ESWT shock wave therapy has been increasingly used in various medical specialties in recent years. This growing interest has urology quickly made its mark in the field of urology as well. Shock wave therapy first demonstrated its effectiveness in urology by breaking kidney stones non-invasively without surgery.
Following the reported successful results, it has also been adopted in orthopedics and physical therapy fields.
Following the successful results in kidney stones, low-intensity shock wave therapy has been increasingly used in recent years for the treatment of organs in the pelvic region (penis, bladder, prostate) in urology.
What is ESWT Shock Wave Therapy?
E: Extracorporeal (applied from outside the body)
S: Shock
W: Wave
T: Therapy
The treatment procedure in which shock waves generated outside the body are transmitted to the body through a probe is called ESWT.
Which Diseases Is ESWT Used to Treat in Urology?
Frequent research is still being conducted on shock wave therapy. As research increases, there are predictions that it will offer hope for more diseases. The most common areas of use in urological diseases today are listed below:
- Erectile dysfunction
- Chronic prostatitis
- Peyronie
- Painful bladder syndrome (chronic interstitial cystitis)
ESWT Treatment for Erectile Dysfunction
Shock waves generated outside the body are directed to the penis, the targeted tissue, through a probe. These waves create a mechanical stimulating effect on the relevant organ through mechanical action.
For the tissue, this constitutes a newly formed microtrauma. The body’s initial response to the microtrauma is to send healing cells to the area, initiating a healing mobilization.
The first step for healing is the transfer of healing cells to that area. To achieve this, blood flow to the application point increases first. Meanwhile, the cellular repair process is triggered. While healing cells take effect on one hand, new blood vessel formation is increased on the other hand to complete the healing process.
Thus, ESWT both provides repair and restructuring in that area, and accelerates blood flow by increasing new vascularization.
Is Shock Wave Treatment Harmful to the Penis?
No serious complications have been reported worldwide to date in patients who have received ESWT treatment.
Treatment planning should be done carefully, especially in patients with serious dermatological conditions or those who have been using intensive blood thinners for a long time. Apart from this, no significant side effects have been reported.
How Many Sessions of Urological ESWT Are Applied to the Penis for Impotence Treatment?
Different techniques, durations, and application modalities have been reported for ESWT treatment to be effective. The generally accepted application is at least 3 weeks, twice a week. For patients who benefit at the end of the third week (6 sessions) and whose body shows a healing response, the procedure 6 hafta (12 session) ya da 9 hafta (18 session) can be applied.
It has been reported in the literature that patients who received 9 weeks (18 sessions) of treatment experienced longer-lasting improvement, and this duration has been found to be more effective for achieving erection in the long term.
In other words, if significant improvement is observed in patients after treatment, similar sessions can be repeated, and it has been determined that the more sessions repeated, the greater the improvement, higher satisfaction rates, and longer erection duration.
The procedure takes approximately 15-20 minutes, and there is no significant pain during the procedure. Pre-procedure patient information is important in this regard.
Effects of ESWT Shock Wave Treatment on the Penis?
- Increase in the number of blood vessels directly on the penis
- Increase in penile diameter (thickening)
- Acceleration of blood flow to the penis
- Increase in the number of new cells in the penis
- Increase in the number of new nerve cells. Therefore, patients experience greater penile fullness compared to before the treatment.
When Are the Effects of Urological ESWT Shock Wave Treatment Seen?
ESWT treatment shows its effect at the cellular level as described above. Therefore, achieving the desired level of effect takes days or weeks. A minimum of 3 weeks is required for the initial effect to occur.
At the end of the third week during treatment, a patient-physician consultation takes place again, and treatment can be extended to 6 weeks or 9 weeks in patients who benefit.
How Is Urological ESWT Shock Wave Treatment Performed?
The patient is placed on their back. Gel is applied to the penis to increase the conductivity of the shock waves. Then, specific points on the penis are selected with the probe, and shock waves from the device are directed to those points. The procedure is completed within approximately 15-20 minutes.
When Should Penile Shock Wave Treatment Be Performed?
There is no specific time of day for ESWT application. It can be done at any time during the day when both the patient and the practitioner are available.
Can I Have Sexual Intercourse During ESWT Treatment Sessions?
There is no obstacle to sexual intercourse during or after this treatment. Sexual intercourse is actually recommended because the higher blood flow during sexual activity helps keep the newly formed blood vessels open and ensures tissue nourishment.
Can ESWT Shock Wave Treatment Be Applied to Any Penis?
It is a form of treatment that can be applied to all penises regardless of size and thickness. Therefore, it can be applied to all penises of all patients experiencing erectile dysfunction, regardless of penis length or thickness.
Which Medical Specialty Performs ESWT Shock Wave Procedures for Erectile Dysfunction?
