Clinical evidence for low intensity extracorporeal shock wave therapy (Li-ESWT) 2018-02-26T16:20:58+00:00

Clinical evidence for low intensity extracorporeal shock wave therapy (Li-ESWT)

Low intensity extracorporeal shock wave therapy has been studied extensively and large double blind studies are being undertaken to investigate its potential to treat erectile dysfunction in various cohorts. Studies are registered with the National Institutes of Health on here. Over 19 studies involving shock waves have been registered and are listed here. The therapy is currently approved in over 20 countries and many hundred clinics worldwide.

Relevant papers are as follows:

Effect of Extracorporeal Shockwave Therapy on Erectile Dysfunction from Vascular Causes: A single-centered, randomised, prospective study – Turkish Study

Abdulkadir Özmez, Asgar Garayev, Ateş Kadıoğlu, Istanbul University School of Medicine, Andrology Department. Presented at the 26th National Congress of Urology 2017

CONCLUSION: Short-term results of ESWT showed significant increase of IIEF-EF score in mild-to-moderate vascular ED. A positive effect of ESWT on ED shows that it can be used as an alternative treatment to traditional methods.


The demographics between treatment groups were similar. Success rate of 54.5% (n=12) was recorded for the ESWT group and 10% (n=1) for the sham group at the 3rd month (p=0.024). Patients who failed were excluded from further study. Baseline IIEF-EF scores were 19.9 (SD±1.5)

and 21 in ESWT and sham groups. Mean IIEF scores at 3rd and 6th months were 24.8 (SD±1.3) and 24.1 (SD±1.5) in ESWT, 23 and 21 in sham groups. IIEF scores at 3rd and 6th month in ESWT group showed significant increase from baseline values (p=0.001;p=0.002).

Doppler finding of cavernosal dysfunction (veno-occlusive dysfunction) and long-term ED were negatively related to the treatment failure(p=0.029;p=0.024), while these factors did not predict success in logistic regression (p=0.9;p=0.234). One patient received an antibiotherapy due to prostatitis, while other demonstrated PSA increase which was later revealed a PI-RADS 4 lesion.

Read summary of study and methods here.

Effects of Next-Generation Low-Energy Extracorporeal Shockwave Therapy on Erectile Dysfunction in an Animal Model of Diabetes

Hyun Cheol Jeong, et al, November 2017  

Research into the effectiveness of treatments of ED using ESWT can be more systematic using animal models. This study using three cohorts of 10 individuals conducted in Korea demonstrated that electromagnetic cylinder ESWT, the technology utilized in SONICWAVE treatment, helps restore smooth muscle function. Histological and immunohistochemical study shows restored levels of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), platelet endothelial cell adhesion molecule-1, cyclic guanosine monophosphate, and neuronal nitric oxide synthase (nNOS) expression levels.

Read the full article here.

Low-Intensity Shockwave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial.

D. Kalyvianakis, I. Mykoniatis, July 2017

A double-blinded, randomized, sham-controlled trial of forty-six patients with ED thirty of whom underwent low-intensity extracorporeal shockwave therapy (LI-ESWT). The study confirmed the beneficial effect of LI-ESWT on penile hemodynamics and the beneficial effect of this treatment up to 12 months. The result is objective and subjective documentation of the value of this treatment modality for men with vasculogenic ED.

Full article available for download here (payment required).

Nature review of ESWT for erectile dysfuction

After treatment, 20 patients (54.1%) in the LIST group achieved erection hardness adequate for penetration compared with no patients in the sham group. A month after sham treatment, patients in the sham group were offered active treatment; 16 of these patients completed treatment and nine of them (56.3%) achieved erections.


Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial

Eric Chung*† and Ross Cartmill*  2015  

LiESWT appears to improve erectile function, is safe and potential plays an important role in penile rehabilitation in men whom failed medical therapy.

Read the full article here.

Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study

Anne B. Olsen, Marie Persiani, Sidsel Boie, Milad Hanna & Lars Lund, Dec 2014

This placebo-controlled study over 5 weeks shows that 57% of the men who suffered from erectile dysfunction had an effect from LI-ESWT. After 24 weeks, seven (19%, active group) and nine (23%, active placebo group) men were still able to have intercourse without medication. This study shows a possible cure in some patients, but more research, longer follow-up in the placebo group and an international multicentre randomized study are needed.

Download the full article here (paid).

Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population.

Srini VS1, Reddy RK, Shultz T, Denes B. 2015  

In this double-blind, placebo-controlled study, LI-ESWT demonstrated a positive long term clinical effect with improvement in erectile function of Indian men with vasculogenic ED who were prior responders to PDE5i therapy. The efficacy and tolerability of this treatment, coupled with its long term benefits and rehabilitative characteristics, make it an attractive new therapeutic option for men with vasculogenic erectile dysfunction.

Read the full article here.

Sound wave therapy is first alternative to Viagra in 15 years

New Scientist February 2016  

Sound wave therapy is first alternative to Viagra in 15 years

Read the full article here.

Does Low Intensity Extracorporeal Shock Wave Therapy Have a Physiological Effect on Erectile Function? Short Term Results of a Randomized, Double-Blind, Sham Controlled Study
THE JOURNAL OF UROLOGY, 2012, Vol. 187, 1769-1775

Vardi Y, et al.

This is the first randomized, double-blind, sham controlled study to our knowledge that shows that low intensity extracorporeal shock wave therapy has a positive short-term clinical and physiological effect on the erectile function of men who respond to oral phosphodiesterase type 5 inhibitor therapy. The feasibility and tolerability of this treatment, coupled with its potential rehabilitative characteristics, make it an attractive new therapeutic option for men with erectile dysfunction.

Read the full article here.

Penile Low-Intensity Shock Wave Therapy: A Promising Novel Modality for Erectile Dysfunction

Yasmin Abu-Ghanem, corresponding author* Noam D. Kitrey,* Ilan Gruenwald,1 Boaz Appel,1 and Yoram Vardi  

LIST is a promising novel therapeutic modality for restoring erectile function in men with vasculogenic ED. It is a safe and non painful treatment with a long-lasting effect on erectile function. Additional well-designed, randomized, large-scale studies are necessary to confirm these findings and to outline the optimal treatment protocol and the suitable candidates. 2014

Read the full article here.

Shockwave treatment of erectile dysfunction

Ilan Gruenwald,corresponding author Boaz Appel, Noam D. Kitrey, and Yoram Vardi  

LI-ESWT is a revolutionary treatment of ED, and probably possesses unprecedented qualities that can rehabilitate erectile tissue. The clinical improvement in subjective erectile function together with the significant improvement in penile hemodynamics following LI-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-ESWT is both feasible and tolerable and without any adverse or unwanted effects. Its main advantage is its ability to improve and potentially restore erectile function in men with ED without additional pharmacotherapy. Hence, LI-ESWT is an appealing addition to the armamentarium of existing treatment options for ED. In the near future we hope that LI-ESWT will be used for the long-term clinical management of ED either as an alternative or as an enhancer to the current treatments of ED. 2013

Read the full article here.