Ereksiyon Sorunu Tedavisinde ESWT En İyi Nasıl Etki Gösterir

How Does ESWT Work Best for Erectile Dysfunction Treatment?

ESWT (shock wave therapy to the penis, (Li-ESWT)) is a widely used treatment method in patients with erectile dysfunction (erectile dysfunction, ED, impotence, erectile dysfunction) in recent years. We also apply ESWT treatment to eligible patients in our clinic. I will talk about what needs to be paid attention to in order for it to be effective.


Erectile dysfunction and ESWT treatment

Erectile dysfunction is defined as the inability to achieve or maintain an erection for adequate sexual intercourse. Erectile dysfunction is a common problem today. Its incidence increases with age and occupation. Erection problems are more common in older people with certain systemic diseases (such as heart disease, diabetes, high blood pressure, high cholesterol, obesity).

In recent years, low-intensity shock wave therapy (LiESWT) has been used as an effective treatment method in the treatment of patients with erectile dysfunction. Professional organizations with serious scientific reliability around the world, such as the American and European Urology Societies, have included ESWT treatment in protocols as a treatment method that can be used in the standard treatment of patients with erectile dysfunction. In our clinical practice, if we decide that it is necessary for our patients who come with erection problems, we apply and recommend ESWT treatment. However, it is more correct to apply this treatment according to scientific rules and by a urologist, preferably someone who has experience in the field of Andrology.

EWST treatment is a method that is applied to different parts of the penis without the need for any anesthesia (local or general). It does not require hospitalization or hospital conditions, it is easily applied in practice conditions. It shows its effect by providing the formation of new vascularity in the inner structure of the penis.


Does ESWT show the same effect in every patient with erectile dysfunction?

No treatment protocol shows the same effect in all patients. The lifestyles, body structures, nutritional habits, medications, and other diseases of the patients also seriously affect the success rate of the treatments. ESWT treatment also does not give similar results in every patient. In order to achieve better results with ESWT, appropriate recommendations and additional treatments should be given to the patients. For some patients, drugs and methods used in the treatment of ED can also be administered with ESWT.


What are the conditions that may limit the effectiveness of ESWT therapy?

The general principle in the treatment of all diseases is to “eliminate the cause of the disease”. Erectile dysfunction is a symptom of many diseases. In order to get an effective result in the treatment, the cause must be tried to be revealed.

If there are known conditions that cause erectile dysfunction, the effect of ESWT may be more limited in these individuals. To summarize the main problems that can cause erectile dysfunction:

  • Diseases that affect more than one organ and organ system in the body, which we call systemic diseases, also seriously affect the erection phenomenon. Let’s summarize these situations:
    • Endocrine causes (hormonal disorders)
    • Cardiovascular diseases
    • High blood pressure
    • Diabetes
    • High cholesterol
  • Obesity (obesity)
  • Excessive alcohol and cigarette use
  • Psychological problems, an extremely stressful life
  • Drugs used
  • Sedantery life
  • Past surgeries (prostate surgeries, organ surgeries adjacent to the prostate, such as large bowel surgeries)
  • Nutrition style


Recommendations for patients to get the best effect from ESWT treatment

There are some issues that patients should pay attention to in order to achieve the maximum effect expected from ESWT, which is a current method in the treatment of erectile dysfunction. It is difficult to solve the erection problem with only ESWT treatment. In this regard, we have some suggestions for our patients to get the best benefit from shock wave therapy to the penis. It is extremely important to comply with these recommendations and lifestyle changes for the effectiveness of treatment.