ESWT applications to the penis for erectile dysfunction are managed by the Urology department. Applications by specialties outside of urology or without physician supervision are not legal in our country and minimize the chance of treatment success.
What Precautions Should Be Taken After Shock Wave Treatment?
There are no specific precautions to be aware of. Following your doctor’s recommendations is sufficient.
ESWT Shock Wave Treatment Prices in Ankara
While prices may vary between centers that offer ESWT shock wave therapy in Ankara, the factors that determine the cost of treatment are as follows:
- Number of sessions
- Session duration
- Type of disease
- Treatment center
- Practitioner experience, etc.
When all these factors are considered, price differences between reputable treatment centers are approximately similar.
Does ESWT Shock Wave Treatment Reduce Pain in Chronic Prostatitis Treatment?
Pain around the penis, groin, testicles, and anus is frequently observed in patients with chronic prostatitis. ESWT is used in pain treatment for chronic prostatitis, which is part of chronic pelvic pain syndrome. However more clinical studies are needed for verification in terms of evidence-based medicine.
ESWT Shock Wave Application in Kidney Stone Treatment
ESWT treatment has been used for breaking kidney stones for many years. When used for kidney stones, it is generally called ESWL. Its success has been scientifically proven through many clinical studies. Therefore, it is frequently used, especially in patients with small kidney stones.
ESWT Shock Wave Treatment for Penile Curvature (Peyronie’s Disease)
Peyronie disease is becoming increasingly widespread. While there are many studies reporting success in this regard, there are also clinical studies reporting failure.
Currently, studies stating that ESWT treatment provides definitive results for directly correcting curvatures are in the minority, while scientific studies reporting that it is quite effective in the early stages of the disease and in painful conditions are in the majority. Therefore, more clinical studies are needed.
Does ESWT Shock Wave Cause Penile Growth, Lengthening, or Thickening?
Although ESWT shock wave therapy may create some enhancement by increasing vascularization in the penis, it is not preferred today for penile lengthening purposes. Penile lengthening techniques and treatments are different. Other treatments besides ESWT have more promising results for patients.
The increased vascularization in the penis due to ESWT application also leads to some increase in thickness and diameter. However, ESWT treatment is not applied solely for penile thickening purposes.
Peyronie disease, when the existing thinning is corrected with treatment, an increase in penile diameter and thickening may occur as the thinned area heals due to increased blood supply.
Besides this, penile thickening if desired, thickening techniques and surgeries are different. Therefore the patient’s expectations need to be very well understood in advance.
The patient should be informed that the results of ESWT application solely for thickening purposes would be debatable.
Is There an Age Limit for Shock Wave Treatment?
There is no age limit for ESWT application. It can be applied to all adult patients.
If ESWT Shock Wave Treatment Fails, Does It Negatively Affect Surgery?
The failure of ESWT treatment does not negatively affect subsequent surgical treatment. On the contrary, it facilitates post-surgical healing by increasing blood flow, even if slightly.
In Summary
- ESWT is the name given to the procedure in which shock waves generated outside the body are transmitted to the relevant anatomical organ in the body through a probe for treatment.
- It is successfully applied in diseases of other departments, primarily orthopedics and physical therapy.
- In urology, it is applied in the treatment of diseases such as erectile dysfunction primarily, Peyronie’s disease, chronic prostatit or painful bladder syndrome (chronic interstitial cystitis) and similar conditions.
- There is no age limit for ESWT treatment. It can be applied to all adult patients.
- No significant side effects have been reported related to ESWT treatment.
- ESWT treatment is a repeatable treatment.
- Oral medications used in the treatment of erectile dysfunction are also used to increase the success of ESWT treatment.
- ESWT treatment does not negatively affect any penile surgery that may be needed later.
- It is used with increasing frequency in urology both in our country and worldwide.
References:
- Therapeutic areas of Li-ESWTin sexual medicine other than erectile dysfunction. Fode M, Russo GI, Verze P. Int J Impot Res. 2019 May;31(3):223-230.
- Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF. Eur Urol. 2017 Feb;71(2):223-233.
- Low-Intensity Shockwave Therapy for Erectile Dysfunction. Rizk PJ, Krieger JR, Kohn TP, Pastuszak AW.Sex Med Rev. 2018 Oct;6(4):624-630.
- Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. J Sex Med. 2017 Jan;14(1):27-35.
- The Basic Physics of Waves, Soundwaves, and Shockwaves for Erectile Dysfunction. Katz JE, Clavijo RI, Rizk P, Ramasamy R. Sex Med Rev. 2020 Jan;8(1):100-105.
- Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Young Academic Urologists Men’s Health Group, Fode M, Hatzichristodoulou G, Serefoglu EC, Verze P, Albersen M. Nat Rev Urol. 2017 Oct;14(10):593-606.