Shock Wave Therapy(ESWT) Hope For People With ED

Pune:Thirty-eight-year old Abhishek had been grappling with a bothersome penile condition for years now. Despite being married for seven years, the condition prevented him from consummating it as he faced difficulty in maintaining an erection. It caused a significant bend in his penis as well as severe pain.  
 After remaining in a shell for two years, he began consulting doctors who offered him a conservative line of treatment, which produced poor results. But a new form of low-intensity shock wave therapy has worked. It has not only improved his erectile dysfunction but also raised his performance on various other parameters.  
 Abhishek was one of 30 men diagnosed with Peyronie's disease (a condition in which men develop a plaque (lump) in the penis) who have registered a significant improvement in their condition during a study conducted by a city-based urosurgeon.  
 The study found a place in a prestigious medical journal - Urology Annals in 2016. It was also presented as a 'breaking research paper' at the World Congress of European Society of Sexual Medicine held at Madrid, Spain in November 2015 and in the World Congress of Men's Health held in New Delhi in December 2015.  
 The high success rate of the therapy has raised the hopes of millions of diabetics in India, as a large chunk of them also grapple with erectile dysfunction. These patients currently have to rely on drugs that help them tide over sexual impotence, but only temporarily.  
 "Numerous therapeutic strategies exist for improving erectile dysfunction. While these therapies have been proven to be safe and effective, they are limited for use before the sexual act and do not modify the physiologic mechanism of penile erection. This is where the low intensity extracorporeal shock wave therapy (ESWT) scores," said urosurgeon Rajendra Shimpi of Ruby Hall Clinic, who carried out the study.  
 The therapy is found to be safe, effective and a well-tolerated treatment, not only in diabetics who have arterogenic impotence in which their body tends to promote the formation of fatty deposits in arteries, including penile arteries, leading to erectile dysfunction but also in patients who have insufficient penile arteries and are hence unable to hold an erection despite oral medication.  
 "ESWT activates the body's own repair mechanism to trigger natural healing whereas oral medication has a lot of limitations," Shimpi said.  
 Shimpi's study showed an improvement by 55% - 65 % on all the parameters of International Index of Erectile Function (IIEF), a well-validated questionnaire for subjective improvement in erectile function after a specific modality of treatment.  
 "More importantly, our study, for the first time, showed actual increase in blood flow to the penis in the post-treatment period in 35% to 45% of patients in both the arteriogenic (patients with diabetes) as well as Peyronie's disease," Shimpi said.  
 In patients of Peyronie's disease, an improvement in the arterial blood flow post therapy was 30% to 40 % and there was also an improvement in the curvature of the penis by 10 - 20 degrees.  
 "The other important finding was that patients with complete ED who were not responding to medications such as Viagra or Tadanafil started responding to the medication. This was seen in 35% to 50% of patients," he said.  
 Confirming the efficacy of shock wave therapy, professor Yoram Vardi, Rambam Medical Centre, Haifa, Israel, in an email, said, "Low intensity shock wave therapy is being increasingly used to induce the regeneration of small coronary heart vessels in patients with angina, who are not suitable for coronary surgery or angioplasty. If the therapy can improve the vasculature of the heart, it might also be effective in the penis as 80% of ED is caused by disorder or dysfunction of the penile blood vessels (vasculogenic)."  
 Professor James Catto, Academic Urology Unit, Institute of Cancer Studies at University of Sheffield, UK, in an email, said, "The potential appeal of shock wave therapy is unlike current treatments which are symptomatic and used on an on-demand basis such as medication. Shock wave therapy aims to provide sustained improvement of erectile mechanism and may cure ED."  
 Erectile dysfunction (ED)  
 * It is the inability to get and maintain an erection for sexual intercourse  
 * ED can be caused by a range of physical and psychological factors, but is mainly due to the narrowing of blood vessels and nerves supplying the penis  
 * The condition could be linked to high blood pressure, high cholesterol or diabetes  
 * Psychological factors include anxiety, depression or relationship problems  
 * In the age group of 35- 65 years, complete ED is seen in 20%, milder form in 20 % and moderate in 28%. Out of this group, about 50 % patients have diabetes  
 * Other sexual dysfunctions such as premature ejaculation and hypoactive sexual desire is also prevalent in diabetics  
 * In the last 15 years since Viagra ( PDE-5 Inhibitors) has been introduced in the market, there has been a sea of change in the management of the condition  
 * The marketing of these drugs and its availability in the Indian market at a cheap rate has also increased the general public's awareness of ED as a medical condition with underlying causes and the availability of effective treatment  
 Extra-corporeal Shock Wave Therapy (ESWT)  
 * ESWT is a non-invasive treatment and does not need hospitalization  
 * The shock waves are generated outside the body and then propagated in the body  
 * The treatment activates the body's own repair mechanism to trigger natural healing by increasing the arterial blood flow to penis  
 * This modality was initially used by Young and Dyson in 1990 and their discovery of therapeutic ultrasound-encouraged angiogenesis (new blood vessels in the affected area)  
 * This finding led to the beginning of its use in coronary heart disease , bone fractures and diabetic foot  
 * Pune-based urosurgeon Rajendra Shimpi modified the protocol of the treatment plan of ESWT and included other parameters for the evaluation such as the cavernosal arterial flow  
 * Shimpi has also designed treatment sessions in Peyronie's disease to gain arterial flow and reduce plaque size. He has also designed the pattern of administration of the shock waves to the penis  
 How therapy works  
 * The treatment has the ability to reverse the cause of impotence by using low intensity shock wave therapy  
 * It involves sending 100 low intensity shockwaves per minute through the penis, stimulating the growth of new micro blood vessels inside the penile tissues

* The low intensity show wave therapy is said to break up hardened arteries (cholesterol coating) or narrowed blood vessel pathways, which restrict the blood flow through the penis - a common problem in a quarter of men over 40 suffering from ED  
 * In order to improve sexual impotence, patients need to undergo 12 sessions of 45 minutes over a period of nine weeks in cases of Peyronie's disease and six sessions of 25 minutes weekly over six weeks for diabetic patients  

* Although the treatment sounds painful, doctors claim the patient will only experience a tingling feeling during the procedure  
 (Source: Urosurgery department, Ruby Hall Clinic, Pune)