Low-intensity extracorporeal shock wave therapy (LI-ESWT) has become one of the standard treatment options for erectile dysfunction (ED) in men.
The principle behind this therapy is that the energy from shock waves promotes local angiogenesis and improves microcirculation, thereby enhancing erectile function.
However, as the application of shock wave therapy becomes more widespread, I frequently encounter a common question from patients in my clinic: Is more always better when it comes to the number of shock wave pulses used in treatment?
l The Impact of Pulse Numbers
According to a systematic review and meta-analysis published in 2022, which included 16 randomized controlled trials (RCTs) with a total of 1,064 patients, the efficacy of LI-ESWT in treating ED was examined alongside the influence of different treatment parameters.
The study categorized the RCTs into three groups based on the number of pulses per treatment session:
- 600 pulses
- 1,500 to 2,000 pulses
- More than 3,000 pulses
Results for the 600-pulse group: Compared to the control group, the treatment group showed an increase in the International Index of Erectile Function (IIEF) score, but the difference was not statistically significant (MD = 1.50, 95% CI = [-1.44, 4.43], p = .32).
Results for the 1,500 to 2,000-pulse group: The treatment group showed a significant increase in IIEF score (MD = 4.80, 95% CI = [2.61, 7.00], p < .0001).
Results for the group with more than 3,000 pulses: Although this group also showed a statistically significant improvement in IIEF compared to the control group (MD = 3.46, 95% CI = [1.89, 5.03], p < .0001), interestingly, the results were slightly lower than those seen in the 1,500 to 2,000-pulse group.
l The Impact of Energy Density
The study further categorized the RCTs into two groups based on energy density settings:
- 0.09 mJ/mm²
- 0.1 to 0.2 mJ/mm²
The results indicated that both energy density settings could significantly improve the IIEF scores.
However, the group with a higher energy density (0.1 to 0.2 mJ/mm²) showed slightly lower effectiveness compared to the group with a lower energy setting (0.09 mJ/mm²). Specifically:
- 0.09 mJ/mm²: MD = 3.81, 95% CI = [2.07, 5.55], p < .0001
- 0.1 to 0.2 mJ/mm²: MD = 3.01, 95% CI = [0.89, 5.12], p = .005
l Conclusion of the Study
This study not only reaffirms the effectiveness of LI-ESWT in treating ED but also highlights the varying effects of different energy densities and pulse numbers on erectile function. The study found that:
- An energy density of 0.09 mJ/mm² led to greater improvement in IIEF scores compared to an energy density between 0.1 to 0.2 mJ/mm².
- Treatment with 1,500 or 2,000 pulses per session resulted in greater improvement than with 600 or 3,000 pulses.
- Patients with moderate ED showed more significant improvements in IIEF than those with mild or severe ED after LI-ESWT treatment.
- The degree of improvement in IIEF also varied with follow-up time, with greater improvements observed at 6 months compared to 1 or 3 months of follow-up.
l Dr. Huang's Commentary:
From a theoretical standpoint, it's clear that simply increasing the number of shock wave pulses or the energy level does not necessarily lead to better results.
The purpose of shock wave therapy is to "induce" the body's self-repair and regenerative capabilities.
Therefore, as long as an adequate amount is applied to achieve this "induction," it is sufficient.
Applying more than necessary has no added benefit.
Therefore, I urge that when using LI-ESWT to treat ED, the treatment efficacy does not increase indefinitely with the number of pulses or energy level.
Physicians should carefully select appropriate pulse parameters to ensure both the effectiveness and safety of the treatment.
For patients with severe ED or those unresponsive to other treatments, it is also important not to blindly increase the number of pulses but to consider combining other adjunctive therapies.
Patients should understand that the key to successful treatment lies not in the quantity of shock waves but in a treatment plan tailored by the physician to their specific condition, ensuring better outcomes and treatment experiences.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949743/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10890328/
