The energy profile entails a slower (5–10 microseconds) rise and fall of pressure than a focused shockwave. The depth of penetration of radial waves varies based on energy input, but can reach up to 3.5 cm in human tissues. These acoustic waves then disperse radially away from the tip of the device with rapid energy attenuation. In contrast, the maximal point of energy of a radial wave, sometimes referred to as a dispersive shockwave, is at the tip of the device ( 19). fSWT devices are currently FDA class II devices, which limits use to physicians typically in IRB-approved research protocols. These create a unique pressure wave that can be directed at a focal point ( 18). Focused shockwaves are generated by initiating a pressure wave via three distinct mechanisms: piezoelectric, electromagnetic, and electrohydraulic. The energy profile of a focused shockwave entails a rapid (10 nanoseconds) rise and fall of the pressure wave. The different waveforms may produce varying biological effects, but these differences for specific indications remain largely unknown.įocused shockwaves, which are the shockwaves used for extracorporeal shockwave lithotripsy treatment of urolithiasis, can be targeted to focal points at various tissue depths (up to 10–12 cm) by utilizing reflection of energy created by an acoustic wave source such that the waves convene at a focus point for maximal energy, limiting energy dispersion and collateral damage to adjacent tissues ( 17). The two types of shockwaves differ substantially in their depth of tissue penetration, ability to focus the shockwave, and the rapidity of the rise and fall of pressure (shape of the shockwave). Acoustic waves can be delivered to tissues by two distinct mechanisms: focused shockwaves and non-focused radial waves. The effect of rWT on men with vasculogenic ED, while often marketed as evidence-based ED treatment modality, is unknown.Įxtracorporeal shockwaves used in medicine entail an acoustic wave of energy that travels through tissues and releases a rapid rise and fall of pressure at tissue interfaces, known as a shockwave. Radial wave therapy (rWT) is an alternative method of creating acoustic waves that is commonly utilized in orthopedics, physical therapy, and dermatology, but has not been evaluated for use in men with ED ( 13- 16). To date, all pre-clinical and clinical trials thus far have utilized focused shockwave therapy (fSWT) ( 12). While there is substantial heterogeneity in treatment regimens employed and the devices used, meta-analyses of these trials suggest men with vasculogenic ED experience a significant improvement in erectile function after SWT ( 8- 11). The efficacy of SWT in this setting has been evaluated in several randomized trials with varying benefit ( 1- 7). Low intensity shockwave therapy (SWT) is an emerging treatment option for men with vasculogenic erectile dysfunction (ED).
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