For men who are considering the choices in restoring erectile dysfunction, or Erectile Dysfunction (ED), the important question may not be only "which medicine acts best", but rather "what are the root factors of the condition that has arisen, and is there an approach to care that matches that cause".

Focused Shockwave for ED is therefore one of the choices receiving more and more interest, particularly among the group of those with factors connected with the vascular system, since this technology is directed at stimulating the process of restoring the tissue and the circulation of blood at a deep level, instead of relying on the temporary action of medicine.

This article will explain how Shockwave works, what character of symptoms it suits, what limitations it has, and why assessment by a doctor is an important step before planning the care of ED suitably.

What is Focused Shockwave Therapy in the context of ED?

Focused Shockwave Therapy, or f-ESWT, is a technology of sending low-energy sound waves in focused form down into the target tissue in a specific position, both in the area of the spongy shaft (Corpora Cavernosa) and in the vascular structures of the pelvic floor. The goal of the procedure is not to stimulate erection in the short term, but to stimulate the process of repair and of creating new blood vessels in tissue that has degenerated.

The mechanism of working at the cell level

When the focused shock waves pass into the target tissue, the body releases Vascular Endothelial Growth Factor (VEGF), which is a substance stimulating the creation of new capillaries (Neoangiogenesis). This process leads to biological results of 3 main characters, namely increasing the density of the capillaries in the spongy shaft, restoring the lining of the wall of the blood vessels (Endothelial Repair), and dissolving fibrous tissue at the microscopic level that may obstruct the circulation of blood.

How does Focused Shockwave differ from the use of PDE5 inhibitors?

Medicines in the group of PDE5 inhibitors, such as Sildenafil or Tadalafil, work by dilating the blood vessels only during the period in which they act; the user must take them before the activity each time. Shockwave, on the other hand, aims at the "underlying structure" of the vascular system. If the assessment finds that the patient has vascular factors as well, this procedure may help support the restoration of the condition of the tissue more lastingly. However, the two approaches are not choices that conflict with one another, and in some cases the doctor may consider using them together according to a plan of treatment specific to the individual.

Who is suited to restoration with Focused Shockwave?

Focused Shockwave is usually considered in those with ED which may be related to vascular factors, such as diabetes, high blood pressure, or high blood lipids, as well as in those who are beginning to respond less to PDE5 medicines, have lost natural erection in the morning, or do not want to rely on the use of medicine as the main thing in the long term.

That said, the suitability should be assessed individually, using the result of the Penile Color Doppler Ultrasonography (PCDU) examination together with the doctor's clinical assessment, before beginning the plan of restoration.

How many times must Shockwave for ED be done, and when is the result seen?

Focused Shockwave is a procedure carried out in the examination room by a doctor, taking about 20–30 minutes each time. In general there is no need to stay and recover, and one can return to daily activities as normal.

Since the mechanism of Shockwave is connected with stimulating the process of restoring the blood vessels and the tissue at the cell level, the response therefore usually takes at least 2–3 months, and requires continuous stimulation several times according to the plan of care that the doctor has planned.

At PYONG MEN the frequency of the treatment will differ according to the plan that the person receiving the service chooses in line with the goal of the treatment, the doctor considering it from the cause of the ED, the severity of the symptoms, the result of the PCDU, and what is suitable for the individual.

Diagnosis before deciding on treatment

Before beginning the procedure, the doctor will assess the cause of the ED in detail. The necessary examination is Penile Color Doppler Ultrasonography (PCDU), in order to assess the circulation of blood of the genital organ, and to help identify whether the ED may arise from narrowing of the arteries, from venous leak, or from both together.

This is together with a blood test in order to assess the level of hormones and the related metabolic states. The results of all the assessments will help the doctor consider whether Focused Shockwave should be used as the main procedure alone, or should be planned together with other technologies, such as Transrectal QMR, Superdose Activated Purified Growth Factor, or the Advanced Pelvic Neuro-Vascular Protocol, so as to correspond to the cause of the erectile dysfunction.

The PYONG MEN approach in using Focused Shockwave to restore ED

At PYONG MEN, the Focused Shockwave procedure is usually not used as a treatment standing on its own, but as part of a plan for restoring ED designed according to the cause, the severity of the symptoms, and the result of the assessment specific to the individual.

In some cases Shockwave may be used as the main procedure, particularly in those with ED at an early stage or with factors connected with the vascular system, while in cases with more complex factors the doctor may consider combining Focused Shockwave with other technologies or procedures, such as restoring the muscles of the pelvic floor, injecting Growth Factor, or approaches connected with the nervous and vascular systems in the area of the pelvic floor — every plan of care being determined after examination, diagnosis, and assessment by the doctor.

In brief

Shockwave for ED is the use of Focused Shockwave Therapy (f-ESWT) in order to stimulate the process of restoring the blood vessels and the tissue inside the spongy shaft of the genital organ
The mechanism of the procedure is connected with stimulating growth factors of the blood vessels, such as VEGF, which has a role in the process of creating new blood vessels at the cell level
This approach is directed at restoring the vascular factors that may be connected with ED, not at stimulating erection in the short term in the same way as PDE5 inhibitors
Considering suitability should rely on the Penile Color Doppler Ultrasonography (PCDU) examination together with assessment by the doctor
The process of response at the cell level usually takes at least 2–3 months, and relies on continuous stimulation according to the plan of treatment
At PYONG MEN, Shockwave is used as part of a programme of care for ED designed according to the result of the assessment and the factors specific to the individual, not as a treatment standing apart or used in the same form in every case

Frequently asked questions (FAQ)

1. Does Shockwave treatment for ED hurt? The procedure uses low-energy focused sound waves. Most of those receiving the service report a slight feeling of tightness at some moments, but this is not considered pain at a level that interferes with carrying out the procedure.

2. After having Shockwave, must the ED medicine being used be stopped? Considering this depends on the diagnosis and the doctor's advice. In some cases the medicine and the procedure may be used alongside each other; in some cases it may be reduced according to the response. One should not adjust medicine by oneself.

3. Is Shockwave suited to every type of ED? Not in every case. Shockwave is usually considered in cases with vascular factors as well. The PCDU assessment will help the doctor identify whether this approach is suitable or whether it should be combined with other technologies.

4. What does the number of sessions depend on? The number of sessions and the frequency of the stimulation depend on the level of severity of the symptoms, the result of the examination, and the plan of treatment that the doctor designs specifically for the individual.

5. How long does the result of the procedure last? Since Shockwave aims at restoring the structure of the blood vessels, the lasting of the result therefore depends on the condition of the patient's blood vessels, the risk factors that can be controlled (such as diabetes and blood pressure), and health behaviour in the long term. A fixed length of time cannot be stated for every case.