Page 97 - Remedial Andrology

Extracorporeal shockwave treatment
The mechanical shear stress provoked by low-intensity extracorporeal shock wave treatment (LI-ESWT) on
the treated tissue was deemed to induce neovascularisation and to enhance local blood flow [1016]. The
mechanism of action involved in ESWT for PD is still unclear, but there are two hypotheses: (i) SWT works
by directly damaging and remodelling the penile plaque; and (ii) SWT increases the vascularity of the area by
generating thermodynamic changes resulting in an inflammatory reaction, with increased macrophage activity
causing plaque lysis and eventually leading to plaque resorption [1067, 1068].

Four RCTs and one meta-analysis [1069-1073] assessed the efficacy of ESWT for PD. Three were sham-
controlled trials while one compared ESWT with the combination of ESWT and PDE5I (tadalafil) [1067].

All trials showed positive findings in terms of pain relief, but no effect on penile curvature and plaque size.
Inclusion criteria varied widely among studies and further investigation is needed. The results are summarised
in Table 28.

Table 28: Efficacy of ESWT in the treatment of PD

Author/Year No. of Inclusion Comparator Follow-up Treatment Results Adverse
[Ref] cases/ criteria protocol effects
controls
Palmieri et al. 50 / 50 PD < 12 mo. Sham 6 month 1 session/week Change in IIEF None
2009 [1069] No previous therapy x 4 weeks (+5.4points)
treatment 2000 sw, Pain reduction
2
0.25 mJ/mm , (-5.1 points)
4 Hz Change in
curvature (-1.4º)
Plaque size
(-0.6 in)
Chitale et al. 2010 16 / 20 Stable PD Sham 6 month 1 session/week Change in IIEF None
[1070] > 6 mo. therapy x 6 weeks. Significant in
No previous No other both groups
treatment parameters Pain reduction
mentioned. Significant in
both groups
Change in
curvature N/S
Plaque size N/S
Palmieri et al. 50 / 50 PD < 12 mo. ESWT + 6 month 1 session/week Change in IIEF None
2011 [1071] Painful tadalafil x 4 weeks Significant in
erections 5 mg OD 2000 sw, both groups
2
Presence of 0.25 mJ/mm , Pain reduction
ED 4 Hz Significant in
both groups
Change in
curvature N/S
Plaque size N/S
Hatzichristodoulou 51 / 51 Stable PD Sham 1 month 1 session/week Change in IIEF Ecchymosis
et al. 2013 [1072] > 3 mo. therapy x 6 weeks N/A 4,9%
Previous 2000 sw, Pain reduction
unsuccessful 0.29 mJ/mm 2 (-2.5 points)
oral Change in
treatment curvature N/S
Plaque size N/S
N/A = no assessed; N/S = no significant; IIEF = International index of erectile function; VAS = Visual Analogic
Scale; ED = Erectile dysfunction.

96 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021