Low-intensity extracorporeal shock wave therapy is a safe treatment for men with erectile dysfunction and might work to improve, or even cure, ED in some patients. But there remain important unanswered questions, including which patients are ideal candidates and which protocol and devices are best. Without answers, offering the ED treatment outside research settings is questionable medicine, some urologists say.
Research on the use of shock wave therapy in Peyronie’s disease has shown it may improve penile pain, but not curvature.
Where low-intensity extracorporeal shock wave therapy for ED may offer the greatest patient benefit is in ED.
Georgios Hatzichristodoulou, MD, associate professor of urology at the Julius-Maximilians-University of Würzburg in Germany, has conducted several of the European studies on use of shock wave therapy for erectile dysfunction and Peyronie’s disease.
“The studies that have been performed in the last 6 years are very promising, especially with vasculogenic erectile dysfunction,” Dr. Hatzichristodoulou said.
The European Association of Urology guideline for erectile dysfunction recommends use of low-intensity shock wave treatment in mild organic erectile dysfunction patients or poor responders to phosphodiesterase type-5 (PDE-5) inhibitors, according to Dr. Hatzichristodoulou, a member of the guideline committee.
But the efficacy and credibility of low-intensity extracorporeal shock wave therapy for ED has come under criticism, according to Dr. Hatzichristodoulou.
“A lot of studies that have been performed were not very well designed,” he said. “There are a couple of reports in the literature of prospective, placebo-controlled studies. And in each of those studies, the treatment protocol was different to the other one. The shock wave devices used to do extracorporeal shock wave therapy were different. The inclusion criteria, the exclusion criteria of patients, and even the endpoints of the studies were different.
“So, those studies cannot be compared, and we cannot draw conclusions for the general population of men suffering from erectile dysfunction.”
Yet, while Dr. Hatzichristodoulou continues to offer shock wave therapy only in the research setting and does not charge men for the treatment, providers in Europe and elsewhere are promoting the treatment and charging patients for it.
“They are saying that shock wave therapy is the new treatment and should be the new standard of care,” Dr. Hatzichristodoulou said. “But according to the literature, we cannot say that.”