Shock Wave (ESWT) Therapy

ESWT, known in English as extracorporeal shock wave therapy, is a new-generation treatment in which ultrasonic sound waves generated outside the body are converted into therapeutic energy and delivered as shock waves through a special applicator to the affected area, without damaging tissue integrity. Micro-traumas are created that stimulate the vessels at tissue level and the surrounding stem and mature cells, enhancing healing and regeneration.

The role of ESWT in urology

In the light of current studies, ESWT is used in urology for three main conditions.

1. Erectile dysfunction: A condition presenting as the inability to achieve penile rigidity, usually accompanied by hormonal and anatomical abnormalities.

2. Peyronie's disease: A progressive condition in which fibrotic plaques in the penis cause deformity, painful erections and penile curvature.

3. Chronic prostatitis: In the current classification it is called "Chronic Pelvic Pain Syndrome". It is a condition without a clearly defined treatment protocol, presenting mainly with genital pain, interrupted urination, frequent urination and burning during urination. Because it is often confused with BPH (prostate enlargement), diagnosis is frequently delayed.

Today, ESWT is listed as a first line treatment in the guidelines of the European Association of Urology.

How Does ESWT Therapy Work?

As a result of the micro-traumas created by the ultrasonic shock waves, mature and stem cells responsible for forming new vessels and tissue are activated in the affected area, increasing local blood supply and providing lasting improvement at tissue level. Blood vessels are hormone-secreting organs with their own pressure sensors. When their structure deteriorates, they protect themselves by forming natural bypasses. ESWT shock waves work by strongly reactivating this capacity in vessels and tissues that can no longer renew themselves.

Is ESWT Used Outside Urology?

ESWT offers a new treatment protocol not only in urology but also in other branches of medicine for chronic, hard-to-treat conditions. It is used in orthopedics for frozen shoulder, heel spurs and synovitis; in physical therapy for dorsalgia and other painful muscle disorders; and in cardiology for coronary disease.

How Is ESWT Therapy Performed?

One course of ESWT consists of 6 sessions. (In the international literature, at least 12 sessions are recommended for patients with severe erectile dysfunction and for Peyronie's patients.) The treatment protocol is usually completed within 3 weeks with 2 sessions per week, coordinated between doctor and patient. Sessions can also be performed daily, completing one course in 6 days. Each session lasts about 15-20 minutes. No hospitalization or anesthesia is required. The procedure is a painless, comfortable regional treatment applied externally to the genital area with an ultrasonic applicator.

What Are the Advantages of ESWT Therapy?

With ESWT, patients are treated on an outpatient basis without hospitalization and can return to their daily activities immediately after each session. Its greatest advantage for patient compliance is that it is a painless, anesthesia-free, new-generation treatment. No significant side effects have been reported in ESWT studies to date. Studies also show it to be more successful than all other treatment protocols in these areas.

In Which Diseases/Conditions Is ESWT Not Applied?

It is not recommended in skin or soft tissue cancers involving the penile area, in bleeding disorders that could cause subcutaneous hemorrhage, and in patients with penile prosthesis implants following penile surgery.

When Does the Patient Notice the Effect?

Every patient's healing process and timeline differs. Effects generally start to become noticeable within one month of completing the sessions and continue to increase progressively until new vessels are fully formed and tissue integrity and permanence are achieved.