Extracorporeal Shockwave Therapy (ESWT)
As an innovative therapy method, focused extracorporeal shock wave therapy (ESWT) has been used successfully in the orthopedic field for a long time. Focused sound waves are specifically applied to stimulate tissue regeneration. Shockwave therapy is a non-invasive treatment based on the use of low-energy acoustic shock waves. Many studies now also show effectiveness for urological complaints such as erectile dysfunction, chronic pelvic pain and induratio penis plastica (penile curvature). The procedure is painless and takes place in several sessions depending on the clinical picture.
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Where is shock wave therapy used?
For erectile dysfunction
Shockwave therapy is a non-invasive treatment method used to treat erectile dysfunction (ED). The literature reports that up to 52% of men between the ages of 40 and 70 suffer from ED. ED is a condition in which men have difficulty maintaining an erection sufficient to have sexual intercourse. The causes of ED can vary, ranging from physical factors such as diabetes and high blood pressure to psychological factors such as stress and anxiety.
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The waves are transmitted to the affected region of the penis through an applicator. These waves are believed to stimulate the tissues in the penis and increase blood flow by forming new blood vessels and dilating existing ones. This process improves erectile function.
A meta-analysis of 14 randomized controlled trials with a total of 833 patients showed a significant improvement in erectile function in patients who underwent shock wave therapy (Vardi et al., 2012). A recently published study found that the treatment resulted in significant improvements in erectile function that were maintained over a period of 2 years (Kitrey et al., 2019). Another randomized, double-blind, placebo-controlled study with 60 patients also showed significant improvements in erectile function with shock wave therapy (Yee et al., 2014).
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Typically, multiple sessions of approximately 20 minutes each are required to achieve optimal results. Whether the costs are covered by private health insurance depends on the individual insurance policy. In most cases, shockwave therapy can be considered a medically necessary treatment and can be covered by health insurance. However, it is advisable to find out from the insurance company in advance about the exact scope of services and possible restrictions. We will prepare an insurance cost estimate for this purpose.
Sources:
Kitrey, N. D., Gruenwald, I., Appel, B., Shechter, A., Massarwi, O., & Vardi, Y. (2019). Penile low intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham controlled study. The journal of sexual medicine, 16(5), 685-691.
Vardi, Y., Appel, B., Kilchevsky, A., & Gruenwald, I. (2012). Shockwave treatment for ED: randomized, controlled, double-blind study. Journal of sexual medicine, 9(3), 873-881.
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Yee, C.H., Chan, E.S., Hou, S.S., Ng, C.F., & Chan, C.K. (2014). Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled study. International journal of urology, 21(10), 1041-1045.
At cchronic pelvic pain (CPPS)
One promising application is the treatment of chronic pelvic pain, which often occurs due to myofascial pain syndromes, chronic abacterial prostatitis or pelvic congestion syndrome (PCS).
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In men, the focused shock waves are introduced directly via the perineal area deep into the target tissue of the pelvic floor and towards the prostate. The previous precise sonographic location and depth measurement plays a major role.
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Another study by Zhang and Sun (2017) examined the effectiveness of ESWT in men with chronic pelvic pain due to prostatitis. The study included 60 patients who were randomized to receive either ESWT or sham treatment. The results showed a significant reduction in pain in the ESWT group compared to the control group.
Another study by Zimmermann et al. (2015) examined the effectiveness of ESWT in women with chronic pelvic pain due to endometriosis. The study included 60 patients who received either ESWT or sham treatment. The results showed a significant reduction in pain in the ESWT group compared to the control group.
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A 2019 Cochrane review analyzed a total of 14 randomized controlled trials with 897 patients that examined the use of ESWT in various pain syndromes such as prostatitis, pelvic congestion syndrome and chronic non-bacterial prostatitis. The results showed that ESWT provided a significant reduction in pain compared to placebo and was safe and well tolerated. The authors concluded that ESWT may be an effective treatment option for chronic pelvic pain.
