Shock waves

Sexual Medicine

Shock Waves

Is it possible to treat erectile dysfunction without invasive interventions or pills? Shockwave therapy appeared on the market claiming to be an amazing therapeutic option over conventional treatments. And after years of use in our practice in Seville we can say that it is true, but with certain nuances: it offers many benefits but not for any type of erectile dysfunction.

Shock Waves

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DEFINICIÓN

Shock waves to treat erectile dysfunction. What is it?

Shockwave therapy has proven to be a very effective treatment in the clinical management of several types of erectile dysfunction, a widespread problem that affects many men today, especially those over a certain age.

Low-intensity shock waves are vibratory waves emitted by a special instrument for medical purposes right at the exact place of the organ, injury or tissue to be restored.

These low-intensity sound waves have the capacity to:

Shock Wave Therapy to Erectil Dysfuncion

When is shockwave therapy used?

This therapy has been successfully used in the treatment of erectile dysfunction (ED) of vascular origin. That is, in the most frequent form of erectile dysfunction in men over 40 years of age, just when endothelial degeneration begins to take place along with other risk factors such as high blood pressure, diabetes and certain habits such as smoking or excessive alcohol consumption.

But it is not only erectile dysfunction (ED) that finds a solution in this therapy but also other pathologies such as:

In addition to producing anti-inflammatory and pain-reducing effects, low-intensity shock waves also help increase blood flow in various tissues.

This is especially useful in diseases with poor blood flow such as myocardial (heart) infarction.

Initially, shock wave therapy started out as high intensity and was applied to remove stones in the kidneys, a pathology known as renal lithiasis.

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DEFINItion

Getting to the root. What is erectile dysfunction?

Erectile dysfunction or ED is nothing more than the difficulty a man of reproductive age has in achieving and maintaining penile erections that are rigid and long-lasting enough for pleasurable intercourse and sexual activity.

Without erections, there can be no intercourse or masturbation. For this reason, erectile dysfunction or ED is currently a major cause of emotional and affective problems in couples and even more so for the man who suffers from it.

“...It is estimated that more than 50 per cent of men over the age of 40 suffer from it, either temporarily or permanently....”

Causes

Why does it happen and why does it cause so many problems?

Among men’s sexual dysfunctions, erectile dysfunction is by far the most significant of all.

Erection is a physiological phenomenon that involves many factors. Starting with the pleasurable nerve stimuli created in the CNS and transported to the neurovascular endings of the blood vessels in the corpora cavernosa of the penis, to the release of chemicals responsible for keeping the blood retained within these bodies until orgasm and ejaculation are reached, thus completing the entire chain of events.

If any of these factors (nervous, psychological, hormonal, cardiovascular, endothelial, anatomical or neurochemical) fail or are not properly related to each other as a perfectly coordinated whole, the erection of the penis will be affected in some way.

Finding the exact cause of erectile dysfunction is a complex but elementary task when it comes to finding the best treatment.

DIAGNOSIS

How is it diagnosed?

When a man feels that his erections do not last as long as before or that he has difficulty reaching a rigidity of the penis that allows for pleasant intercourse, he goes to a urologist.

The doctor should perform a thorough review of the patient’s history of previous illnesses and living, eating, and sexual habits. Based on this, you can make the medical history.

It also rules out the possibility that ED is caused by emotional factors such as:

Certain medications and consumer substances (alcohol, drugs, etc.) can also cause some erectile dysfunction.

Other elements to consider are the:

doctors looking at x-rays
OTHER TREATMENTS

Apart from shock waves, what other treatments are used in its clinical management?

Traditionally, erectile dysfunction has been treated based on the cause that originates it: by treating the cause, everything that derives from it is treated.

The most widely used first-line treatment has been the administration of erection-retarding drugs such as sildenafil, tadalafil and vardenafil (Viagra®, Cialis® and Levitra® respectively).

andromedi_aplicacion_de_caverject_inyectable_02

Injectable caverject application. Exterior.

andromedi_application_de_caverject_injectable_01

Injectable caverject application. Inside.

They act by inhibiting the enzyme that induces the state of flaccidity in the penis, the enzyme 5′- Phosphodiesterase found in the capillary endothelium of the corpora cavernosa.

Nevertheless, these medications can cause negative or unwanted effects in some patients, so their use should be carefully monitored by a doctor.

Other conventional treatments for ED include:

Intracavernosus injections
Intracavernosus injections

ntracavernous injections of vasodilator drugs.

Vacuum Devices
Vacuum Devices

The use of vacuum devices (which suck blood into the corpora cavernosa).

Penile prosthesis implantation
Penile prosthesis implantation

Penile prosthesis implantation surgeries, for the most severe cases which do not respond to the previous ones.

doctor
scientific studies

What is the basis of shock waves? Why does it work for erection problems?

doctor

Scientific studies have been carried out to determine the effects of low-intensity shock waves on the body’s tissues and have concluded that this type of medical therapy has a high capacity to promote the processes of blood irrigation and the formation of new vascular networks (or new blood vessels) and with them, the chemical balance of organic substances and cells renewal.

