Shock Wave Therapy in Patients with Erectile Dysfunction
Authors: Vassilev Vassil , Stoilov Dimitar , Yotovski Valentin , Krastanov Aleksandar , Milushev Metodi , Yanev Krassimir , Georgiev Marincho , Dimitrov Plamen , Lillyanov Ivan , Ivanov Georgi , Kolev Nikolai , Stoykov Boyan 
Published: February 2023

Erectile dysfunction is a serious medical problem because it directly affects the sex life of a man, but it also has an overall effect on his self-esteem and social behaviour.
Pathophysiologically, erectile dysfunction may be due to factors of vascular origin, anatomical and structural features, neurological disorders, hormonal problems, drug-induced disorders, or iatrogenic trauma. The so-called psychogenic erectile dysfunction is not uncommon. In addition to the establishedtherapy with phosphodiesterase inhibitors, there are a number of publications that focus on the effect of Shock wave therapy as an alternative for treating erectile dysfunction. However, this issue remains debatable. Extracorporeal shockwave therapy is used as a method of treating erection problems, as itinduces neovascularization and improves blood flow to the cavernous tissue.
Our goal is to test the efficacy and safety of Shock Wave therapy and to determine its place in the treatment of patients with erectile dysfunction.
Clinical follow-up included 120 men between the ages of 30 and 75 (mean 55.68) diagnosed with erectile dysfunction. Patients were treated and monitored for a period of two years (January 2017 to April 2019). Detailed anamnestic data was taken, including sexual history, and full laboratory tests were performed.We used the following questionnaires to evaluate the extent of erectile dysfunction: International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS). All patients underwent shockwave therapy. Course duration was ten weeks, one procedure per week. Extracorporeal shock wave therapy equipment (BTL-5000) was used.
With regard to the Erection Hardness Score (EHS), there was a significant improvement in penis firmness, immediately after the first procedure, which persisted after the end of treatment until the third month after therapy. Improvement in firmness was mainly observed in patients with moderate and mild erectile dysfunction, while no significant improvement was observed in patients with complete inability to achieve erection.
With respect to the International Index of Erectile Function (IIEF-5), there is a significant improvement in erectile function, mainly in the groups with mild and moderate erectile dysfunction. The effect of therapy is maintained until the third month of treatment. No improvement in the condition was observed in patients with severe erectile dysfunction.
The mean value of IIEF-5 increased significantly from 14.54 to 18.85 after the end of treatment, and this value was sustained until the third month after the treatment – 18.55. The procedure was well tolerated by patients, with no side effects reported during and after the procedure.
The developments in modern technology and in the pharmaceutical industry have fundamentally changed the understanding of erectile dysfunction and the methods of treating it. More and more young people are rejecting the continued use of medication and looking for an alternative to effective treatment. Thus, there is a need for new methods of treating patients with erectile dysfunction. Based on publications in world literature, and on our own results, we have come to the conclusion that extracorporeal shock wave therapy may be an alternative to therapy with Phosphodiesterase 5 inhibitors (PDE5). Following the course of treatment, there was a significant increase in the number of patients without erectile dysfunction, and an increase in the total IIEF-5 score from 14.54 before treatment to 18.55 3 months after the end of therapy. This confirms the assumption of a lasting effect of the therapy 3 months after the end of treatment.