What is Penile Shockwave Therapy?

As you get older the blood vessels that supply blood to your penis begin to collapse or breakdown. Good blood flow is essential to good erections.

Penile Shockwave Therapy improves blood flow by:

• Opening existing blood vessels
• Stimulating the growth of new blood vessels

The increased blood flow results in stronger, harder, and more sustainable erections.

Your Treatment Regimen

Your doctor will base the number of treatments on the severity of the disease and your desired results. Typically, you will have either of these two regimens:

• For mild to moderate symptoms – 1 treatment every week for 6 weeks
• For moderate to severe symptoms – 1 treatment every week for 6 weeks then 1 treatment every month for 6 more treatments

To assess what your symptoms are like at baseline before your treatment we will
have you fill out a SHIM Score and Erectile Hardness Score. You will find this at the
back of this pamphlet. During your treatment and afterwards, we will use these
scoring systems to help see if you are having improvements in your erectile
dysfunction (ED).

Optimize your chances for success

An important aspect of optimizing yourself for success with treatment is to make sure you address the most common causes of erectile dysfunction, please consider these recommendations as you undergo penile shockwave therapy to help maximize your benefits:

• Discuss blood pressure, cholesterol, and blood sugar control with your primary care physician if you have hypertension and/or diabetes as these are some of the biggest risk factors for ED
• Eat healthy with a well balanced diet and make sure to hydrate well
• Continue to be physically active and work out if your primary care physician thinks you are healthy enough for strenuous activity
• If you are taking ED medications (Viagra, Cialis, etc), you may need to continue to take these at first or even after the treatments have completed.

In some patients, the results are good enough to be able to stop the medications entirely. In others, the medications may have to be continued after the treatments but the treatments will have made the medications more effective.

What is the day of treatment like?

Arrive and check in, when we are ready to begin your procedure we will bring you back to the procedure room. Sometimes the doctor would like to speak with you beforehand and may have a quick visit with you in one of our patient rooms. You will then undress from the waist down and cover up with a sheet.

Our technologist will then put a hydrophilic gel on your penis and perineum (this allows for better transducing of the shockwave energy). The DuoLith device will be placed onto the penis and the procedure will begin. You will hear a clicking sound which means that the system is working. We will start with a low energy initially to make sure you tolerate the procedure. We will then slowly increase the energy to where you may notice a slight tingling sensation but no pain. The shockwave energy will be targeted in three locations: on the right shaft of the penis, the left shaft, and the perineal region (the erectile tissue extends into the perineum thus we need to stimulate angiogenesis in this area as well). After about 10-20 minutes we will reach the maximum allowed shocks for the procedure and you will be able to wipe off the gel, dress, and leave the office.

Frequently Asked Questions about Penile Shockwave Therapy

• How successful is it?
  • According to the currently available studies, about 75-80% of patients
    have an improvement in their sexual function scores compared with a placebo treatment. It is unfortunately hard to know which patients
    will not be responders to the technology.
• How long do the results last for?
  • Results may vary in how long they last for depending on several factors including how well other medical issues (high blood pressure/diabetes/etc) are controlled and how much initial success patient’s have after completing treatment. Studies have not concluded what long term effectiveness rates are but the general consensus is that results should last up to a year in patients with mild ED issues with benefits for up to 3 years.
• How exactly does shockwave help my erections?
  • Most of the data regarding the mechanism of action come from animal studies that have shown that, in multiple areas of the body (kidney, bone, extremities), low amplitude shockwave causes tissues to release factors that are angiogenic/vasculogenic (help create new blood vessels). Shockwave also can activate the endothelial nitric oxide synthase pathway which is the same pathway that ED medications activate. The combination of these actions is thought to increase the amount of blood flow into the penis and help maintain a harder erection.
• Why so many treatments, can’t I just have one shock therapy and be done?
  • As stated above, we are trying to cause new blood vessels to be created to help increase blood flow and unfortunately that doesn’t happen overnight. This is why your treatment will be spread out over several appointments to allow the effects to gradually change the tissues. Therefore you may also notice your erections will improve gradually throughout the treatments and even afterwards. Don’t be discouraged if you don’t notice sudden improvements after the first treatment.
• Why doesn’t my insurance cover this procedure?
  • While the technology has been approved by the FDA for use in patients, it was for use in podiatry for plantar fasciitis. It has been deemed safe by the FDA with no serious side effects and therefore can be used for ED treatment but insurances as of yet have not begun to cover this treatment (just like they were and have been resistant to covering ED meds as well).
• Can I drive myself to the procedure appointment?
  • Yes, there is no anesthesia required for the procedure so you may drive to and from the appointment.
• Is it painful?
  • No, we use the DuoLith technology with has the least amount of discomfort associated with the procedure. Normally, patients have to apply a numbing cream to their penis prior to the procedure. But with the DuoLith, you will only feel a slight tingling sensation. You will not need to take any pain medications or use any numbing creams throughout the course of your treatment regimen.
• When can I return to sexual activity?
  • You may continue to have sexual activity throughout the treatment protocol. In fact, some patients notice an improvement in their sexual function right away.