  • Quitting smoking and alcohol: Patients who consume excessive alcohol and cigarettes should definitely quit alcohol and cigarettes. Alcohol and smoking are serious risk factors for cardiovascular diseases and erections. Depending on the amount and duration of alcohol and cigarettes used, serious cardiovascular and erection problems occur. Patients who use alcohol and cigarettes should definitely quit these habits. The most important causes of erection problems, especially in young patients, are alcohol and cigarette use.
  • Weight loss: It is important for overweight (obesity) patients to reach their ideal weight. For this purpose, a regular sports program and diet are important. If the cause of obesity is an endocrine disease, then the patient should be treated by an Endocrinologist. In addition, it may be more effective to adjust the diet, preferably by a dietitian. The Mediterranean diet is a recommended diet for cardiovascular and healthy erectile function. In the Mediterranean diet, there is a diet based on seafood, vegetables and fruits. If weight is a serious problem in patients, bariatric surgery (obesity surgery) may be required.
  • Exercise: It is very important for physically inactive patients to plan a regular sports program. There are different exercise programs. It is important to walk or jog at a brisk pace, at least 45 minutes a day, every day. Cardiovascular diseases are also seen very rarely in those who act in this way. Regular exercise program in diabetics is also very effective for regular sugar control. In addition, exercises for the pelvic muscles are very effective and important for ED patients. Kegel exercises have an important place in this group of exercises. It is known that regular Kegel exercises are very effective in patients with ED problems. We also recommend exercise and especially Kegel exercises to our patients.
  • Dealing with stress: It is beneficial for our patients who have a stressful life to find ways to cope with stress and to receive supportive treatment from the relevant departments if necessary. It is very important to eliminate the stressful situations in the patient’s family, workplace and other social life.
  • Healthy nutrition: A healthy nutrition and diet program should be implemented. The most effective diet recommended for this purpose is the Mediterranean diet (Mediterranien diet) in the literature.
  • Suppplementary treeatment: Additional supportive treatments can be effective under doctor control.
  • Control of blood sugar: If you have diabetes, it is very important to have blood sugar under control.
  • Healthy cardiovascular system: If there are cardiovascular diseases and high blood pressure, it is important to control them.
  • Normal cholesterol: If there is high cholesterol, appropriate diet and treatment should be done.
  • Beware of drugs used: Patients using drugs that may cause erectile dysfunction should discontinue them.
  • Testosterıone suplementation: If there is an underlying hormonal cause (testosterone deficiency), treating it also increases the effectiveness of ESWT. ESWT is less effective if there is a testosterone deficiency. Testosterone is an important male hormone closely related to erection and sexual desire. In its deficiency, both sexual desire decreases and erection problems occur. Serum testosterone levels of patients who will undergo ESWT should also be checked, and testosterone therapy should be applied to deficient patients.


Combined treatments with ESWT may be more effective for the treatment of ED

There are other treatment methods besides ESWT treatment for the treatment of erectile dysfunction. It has been shown that the improvement in erection will be better when these treatment methods are used together with ESWT. In our own practice, we have observed that combination therapies are more effective in suitable patients.

Treatment protocols that can be combined with ESWT in patients with erectile dysfunction are as follows;

  • ESWT + PDE5i (erectile dysfunction drugs): In the literature, it has been shown that ESWT application is beneficial in patients for whom PDE5i group drugs (ED drugs, impotence drugs) are not effective. It has been reported that these patients benefit from PDE5i group drugs after ESWT treatment. In this regard, it is more effective to start PDE5i group erection drugs together with ESWT at the same time in patients who come with the complaint of ED. According to our observations in our own patients with Bixim, the treatment is more successful in patients treated with combined therapy.
  • ESWT + vacuum device: Vacuum device is also a treatment method applied in ED patients. Penile vacuum device can be used together with ESWT for eligible patients.
  • ESWT + penile injection treatments: Penile injection is another treatment method used in the treatment of ED. ESWT treatment can also be applied to patients who inject into the penis due to ED.
  • ESWT + PRP and stem cell therapy: There are many experimental and clinical studies on PRP and stem cell therapies. Different results have been reported in these studies. In general, PRP and stem cell treatments are still in the experimental stage and their routine use is not recommended by the American and European Urology Societies (AUA, EAU). They are methods that can be used routinely in the future if good results are obtained. Again, although there is information that the combined use of PRP and stem cell and ESWT treatment is effective in experimental studies, there are not enough human studies yet.

In summary; ESWT is a treatment method that is applied in patients with erectile dysfunction and has been shown to be effective in appropriate patients. It is an important advantage that it has no side effects, does not require anesthesia and hospitalization. ESWT does not show the same effect in every patient. Patients who will undergo ESWT should undergo a general evaluation. If there are factors that coexist in patients and negatively affect erection, these must also be treated.


Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul/ Turkey

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