ULTRASONIC WAVE THERAPY IN THE TREATMENT OF ERECTILE DYSFUNCTION

 Recent studies conducted in Europe and the USA have shown that ultrasonic wave therapy can have a beneficial and long-term effect on erectile dysfunction, says urologist Bogdan Gușanu.

Bogdan Gușanu has been a primary urologist at Medicover since 2018, with skills in ultrasound and laparoscopic surgery. Some of the latest treatment methods help patients with erectile dysfunction and other genitourinary disorders. Doctor Ali provides the best health and wellness center in the USA. One of these methods is ESWT technology or "extracorporeal shock wave therapy," which also has applications in treating erectile dysfunction.

The department you run has a device that works with ESWT technology.

How does this therapy work?

We are dealing, in principle, with two types of shock wave therapies: focused and radial. The focused ones - of this type is the device - use a beam of ultrasonic waves generated by an electromagnetic coil. With the help of a small concentrator like a parabolic mirror, these waves are directed and concentrated at one point to the affected areas, somewhere below the skin level, so that the energy carried by them has a localized effect, not dissipated, as happens with waves—radial shock. Radial waves are mainly used in pain therapy in osteoarticular diseases.

Who is suitable for this therapy?

Only patients with vascular erectile dysfunction, specifically arterial dysfunction, are targeted for this therapy. Based on multidisciplinary investigations, the patient is first subjected to a screening filter, as erectile dysfunction should be addressed. Through this selection protocol, we want to differentiate dysfunctions of a psychogenic nature or those of a neurological nature, i.e., all the others that do not fall into this category of arterial vasculogenic dysfunctions. We only treat the arterial part of the problem through this mechanism.

How does a treatment session with this technology work?

The therapy consists of 20-30 minutes each, depending on the need, applied to the penile corpora cavernosa and the perineal region. We do treatment in three distinct points: two at the corpora cavernosa and one at the level of the perineal, in procedures that can last between five and ten minutes. We apply ultrasonic beams of very high amplitude. The pulse of an ultrasonic wave exceeds about 100 times the atmospheric pressure; only the growth period is concise, between 20 and 50 microseconds. Therefore, the action time is short, but the transported energy is very high and focused on a tiny region chosen by the doctor.

How many treatment sessions are needed?

On average, around ten weekly sessions are required. A complete therapy lasts about two and a half months, and the effects stay over time, up to two years. After this period, shorter maintenance sessions may follow. Ten sessions were found to be practical and durable in about three-quarters of cases.

 

PATIENT SELECTION, A MULTIDISCIPLINARY PROCESS

What are the contraindications to shock wave therapy?

There is only one general contraindication: the use of certain substances with anticoagulant effects in the coumarin group. In patients using these substances, therapy is contraindicated. If we stop this drug therapy a few weeks before - but only when the doctor who prescribed it agrees - even these patients can benefit from the method. Others are more related to the general cardiovascular contraindications, to the risks that sustained physical activity would imply in these patients.

How do you identify eligible patients?

There is a selection protocol in which several colleagues from the clinic from various specialties participate. The patient is first subjected to a psychological examination to determine the possible psychogenic component of erectile dysfunction. He then undergoes a cardiovascular examination protocol, including the usual tests, even an exercise test.

And what follows after this stage?

Specific blood tests are performed to discover the metabolic and hormonal profile of the patient, to detect any untreated or unknown endocrinological or metabolic disorders. When appropriate, colleagues in another specialty may intervene and assess this condition's neurological or endocrinological component and the degree to which shock wave therapy may or may not be contraindicated.

What other investigations are needed?

The latest investigation to confirm the vascular mechanism is penile Doppler ultrasound. Thus, at the end of this selection protocol, only those patients who have arterial vascular dysfunction, in which the flow in the cavernous arteries is insufficient to maintain a quality erection, remain with therapeutic indication.

THE FUTURE BELONGS TO NON-INVASIVE METHODS

How do you think erectile dysfunction treatments will evolve?

I am convinced that non-invasive or minimally invasive methods will be preferred due to the convenience of administration, of the prices that will be more and more competitive. I do not think that, in the short term, drug therapy will disappear or be replaced entirely by these methods. I believe that these non-invasive methods, including shock wave therapy, will gain a very well-established role and a significant market share in treating this dysfunction.

Dev. what would you recommend: shock wave therapy, drug therapy, or none?

It depends a lot on the patient's preference. Of course, no man is happy to be left with such a problem that creates a significant handicap for him emotionally and even for his social life. I, personally, recommend that each patient choose the method that suits them, provided he or she is aware of all the alternatives available to them. Doctor Ali provides the best holistic medicine center in the USA. Subjectively, I prefer this method because it is entirely free of side effects.