The Tribune

By DR GREGGORY PINTO

Low intensity shockwave lithotripsy (Li-ESWT) has the great potential to offer a curative treatment for poor blood supply/vasculogenic erectile dysfunction, which is a common cause of poor erections for many men.

Erectile dysfunction (ED) is a condition that includes an inability to achieve and maintain a good quality erection with stimulation. Premature ejaculation is also a form of erectile dysfunction. Normal erectile function requires an adequate blood and nerve supply to the penis, adequate testosterone levels as well as the important emotional and psychological component.

Blood flow is imperative for good quality erections. The penile vessels widen when a man is sexually stimulated and the dual chambers in the penis are engorged with blood. This blood provides the firmness of the erection. Poor penile blood flow leads to a weak erection that is difficult to maintain.

Low intensity shockwave therapy was first introduced as a potential treatment for erectile dysfunction in 2010. The common management options for erectile dysfunction include PDE5 inhibitor medications such as Cialis, Viagra or Levitra; intracavernosal penile injections, intraurethral suppositories, use of penile vacuum devices or the surgical placement of a penile prosthesis.

All of these treatment modalities do not address the underlying cause of the erectile dysfunction.

Pills, injections, suppositories, pumps and penile prosthesis do not attempt to reverse the root cause of the erectile dysfunction.

A patient may take Viagra or Cialis and have a satisfactory improvement in erectile function, but the erection dysfunction is not cured. Men would still be reliant on the medications and potentially these medications may become less effective over time, as the pathological cause such as impaired blood supply, progressively gets worse.

There is a high prevalence of diabetes mellitus and hypertension and cardiovascular disease in Bahamian men and many of those who are afflicted have impaired erections due to a poor penile blood supply, called vasculogenic erectile dysfunction. Hypertension and cardiovascular disease can cause hardening and narrowing of blood vessels that supply the penis, which leads to a reduction of blood flow to the penis that is needed to achieve and maintain a strong erection.

There is a recognised correlation between men presenting with erectile dysfunction and presenting at the same time or are at a high risk of developing cardiovascular disease.

It is advised that men who present with erectile dysfunction and have cardiovascular risk factors be investigated for possible subclinical cardiovascular disease. Men in their 40s with erectile dysfunction have a 50-fold increased risk of cardiovascular disease, and men in their 20s that present with erectile dysfunction have a 70-fold increased risk of developing cardiovascular disease later in life. Erectile dysfunction is often an early sign of cardiovascular disease.

The Prostate Cancer Prevention Trial (PCPT) evaluated prospectively the time to the development of cardiovascular disease after the diagnosis of erectile dysfunction. Some 4,247 men in the trial had no reported erectile dysfunction at the beginning of the trial and 2,420 of them developed erectile dysfunction within five years. The men who developed erectile dysfunction, had a 1.45 times higher likelihood of developing a cardiovascular event, compared to the group of men that did not develop erectile dysfunction. Men who have cardiovascular disease are at risk of having a cardiovascular event such as a myocardial infraction/heart attack but it is not inevitable.

Diabetes is a common cause of sexual dysfunction as it could lead to impaired nerve and blood supply to the penis. Diabetic men are four times more likely to have erectile dysfunction than men without diabetes, and diabetic men on average experience erectile dysfunction fifteen years earlier than non-diabetic men.

Low-intensity extracorporeal shockwave therapy involves using low intensity sound waves that pass through penile erectile tissue and clear obstructive plaque from the blood vessels and promote new blood vessel formation/neovascularisation. This treatment could lead to the reversal of impaired blood supply to the penis and correct erectile problems. The treatment is minimally invasive and painless and is performed in office with no anaesthesia necessary. The urologist applies a small probe coated in gel, that delivers low intensity shock waves to the penis. The treatment session lasts fifteen minutes and can be done on a lunch hour with return to work without any discomfort. The procedure is very well tolerated.

Shockwave therapy for erectile dysfunction is very different than the extracorporeal shockwave lithotripsy (ESWL) used to break up kidney stones.

The energy used for penile shockwave is about ten percent of the energy levels used in treating kidney stones and the energy is concentrated on a very small area, whereas shockwaves for kidney stones are spread over a larger area.

Meta-analysis of 10 randomised controlled trials involving 873 men showed that Li-ESWT significantly improved erectile function in men with vasculogenic erectile dysfunction, in terms of both patient objective and subjective outcomes.

There are multiple ongoing studies using shockwave therapy for erectile dysfunction related to impaired blood supply.

The Food and Drug Administration (FDA) has not yet endorsed the use of low intensity extracorporeal shockwave therapy for erectile dysfunction.

Several randomised controlled studies have shown very promising results since 2010 and FDA approval may soon be forthcoming.

Erectile dysfunction shares many of the risk factors with coronary artery disease, which includes high cholesterol, hypertension, obesity and smoking. Younger men in particular should be assessed for cardiovascular disease if they present with erectile dysfunction.

The causes of erectile dysfunction are potentially numerous, including conditions that could lead to impaired blood supply and nerve supply to the penis, and low testosterone. Medications may lead to reduced erectile dysfunction, such as antipsychotics, antidepressants and antihypertensive medications.

Emotional distress, anxiety, psychological conditions could all potentially negatively affect erections.

Seek confidential, compassionate and comprehensive care for erectile dysfunction.

You are not alone as almost every man faces erectile dysfunction at some point in his life. You can always rise again. Never give up hope.

• Dr Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon trained in South Africa, Germany and France. He can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, #68 Collins Avenue/Sixth Terrace, Nassau. Call (242) 326-1929, e-mail welcome@urologycarebahamas.com, or visit the website:www.urologycarebahamas.com.