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The following is a conglomeration of scientific articles which examine low-intensity extracorporeal shock wave therapy and related topics. While the potential benefits of radial waves and focused shock waves to enhance blood flow and stimulate regeneration have been demonstrated in multiple studies, Uroshock and UP, LLC don't claim other investigator's data as our own. Some of the studies feature equipment that may be different from Uroshock. The studies advocate for proof of concept rather than to imply that the outcomes cited will be identical with the Uroshock device. Our site was constructed for the edification of informed consumers. As such, we provide a diversity of research perspectives. This is not a cheerleading site for any one viewpoint. Always consult with your physician regarding any medical decisions.  

LOW-INTENSITY SHOCKWAVE THERAPY (LiSWT)

There are passionate proponents of both radial and focused shock waves for the treatment of erectile dysfunction. This well-constructed study determined that there was no significant difference in the outcomes between radial and focused shock waves.

This article highlights two important points. Patients with the most severe cases of erectile dysfunction are less likely to respond to treatment. Also, the benefits may be transient, meaning some patients will require re-treatment.

This review article describes and illustrates the proposed mechanism of action of LiSWT, and compares focused versus linear delivery modes of treatment. Shock wave therapy offers the unique prospect of a cure, but there are still unanswered questions.

Favorable data for outcomes with LiSWT continue to accumulate. In this study patients were treated with two courses of treatment (18,000 shocks at .09 mJ/mm2.) The results confirmed both safety and efficacy.

74% of men's health specialists would choose LiSWT for their own treatment of ED, and 15% would choose PRP or stem cell injections.

This study evaluated patients with documented reduced blood flow to the penis. One group was treated with  LI-ESWT while the other group had a sham procedure. This is a well-designed, prospective, controlled study; the gold standard. The results suggest improved blood flow in the group that was treated with shock waves.

In this study patients who failed to respond to pde5 drugs were treated with lieswt, and given repeat drugs. After lieswt about half were able to regain erectile function. While low intensity shock waves didn't cure these patients, it demonstrated that it can potentially be of benefit even in severe cases.

If you are not satisfied with pde5 inhibitors, such as Viagra, you are not alone. 30 to 40% of ed patients are either unable to tolerate side effects, or unhappy with the results of these medications.

This important study that was published in the highly respected Journal of Urology found that the benefits of shock wave therapy persisted more than two years in most patients with mild erectile dysfunction, and in about half of patients with more severe forms. 

This study used a metric commonly employed in urology, SHIM (sexual health inventory for men.)  The study determined that liswt seemed to be effective, although less so for patients with more advanced age and more co-morbidities, which seems logical.

This study published in European Urology demonstrated that low intensity shock wave therapy was well tolerated, and capable of ridding some men of a need for pde5i. Other men still needed drugs such as Viagra, but had improved erections after treatment.

This study published in 2017 found that while the evidence of single-arm studies was supportive, the data derived from randomized trials were ambiguous, and suggested that further studies were needed.

This study examined erectile function and cellular changes in hypertensive rats treated with shock wave therapy. They found improved erections after shock wave treatment both with and without pde5 inhibitors.  They also found evidence of vascularization, which is one of the proposed mechanisms to explain the improved erectile function seen in patients undergoing shock wave therapy.

Cavitation build up is one of the proposed mechanisms that help to stimulate regenerative processes which may account for repair of erectile dysfunction. Using sophisticated techniques including high speed imaging, the investigators demonstrated that some radial shock wave units can generate cavitation, a key element.

This study concluded that even patients with prolonged periods of erectile dysfunction could benefit from LiESWT. This is controversial, as other investigators have gone so far as to state, "You can't raise the dead!"

This is one of the few studies with data based upon long term outcomes of LiSWT for ED (5 years.) The good news is that low intensity shock waves are associated with an excellent long-term safety profile. Over time, results seem to fade, and patients often require re-treatment to maintain their gains.

While there are still wide variances between different protocols and shock wave units, the most recent data suggests that lower power units generating energy flux density between .05-.1 mJ/mm2 may be as effective as more powerful units generating up to .25mJ/mm2. Meta analysis suggests that 3000 shocks per session may be optimal.

This is a great article, and anybody who is considering PRP, LiSWT, or any other form of regenerative therapy for treatment of ED should read this. There are a variety of studies with conflicting data, and the author feels that none of the studies are adequate to allow for definitive conclusions. There need to be more patients enrolled, and more long term data. Certainly the long-term benefits are not known, and many if not most patients require retreatment down the road.

This is the first article which examines combination therapy. Patients were treated with both daily Tadalafil (Cialis) and a three week course of LiSWT, with favorable results. While the goal of shock wave therapy is the elimination of a requirement for meds, certainly some patients benefit from receiving both modes of treatment.