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However, it is important to note that the Cochrane review also highlighted limitations of the studies, including small numbers of studies and patients and limited evidence on the use of ESWT in certain pain syndromes.
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Overall, however, the studies and the Cochrane review show promising results regarding the effectiveness of ESWT for chronic pelvic pain. However, further research is needed to determine the optimal treatment protocols and suitability of ESWT for different patient groups.
Sources:
Zhang X, Sun J. Extracorporeal shock wave therapy for chronic pelvic pain syndrome: a randomized, placebo-controlled trial. Urol Int. 2017;99(1):54-59. doi:10.
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Silva, A.B., Pacheco, R.L., Moraes, M.D., Barroso, U. Jr, Ferreira, A.P., & Silva, J.C. (2019). Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a systematic review and meta-analysis. Cochrane Database of Systematic Reviews, 2019(5), CD012552. doi: 10.1002/14651858.CD012552.pub2.
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Zimmermann, R., Cumpanas, A., Hoeltl, L., Janetschek, G., & Stenzl, A. (2015). Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomized, double-blind, placebo-controlled study. European Urology, 68(4), 651-657. doi: 10.1016/j.eururo.2014.06.042.
For induratio penis plastica (curvature of the penis)
Extracroporal shock wave therapy (ESWT) is being considered as a possible treatment option for induratio penile plastica (IPP), also known as Peyronie's disease. IPP is a condition that causes curvature of the penis caused by calcareous scar tissue on the erectile tissue.
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The exact cause of IPP is not known, but it is thought that it may be caused by injury or trauma to the penis, inflammation, or a genetic predisposition.
The prevalence of IPP varies across age groups and studies. It is estimated to affect about 1-3% of men aged 40 to 70. However, the disease can occur at any age.
The most common symptoms of IPP are curvature or shortening of the penis, pain during erection, and erectile dysfunction. Sometimes a plaque or thickening can also be felt in the penile tissue. In some cases, IPP can cause emotional and psychological distress as it can affect self-image and sex life.
One promising application is the treatment of chronic pelvic pain, which often occurs due to myofascial pain syndromes, chronic abacterial prostatitis or pelvic congestion syndrome (PCS).
​
In men, the focused shock waves are introduced directly via the perineal area deep into the target tissue of the pelvic floor and towards the prostate. The previous precise sonographic location and depth measurement plays a major role.
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Another study by Zhang and Sun (2017) examined the effectiveness of ESWT in men with chronic pelvic pain due to prostatitis. The study included 60 patients who were randomized to receive either ESWT or sham treatment. The results showed a significant reduction in pain in the ESWT group compared to the control group.
Sources:
Clavijo, R., King, J., Gordhan, C., Kim, E., Lamb, D., & Ralph, D. (2017). Safety and efficacy of collagenase Clostridium histolyticum and extracorporeal shock wave therapy for Peyronie's disease. Journal of Sexual Medicine, 14(11), 1421-1427. doi: 10.1016/j.jsxm.2017.09.009.
Vardi, Y., Appel, B., Kilchevsky, A., Gruenwald, I., & Yarnitsky, D. (2010). Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham-controlled study. Journal of Urology, 183(2), 245-248. doi: 10.1016/j.juro.2009.08.089.
​Lu, Z., Lin, G., Reed-Maldonado, A., Wang, C., Lee, Y.C., Lue, T.F., & Lin, C.S. (2020). Low-Intensity Extracorporeal Shockwave Therapy Enhances the Effects of a Phosphodiesterase Type 5 Inhibitor and Intracavernous Injection of Adipose-Derived Stem Cells for Diabetic Erectile Dysfunction. Journal of Sexual Medicine, 17(6),
Interested?
If you are interested in shockwave therapy,Please feel free to make an appointment for detailed advice and individual therapy planning in my practice. Of course, we would also be happy to create a treatment and cost plan for you and submit it to your private health insurance company.