Long-term Restoration of the Penile Microcirculation in Patients with Vasculogenic Erectile Dysfunction with Low-Intensity Shock Wave Treatment

Aleksandre Botchorishvili, Giorgi Botchorishvili


Background: Vasculogenic erectile dysfunction is a prevalent disease that can be treated using low-intensity shock waves (LI-SWT).

Aim: The aim of this study was to determine the most effective treatment plan and combination of factors leading to the  desired result.

Methods: 261 patients were randomly selected, including 19 who underwent sham treatment and gave written consent to undergo LI-SWT. The ages of the patients ranged from 23 to 75 years old and they were divided into three groups. One group received treatment every day (24), another group received treatment twice a week for three weeks (167), and the third group received treatment twice a week with a one-week break (70). All patients filled out questionnaires and underwent penile triplex ultrasonography with ultrasound detection of penile arteries and penile blood flow velocity (PBFV) at baseline, immediately after treatment termination, and six months later. Additionally, 144 out of 261 patients were followed up after 12 and 24 months. The study used IBM SPSS Statistics, ver. 23.0 to compare treatment type effects with other criteria such as the duration of erectile dysfunction, patient age, intensity/frequency of treatment procedures, Erectile Hardness Score (EHS), International Index of Erectile Function domain (IIEF-ED) score, concomitant diseases, metabolic disorders, environmental factors, habits, sexual activity, and different treatment options in the past.

Results: Investigations showed that the improvement in IIEF5 and EHS scores was mostly subjective, while the velocity changes after treatment with simultaneous improvement of artery detection were more objective. These changes interacted with the disease duration, the number and frequency of the procedures, different comorbidities, etc. Artery visualization and velocity increase over time, from screening level to improved measures after treatment termination, 6, 12,24 months with improvement tendency. The study also found that the frequency of treatment provided affected the artery visualization dynamics data and that there were statistically significant interactions between the frequency of the provided treatment, different comorbidities, and disease duration in velocity measures.

Conclusions: Overall, improvement was detected in all three groups, and such improvement was not related to different treatment strategies. Additionally, the study found that LI-SWT was a safe and feasible treatment option resulting in clinical improvement rates during long-lasting follow-up.


Vasculogenic ED; Low-Intensity Shock Wave Treatment; Penile Arterial Flow Improvement.

Full Text:



Parazzini F, Menchini Fabris F, Bortolotti A, Calabrò A, Chatenoud L, Colli E, Landoni M, Lavezzari M, Turchi P, Sessa A, Mirone V. Frequency and determinants of erectile dysfunction in Italy. European urology. 2000 Jan 27;37(1):43-9.

Sangiorgi G, Cereda A, Benedetto D, Bonanni M, Chiricolo G, Cota L, Martuscelli E, Greco F. Anatomy, pathophysiology, molecular mechanisms, and clinical management of erectile dysfunction in patients affected by coronary artery disease: a review. Biomedicines. 2021 Apr 16;9(4):432.

Meller SM, Stilp E, Walker CN, Mena-Hurtado C. The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. Journal of Invasive Cardiology. 2013 Jun 4;25(6).

Lue TF. Erectile dysfunction. New England journal of medicine. 2000 Jun 15;342(24):1802-13.

Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. European urology. 2010 Aug 1;58(2):243-8.

Yee CH, Chan ES, Hou SS, Ng CF. Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double‐blinded, placebo controlled study. International Journal of Urology. 2014 Oct;21(10):1041-5.

Campbell JD, Trock BJ, Oppenheim AR, Anusionwu I, Gor RA, Burnett AL. Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile dysfunction. Therapeutic Advances in Urology. 2019 Mar;11:1756287219838364.

Chung E, Cartmill R. Evaluation of long-term clinical outcomes and patient satisfaction rate following low intensity shock wave therapy in men with erectile dysfunction: a minimum 5-year follow-up on a prospective open-label single-arm clinical study. Sexual medicine. 2021 Aug;9(4):100384-.

Chung E, Bailey W, Wang J. A prospective, randomized, double-blinded, clinical trial using a second-generation Duolith SD1 low-intensity shockwave machine in males with vascular erectile dysfunction. The World Journal of Men's Health. 2023 Jan;41(1):94.

Kalyvianakis D, Mykoniatis I, Memmos E, Kapoteli P, Memmos D, Hatzichristou D. Low-intensity shockwave therapy (LiST) for erectile dysfunction: a randomized clinical trial assessing the impact of energy flux density (EFD) and frequency of sessions. International Journal of Impotence Research. 2020 May;32(3):329-37.

Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, Kang SH, Cheon J. The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy. Korean journal of radiology. 2009 Dec 1;10(6):587-95.


  • There are currently no refbacks.


Become a REVIEWER 


ISSN: 2346-8491 (online)