Extracorporeal Shock Wave Therapy for Erectile Dysfunction and Its Application

Introduction

Sex is one of the integral parts of human life. Sex is not only necessary for reproductive purposes but also associated with physical and psychological well-being. Any type of sexual disorder thus affects the quality of life. Erectile dysfunction is one of the most common male sexual problems. Almost one-fifth of the adult male population in the world is affected by this condition. Over the years, several medications have been used for the treatment of such cases.

What Is Erectile Dysfunction?

Penis is the external genital organ of the males. It also helps in the process of excretion. Penis has three parts; these are root, body, and glans. The root is the proximal fixed part of the penis, which is attached to the underlying pelvic floor. This part is not visible externally. It is made up of three erectile tissues and two muscles. It is made up of the left and right crura and bulb of the penis. These two muscles are ischiocavernosus and bulbospongiosus. The body part connects the root and the glans. This layer is composed of three cylinders of erectile tissue. These erectile tissues are two corpora cavernosa and one corpus spongiosum. The glans is the most distal part, which is conical in shape. It is an extended part of the corpus spongiosum. This portion contains the external urethral orifice.

Penile erection is a physiological process that causes hardness and increase in size. This is associated with nerve stimulus and increased blood flow in the penis. Erectile tissues play a vital role in the erectile process. Corpora cavernosa is situated within a collagenous sheet known as the tunica albuginea. This portion provides structural support, and it is surrounded by smooth muscle trabeculae. Corpora cavernosa is full of tiny blood vessels, which are known as sinusoids. The bulb of the penis is formed by the corpus spongiosum. The tunica sheet present in this region is less dense, and the sinusoids present are wider in nature. Constriction of this layer and increased blood flow in this region causes ejaculation. The bulb of the penis is surrounded by a muscle known as bulbospongiosus. The anterior fibers of these muscles help to maintain an erection by increasing the pressure on the bulb. Ischiocavernosus surrounds the crura. The contraction of this muscle forces blood into the corpora cavernosa. The blood supply of the penis is maintained through dorsal arteries, deep arteries, and bulbourethral arteries. The sensory and sympathetic innervation by the pudendal nerve and parasympathetic innervation by the peri-prostatic nerve plexus plays a crucial role in the process of erection.

Erectile dysfunction is nothing but a problematic erection. In such a situation, the sufferer is unable to achieve a proper erection for penetration or is unable to maintain the erection for sufficient time. Usually, seven to thirteen minutes of erection before ejaculation is normal.

Pathophysiology: The pathophysiology of erectile dysfunction depends on the causative factors. The causative factors for erectile dysfunctions are:

• Stress, anxiety, and depression.

• Smoking, chronic alcoholism, and drug addiction.

• Trauma, nerve injury, or neural dysfunction.

• Chronic disorders like diabetes and hypertension or hormonal factors.

• Excessive masturbation or altered sexual habits.

• Injury to the smooth smooths of the penis, fibrous tissue formation, and occlusion of the blood vessels.

• Different medications like chemotherapeutic medications, anti-hypertensive drugs, antidepressants, and antiarrhythmics are responsible for erectile dysfunction.

All these factors lead to disruption of neural stimuli and blockage in the blood supply. This is responsible for the inability to appropriate erection during intercourse due to improper relaxation of the muscles.

Symptoms:

The symptoms of erectile dysfunction are:

• Inability to keep an erection.

• Unable to keep an erection for a sufficient time period.

• Quick ejaculation, also known as premature ejaculation.

• Delay in the ejaculation.

• Low sexual drive.

What Are the Traditional Treatment Options?

There are various treatment options for erectile dysfunction. These are:

1. Physical therapy includes the stoppage of habits, weight reduction, and diet control. Procedures like Kegel exercises can be helpful in increasing blood flow to the pelvic floor. Apart from this, psychological treatments can also be done for the reduction of stress and anxiety.

2. A vacuum pump is a mechanical device that creates a vacuum and causes an increase in the blood supply to the penis. But this technique is controversial and may cause injury to the penis.

3. Oral phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are the most commonly used drugs in such situations. Drugs like Sildenafil and Tadalafil belong to this category. Degradation of cyclic guanosine monophosphate (cGMP) via phosphodiesterase inhibition caused by these drugs increases the relaxation of cavernosal smooth muscle. Side effects like alteration in blood pressure, cardiovascular symptoms, sweating, and hot flashing are very common in such cases.

What Is Extracorporeal Shock Wave Therapy?

This is also known as low-intensity shockwave therapy (LiSWT). In this non-invasive method, targeted passing of the acoustic waves induces stress in the tissue. This stress is induced by two methods. One is mechanical stress caused by high-magnitude shock waves. The second one is cavitation and the violent collapse of the tissue, which is correlated with growth. Microbubbles are formed by the implosion of bubbles that is responsible for the formation of tissue lesions. These gradual micro lesions are associated with the formation of new blood vessels. Also, factors like the activation of stem cells, chemokine production, secretion of vascular endothelial growth factors, and migration of the progenitor endothelial cells to the affected sites aid in this process. Also, the production of nitric oxide is helpful in increasing blood flow and nitrergic-nerve repair after injury.

What Is the Procedure of Extracorporeal Shock Wave Therapy?

In this process, a handheld device is used for extracorporeal shock wave therapy. A total number of eight to twelve sessions are advised to the patient, with each session lasting for 15 to 20 minutes. Usually, 3000 pulses are given in each session with an energy of 0.15 millijoule per square millimeter with a frequency of 4 hertz. 2000 pulses are given to the body of the penis, and 1000 pulses are given at the base of the penis.

What Are the Side-effects?

The side-effect of this procedure are:

1. Pain during the procedure.

2. Formation of inflammation and bruises in the penis.

3. Pain and blood during urination.

Conclusion:

Erectile dysfunction is a common male sexual disorder. This is characterized by the inability to maintain proper erection. Extracorporeal shock wave therapy is a non-invasive therapy that can be used for the treatment of this. This procedure helps in the vascularization of the penile structures. The side effects of the other treatment option can be eliminated through this procedure.