What is the treatment protocol for erectile dysfunction (ED) using acoustic radio wave therapy?

Treatment Protocol for Erectile Dysfunction with Acoustic Radio Wave Therapy

Low-intensity shockwave therapy (LiSWT) is not currently included in major erectile dysfunction treatment guidelines as a first-line therapy, but may be considered as an adjunctive treatment option for men with mild vasculogenic erectile dysfunction, particularly those who are non-responsive to PDE5 inhibitors. 1

Current Position of LiSWT in ED Treatment Algorithm

• Standard first-line treatments for erectile dysfunction include FDA-approved oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil), which should be offered with proper dosing instructions and titration before considering alternative therapies 1
• LiSWT is considered an innovative treatment modality that requires further large-scale, placebo-controlled studies for full clinical validation 1
• The European Association of Urology guidelines (2025) recommend that LiSWT may be used in men with mild vasculogenic ED (weak recommendation) 1

LiSWT Protocol Parameters Based on Available Evidence

• Most common device settings in clinical studies:

  • Energy density: 0.09 mJ/mm² 2, 3
  • Frequency: 5 Hz 2
  • Number of shocks: Typically 1,500 shocks per session (900 to penis shaft/base/hilum and 600 to proximal corpora/crura) 2
  • Treatment schedule: 4-12 sessions, with weekly treatments being most common 2, 3

• Alternative protocol observed in clinical practice:

  • 3,000 shocks per session at 0.09 mJ/mm² for focused regimens 3
  • 10,000 shocks per session at 15 Hz and 90 mJ for non-focused regimens 3

Clinical Efficacy and Patient Selection

• LiSWT has shown modest improvements in erectile function in some studies, with mean IIEF-EF score improvements of 3.5 points compared to sham treatment at 3-month follow-up 4
• Most beneficial for patients with:
  • Mild to moderate vasculogenic ED 1
  • PDE5 inhibitor non-responders (52.5% of treated patients achieved EHS >2 at 6 months vs 27.8% in sham group) 4
• Treatment effects have been reported to last up to 2 years in some studies 5

Safety Profile

• LiSWT is generally considered safe with minimal adverse events reported across studies 2, 3, 4
• No significant side effects were observed in comparative studies of different shockwave technologies 3
• The non-invasive nature of the treatment makes it an attractive option for patients who reject more invasive therapies 4

Important Clinical Considerations

• LiSWT should not replace comprehensive ED evaluation and management:

  • Thorough medical, sexual, and psychosocial history is essential 1
  • Physical examination and selective laboratory testing (including morning total testosterone) should be completed 1
  • ED may be a risk marker for underlying cardiovascular disease that requires evaluation 1

• LiSWT may be more effective when combined with other treatments:

  • Combination with PDE5 inhibitors, vacuum erection devices, or daily tadalafil may enhance results 1
  • Psychosexual counseling should be considered to address psychological factors and improve treatment adherence 1, 6

Limitations and Caveats

• Despite promising results, there is still no standardized treatment protocol for LiSWT 2
• The clinical significance of improvements may not be perceived as meaningful by all patients 1
• LiSWT should be presented as an adjunctive rather than primary treatment option given the stronger evidence supporting PDE5 inhibitors 1
• Treatment decisions should be made jointly by the physician, patient, and when possible, the partner, considering preferences, expectations, and the physician's judgment 1