Low-Intensity Shockwave Therapy Improves Erectile Function for up to 2 Years

David K. Charles, M.D.

Credit: University of Virginia

Low-intensity shockwave therapy (LiSWT), a noninvasive treatment for erectile dysfunction (ED), was shown to improve erectile function over the long term in a new study. The treatment works best at one year, with benefits lasting up to two years. However, the improvements start to decrease between two and three years.

Although the study recruited a small group of participants, the results show that LiSWT might offer significant, lasting benefits for some men.

Besides lifestyle changes, other ED treatments tend to be more invasive and therefore not very popular. Additionally, these treatments do not reverse the underlying pathology. LiSWT was developed as a viable treatment option for the condition in 2010. Since its inception, studies have demonstrated the therapy is a well-tolerated and low-risk technique.

“While LiSWT has shown sustained results in the short term (i.e., ≤6 months) with improvements in the 5-item International Index of Erectile Function (IIEF-5) score, Sexual Encounter Profile (SEP) score, and Erection Hardness Score (EHS), few studies have looked at its long-term durability,” wrote a team of investigators including David K. Charles, M.D., a urologist affiliated with the Department of Urology at the University of Virginia.

The long-term study was conducted at the University of Virginia and assessed LiSWT durability over time. Investigators recruited 30 men with ED to receive either LiSWT or sham (placebo) treatment. The LiSWT protocol involved three weeks of therapy targeting the penis and its surrounding areas. Patients in the placebo cohort were crossed over to LiSWT treatment at 1 month. All patients participated in follow-up appointments for ED at approximately 12, 24 and 36 months posttreatment.

Researchers measured changes in erectile function from baseline up to 36 months posttreatment using two key scores: Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS). Patient satisfaction was also evaluated.

The median age of patients was 69 years, 20% had a history of diabetes, 17% had low testosterone levels at baseline and 23% had a history of smoking.

At the start, participants had a SHIM score of 10.8, which was indicative of moderate ED. After treatment, SHIM scores improved to 15.6 at 1 year and 15.0 at two years but dropped to 12.2 at three years. SHIM scores improved at all time points except for the 36-month follow-up.

Similarly, EHS scores rose from 1.87 (poor erections) to 2.70 at one year and 2.66 at two years but declined to 2.29 at three years. Like the SHIM scores, EHS scores were significantly improved at all time points except at 36 months.

Patient satisfaction was deemed moderate, with no reported side effects.

Investigators noted the small sample size as a limitation of the study. Additionally, conducting the research at a single institution and a lack of objective measurements of penile hemodynamics further hindered the findings. However, subjective erectile function evaluations were well correlated with objective penile hemodynamics. A further limitation was that patients were unblinded after crossover, which made it difficult to distinguish between actual treatment response and placebo effect during the follow-up period. Investigators noted that ED treatments commonly exhibit a high degree of placebo response.

However, the findings add to previous research and support the use of LiSWT as a safe and effective treatment option for men experiencing ED.

“Further research is needed to standardize treatment protocols, as well as to explore the potential opportunity for multiple treatment courses in patients who do not have a sustained improvement in erectile function,” investigators concluded.