In addition to creating new blood vessels and increasing irrigation, clinical trials have shown that this therapy can also be used to:

1 Promote the growth, migration and division of stem cells that can give rise to any type of specialized cell under the appropriate molecular stimuli and repair tissues.

2 It increases the synthesis of growth factors for new capillaries such as VEGF (vascular endothelial growth factor.

3 By helping in the renewal of the capillary endothelium layer often damaged and worn out by metabolic factors (such as toxins) and cardiovascular factors (such as high blood pressure and excess cholesterol in the blood).

Along with tissue renewal also comes improvement in the condition of the nerves responsible for transmitting sensory and motor signals throughout the body, especially in the penis, where a large number of pleasurable stimuli are perceived.

One of the many advantages of this non-invasive physical therapy is its proven safety which ensures that the patient feels no pain and has no side effects.

Treatments

The treatment step-by-step: the sessions

Low-intensity shock wave therapy for the treatment of erectile dysfunction (ED) of vascular origin consists of four, five or six sessions, one per week for a maximum total duration of six weeks and depending on each individual case (not all patients should receive the same). 

The instrument used is a low-intensity wave emitter for medical purposes and has the ability to be adjusted depending on the region of the body and the desired effect. In our Seville centre we use the Renova brand.

When the patient with erectile dysfunction arrives at the medical centre, he enters an office. It is not necessary to enter the operating room or receive any type of anaesthesia so the treatment is totally painless.

The procedure steps are:

1 The patient lies down on a stretcher and the doctor examines the genital region. It is recommended that the pubic hair be removed to make it easier to reveal the appearance of the penis and scrotum.

2 The treating physician proceeds to apply the wave emitter to the entire length of the penis, gently and carefully. The patient does not feel any discomfort during treatment.

3 The application of shock waves is done from the most distal portion of the penis at the glans, to the base of the corpora cavernosa.

4 At the end of the session, the patient gets dressed again and can return home or to work without being admitted or receiving any medication.

Each session usually applies approximately 3,000 waves and lasts about half an hour.

Shock waves impotence results. Before.

andromedi shock waves impotence treatment

Shock waves impotence results. After.

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Results

What are the results to be expected after the shockwave sessions?

According to the Spanish Urological Acts of 2016, 80 per cent of men with erectile dysfunction who undergo this treatment achieve an improvement (to varying degrees) in the quality and duration of their erections.

From this study, 60 per cent of patients with mild erectile dysfunction and 40 per cent with moderate erectile dysfunction achieved improvement.

This improvement was measured based on three parameters:

andromedi_shock_wave_impotence_results_01

Shock waves impotence results. Before.

andromedi_shock_wave_impotence_results_02

Shock waves impotence results. After.

Low-intensity shockwave therapy is positioning itself as one of the newest, safest and most effective treatments for erectile dysfunction in men with vascular problems.

In addition to improving the erection of the penis, low-intensity shock waves complement very positively the body’s response to drugs that retard or inhibit the 5′-phosphodiesterase enzyme (such as viagra®, cialis® or vardenafil®), which induces the state of flaccidity. 

The latter is achieved by repairing the vascular endothelium, where an endogenous substance that regulates erection is secreted: nitric oxide.

RISKS

Are there risks associated with shock wave treatment?

No, none. The reality is that low-intensity shock wave therapy is a fairly safe treatment because it does not require the application of drugs or exposure of deep tissues, as is the case in surgery, so there is not the slightest risk of developing an infection or destroying any nerve or vascular element.

It is important to clarify that shock wave treatment in vascular ED is a simple, non-invasive procedure in which:

Frequent questions

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Can you have sex after receiving shock waves?
There is not the slightest inconvenience for the man who undergoes shock wave therapy for erectile dysfunction, to have to take sexual abstinence because the treatment is non-invasive and does not generate inflammatory effects of any kind. Sex life can continue without problems.
Is shock wave treatment painful? Could it leave me any negative after-effects?

This treatment is totally painless, so much so that it does not require the patient to receive anaesthetics or painkillers. The risks of complications are very small and are not a major concern. 

However, the patient must be monitored by the physician throughout the treatment.

How soon can I see the positive effects of the treatment?
It is estimated that improvement in erectile function may be evident within three to five months after the start of treatment. This time may vary from patient to patient. If you do not perceive any positive effect, most probably the mistake has been made by your doctor, who will have indicated it without taking into account the type of erectile dysfunction you present.
Can I take sildenafil (Viagra®) after receiving ED shock waves?
Yes. In fact, shock wave therapy increases the effectiveness of shock waves according to certain scientific studies. No contraindications or adverse effects have been reported.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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