VENOUS LEAK

The Journal of Sexual Medicine: The False Diagnosis of Venous Leak:

Constriction rings operate by correcting venous leak. They do not increase blood flow into the penis, and would not be expected to improve erections for patients who suffer from primary vascular insufficiency. The absolute best test to determine blood flow in the penis is dynamic infusion cavernosometry, which measures the pressure within the corpora cavernosa during an erection. Patients who had been diagnosed with venous leak by duplex sonography were later studied by cavernosometry, the gold standard. This study demonstrated that a tool more commonly used by urologists, duplex ultrasonography, often led urologists to overdiagnose venous leak. 

TESTOSTERONE SUPPORT
 

Not all so called " natural" pills for erectile dysfunction are as pure as the manufacturers would have you believe. Even though they are not legally allowed, some contain pde5-inhibitors, and may have the same side effects and dangers as prescription meds. (PV13 is tested by an outside third party (CTLA Labs) and absolutely contains no banned substances.)

This was a summary of the validity of popular herbal supplements touted for treatment of erectile dysfunction compiled by the revered Mayo Clinic.

This study evaluated the 5 highest-ranking T boosters on Amazon and analyzed the objective data pertaining to the 10 most common ingredients present in those products. While they were able to find 191 studies, less than 20% of these involved human subjects. The investigators state that there was NO EVIDENCE of efficacy in the studies, and furthermore, questioned the authenticity of the publicized customer reviews.  

Unlike the previously reviewed paper  the investigators did find evidence supportive of some of the claims regarding components of testosterone boosters (about 25%.) However, they raised concerns that the same potential side effects seen in exogenous testosterone could occur with "natural" boosters-such as blood clots.

This paper considered the data from prospective controlled studies, which are the highest standard in research. They concluded that there was good evidence to support claims of testosterone enhancement by two herbal extracts: fenugreek seed and ashwagandha root.

In this randomized double-blind placebo-controlled trial subjects received Fenugreek at doses of 400 mg, 500mg, or a placebo. The subjects were later evaluated for health-related quality of life parameters, as well as aging male symptoms, anxiety levels, and grip strength. Those who received Fenugreek extract outperformed their nontreated cohorts. 

PENIS ENLARGEMENT

The authors reviewed 17 published studies regarding penis enlargement. Most of the studies were of poor quality. They did find evidence of positive outcomes with penis extenders.  They concluded that extenders were the preferred treatment choice for those patients that did opt for some form of intervention. 

This article from the Journal of Sexual Medicine alerts readers to the condition of dysmorphobia; a false perception of inadequacy of their genitalia. It also references the popular view that extenders can increase length by 1.5 to 2.5 cm (about an inch.)

PDE5 INHIBITORS

This study from Brazil noted that 30% of patients who respond to pde5 inhibitors discontinue their use within 6 months. Interestingly, the authors referenced additional studies which reported that up to 50% of patients discontinue their use of pde5 inhibitors at 17 to 18 months follow-up. 

STEM CELL SUPPORT

This interesting article suggests that diet, adequate sleep, and ketogenesis all play an important role in supporting stem cells and progenitor cells. These are the cornerstones of regenerative medicine, which is responsible for repair, restoration, and renewal.

ERECTILE DYSFUNCTION: CONTEMPORARY ISSUES

Two unfortunate men who developed erectile dysfunction after being infected with Covid-19 had penile tissue removed at the time of implantation of penile prosthetics. The tissue was analyzed for endothelial Nitric Oxide Synthase (eNOS, a marker of endothelial function) and COVID-19 spike-protein expression. There was a reduction of the Nitric Oxide Synthase, and persistent evidence of Covid-19, suggesting a causal relationship.

Covid-19 has affected more than 7,500,000 people worldwide, and many of the survivors find themselves suffering from lingering consequences, among them erectile dysfunction and fertility issues. The virus affects both testicular function which may result in decreased testosterone production, as well as global inflammation that can result in endothelial dysfunction, the hallmark of ED.

According to this large international study the incidence of erectile dysfunction in young men may be as high as 30%. Clearly ED can no longer be considered just a disease of the aged  man.

According to the American Journal of Preventive Medicine, e-cigarettes ( Electronic Nicotine Delivery Devices ENDS) increase the risk of ED, likely because of nicotine's known consequences, which include reduced blood flow.  

Based on a review of over 60000 patients the Italian study found that infection of Covid-19 resulted in a six-fold increase in erectile dysfunction.

According to the most recent data, it seems that watching porn does not cause erectile dysfunction. A confounding variable is refractory time. As men get older, the refractory time increases, meaning it takes more time to recover before one can engage in intercourse again.

PRP (PLATELET RICH PLASMA)

Some clinicians recommend the addition of PRP (platelet rich plasma) to LiSWT protocols. This study found that patients who underwent this additional procedure did not demonstrate increased gains in restoring erectile function. 

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