transient micromechanical forces that induce biological changes in the cells.
Shock wave treatment stimulates a pro-inflammatory response in the tissues where the waves are applied. The body reacts by increasing blood circulation and metabolism in the impact area, which in turn accelerates the healing process.
In the specific case of erectile dysfunction, shock waves improve erection by means of two mechanisms:
Promotes neoangiogenesis (the formation of new blood vessels) in the penis, thus increasing the blood supply and thus allowing for more vigorous erections
Induces invigoration / rejuvenation of the smooth muscle of the penis. The majority of patients suffering from erectile dysfunction have this problem because the smooth muscle of the penile arteries is damaged, which inhibits the correct functioning of the so-called veno-occlusive mechanism. Shock wave therapy has been shown to induce smooth muscle repair in the penis, thereby improving the veno-occlusive mechanism.

Am I an ideal candidate for shockwave therapy?

In theory, shock wave treatment can help all erectile dysfunction patients and even improve erection in men who do not have any such problems so that it can be used as a prevention for erectile dysfunction.
A complete diagnostic evaluation before proceeding with treatment is important to determine the optimal therapeutic protocol.

What Benefits Can I Expect?

A growing body of scientific evidence shows that shock wave therapy for erectile dysfunction can be helpful in the following cases:
Patients who suffer from mild to moderate erectile dysfunction and who respond well to PDE-5 inhibitors may regain spontaneous erections and no longer need to use the drugs.
Patients who have moderate or severe erectile dysfunction and who are unresponsive to PDE-5 inhibitor drugs but who have received intracavernous injections or other second-line topical treatments, may respond to PDE-5 inhibitors following therapy with shock waves.
Shockwave therapy in combination with any other therapeutic modality improves the results.

Are the results permanent?

The effects of shock wave therapy are permanent and this is demonstrated by several published scientific evidence. However, erectile dysfunction is also caused by the patient's lifestyle. The improvements induced by shockwave therapy can reverse over time if the underlying issues are not resolved.

What to do if the therapy does not work?

Patients usually respond well to shock wave therapy, but it may take a few months for maximum effect. If after 3-4 months the patient still does not show a significant improvement, other therapeutic modalities are considered.

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© 2020 by Dr. Fabio Castiglione