ESWT (shock wave therapy) has been used in urology for a long time. This treatment method is a scientific treatment method recommended by the American and European Urology Associations. It has no side effects and complications. It is widely used especially in patients with erectile dysfunction. We have been applying this treatment method to our patients for a long time and our results are quite successful. In this article, I will talk about the use of ESWT in erectile dysfunction and other urological diseases.

What is ESWT-shock wave therapy?

ESWT is the method of applying low-intensity shock waves (Li-ESWT) created outside the body to the targeted area of ​​the body with a special applicator head.

ESWT is used in the treatment of the following diseases in urology

ESWT-shock wave therapy is widely used in urology for the treatment of three diseases. There are many studies in the medical literature on the effectiveness of shock algae therapy in the treatment of these diseases. These diseases are:

• Erectile dysfunction (ED, erectile dysfunction, impotence, erectile dysfunction)
• Peyronie’s disease
• Chronic prostatitis

What are the advantages of ESWT treatment?

ESWT, which is used in the treatment of ED, Peyronie’s disease and chronic prostatitis, has important advantages. These;

• High efficiency (success rate)
• No anesthesia required
• It is a painless treatment
• No side effects
• Does not require hospitalization
• It is an inexpensive treatment method

What are the situations in which ESWT should not be applied?

There are no very serious conditions that require no ESWT treatment. Some of the situations in which shock wave therapy should not be applied to the penis are as follows;

• Infection in the area to be applied
• Open wound in the area to be applied
• If the patient has a penile prosthesis

What is the price of 2023 ESWT treatment?

The cost of ESWT-shock wave therapy varies according to the disease, the number of sessions applied and the person applying it. Treatment with devices that are suitable in this regard increases the chances of success. In addition, the person applying and his experience are also important. It is important that this application is made by a Urologist, preferably someone who is interested in the subject.

The use of ESWT in the treatment of erectile dysfunction

Erectile dysfunction (ED, erectile dysfunction) means the inability to achieve or maintain an erection sufficient for a normal first intercourse. It is more common in men over the age of 40, but today there is an increase in the incidence of young men under the age of 40.

The most common causes of erectile dysfunction are:

Most causes of erectile dysfunction are organic, that is, due to a disease. In addition, psychological reasons lead to erection problems. The most common causes of erectile dysfunction are:

• Cardiovascular diseases
• Diabetes (especially in long-term and poorly controlled patients)
• Excess weight
• Still life
• Excessive smoking
• Excessive alcohol consumption
• High blood pressure (hypertension)
• As a side effect of some drugs (cholesterol drugs, blood pressure drugs, psychiatry drugs)
• Hormonal causes
• Neurological diseases
• Radical prostatectomy (prostate cancer surgery)
• Radical cystectomy (bladder cancer surgery)
• Psychological reasons

How does ESWT work in the treatment of erectile dysfunction?

The mechanism of action of ESWT-penis shock wave therapy has been demonstrated in many studies. These;

• Provides the formation of new capillaries in the penis
• Improves penile capillaries
• Activates stem cells
• Provides nerve regeneration (healing)
• Reduces inflammation
• Reduces free radical formation (reduces oxidative stress)
• Provides reshaping of erectile tissue

How many sessions and how is ESWT applied to the penis?

It is applied between 6-12 sessions depending on the patient’s condition. More effective results are obtained by repeating it after 4-6 months. We usually practice 2 times a week.

The session of shock wave application lasts approximately 10-15 minutes. Up to 1500 shock waves are applied to different parts of the penis in each session.

What should be considered in order to obtain better results from ESWT?

ESWT treatment is effective at an average of 60-80%. Its effectiveness is higher in young and mild-moderate vascular and erection problems. In order to get better results from ESWT-shock wave therapy to the penis, the following should be considered;

• Overweight patients reach their ideal weight
• If you have diabetes, sugar control and an appropriate diet
• A regular sports program
• If there is high blood pressure, it should be taken under control.
• Cessation of alcohol and smoking use
• If there is a drug habit, their discontinuation
• If there are psychological problems, their treatment

Chronic prostatitis and ESWT treatment

Chronic prostatitis is a chronic inflammatory disease of the prostate. It usually manifests itself with urinary complaints, pain in the groin and around the anus, sexual problems (erection problem, premature ejaculation) and psychological problems.

In chronic prostatitis patients, ESWT is applied once or twice a week for 4-6 sessions. 3000 shock waves are applied in each session. The application is made to the perineum (between the scrotum and the anus) while the patient is in the supine position.

How does ESWT affect chronic prostatitis?

In chronic prostatitis patients, ESWT provides recovery by different mechanisms. These mechanisms are:

• Decreases muscle contraction: The spasms of the muscles in the pelvic region are resolved and patients are relieved. Groin pain decreases or disappears.
• Reduces pain by affecting pain receptors
• It affects nerve conduction. In this way, the flow of nerve impulses is blocked and pain is eliminated in this way.
• Regeneration of nerve damage
• Healing of inflammation
• Regulation of hypersensitization
• Reduces oxidative stress in prostate tissue
• It prevents the increase of mast cells in prostate tissue, reduces the destruction of mast cells.

What are the criteria for recovery after ESWT treatment?

In cases of chronic prostatitis, improvements are observed in the complaints of patients after ESWT. These;

• Pain improves or decreases
• Urine complaints improve,
• Premature ejaculation can be corrected
• Psychological problems improve
• Patients’ quality of life improves

ESWT-shock wave therapy application in the treatment of Peyronie’s disease

Peyronie’s disease is a disease characterized by calcification and hardening of the tunica albuginea in the penis, called the caorpus cavernosum, which surrounds the structures responsible for erection. As a result, it is a condition that leads to pain, bending and sometimes erection problem in the penis during erection.

The disease has two stages, acute and chronic. The acute stage lasts for 1 year-18 months. In the chronic stage, the disease is now stabilized and there is no pain. There is no one hundred percent effective drug treatment for Peyronie’s disease. In the acute period, some drugs can be given to reduce pain and slow down inflammation. In the chronic period, the treatment is surgery. The curvature is corrected with surgery. If the patient also has erection problems, penile prosthesis surgery is suitable as a treatment for these patients.

If ESWT is applied in Peyronie’s disease;

• Pain decreases or disappears
• Plaques may shrink, sometimes disappear completely, or the progression of the disease may stop in some patients.
• There may be partial improvement in the curvature
• If there is an erection problem together, this situation will be corrected with ESWT.

In conclusion; ESWT-shock wave therapy to the penis is an effective treatment for men with erectile dysfunction. Apart from erectile dysfunction, ESWT is also applied in the treatment of Peyronie’s and chronic prostatitis patients. It is possible to get positive results in these diseases in suitable patients and if the right indication is given.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY

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