(310) THE HISTORY OF SHOCKWAVE THERAPY IN UROLOGY- FROM STONES TO DECREASING GROANS
Authors: Passarelli R , Velez D 
Published: December 2024

Introduction

Extracorporeal shockwave lithotripsy (ESWL) was first described in the literature in 1980 as a treatment for nephrolithiasis. Low intensity-extracorporeal shockwave therapy (Li-ESWT), a lower energy derivative of ESWL, has been suggested to have regenerative tissue effects and has been investigated as a minimally invasive option for a myriad of reproductive and sexual health conditions.

Objective

Here, we present a brief history of shockwave therapy in urology from its inception as a treatment for nephrolithiasis to its investigative uses today in the field of reproductive and sexual health.

Methods

A literature review was performed via PubMed on ESWT in the field of urology. An additional search was conducted on clinicaltrials.gov to find ongoing clinical trials for ESWT and men’s health related urology topics. Key words included ESWL, ESWT, shockwave, erectile dysfunction, Peyronie’s Disease, sexual health.

Results

ESWL has been accepted as a standard of care for nephrolithiasis via mechanically disruptive effects, with the first lithotripters utilizing a water bath to transmit energy to the target area. After ESWL, ESWT was next described for usage in Peyronie’s Disease (PD), first in 1999. By then, devices had evolved from a lithotripter transmitting energy in a water bath to a handheld probe in the clinic setting. The first randomized control trials (RCT) were published on this topic in 2009 and 2010 respectively. Both trials did not show clinically relevant improvements in penile curvature, however suggested that ESWT provided pain relief. Current American Urological Association (AUA) guidelines state that ESWT can be offered to improve penile pain in active-phase PD. Around the same time, investigation into the lower energy Li-ESWT as a regenerative treatment for vasculogenic erectile dysfunction (ED) began. The first study was published in 2010 and the first RCT published in 2022, both of which suggest effectiveness of Li-ESWT for ED treatment, however current AUA guidelines however describe this treatment as investigational. Today, there are over 10 active clinical trials assessing ESWT in this space, and many current urology clinics that offer this treatment to men off-label. EWST has further been investigated as a treatment for chronic pelvic pain (CPP), interstitial cystitis (IC) with findings of improvement in pain and symptoms for both. Most recently, ESWT has been explored preliminarily in overactive bladder (OAB), stress urinary incontinence (SUI) and female sexual dysfunction (FSD).

Conclusions

ESWL is a well-established treatment for nephrolithiasis dating back over 40 years. Its use has prevailed to this day as a minimally invasive alternative other stone treatments, such as ureteroscopy. Secondary to its regenerative properties, the lower energy derivative Li-SWT has been explored in the men’s health landscape through treatment of PD and ED, but also most recently as alternatives to surgical intervention or adjunctive medical therapy for CPP, IC, SUI, OAB, FSD. This demonstrates the gaining traction of ESWT in recent years as a topic of multiple current studies, and that usage will likely continue to grow in the field of reproductive and sexual health.

Disclosure

No.