A Useful Guide to Low Intensity Shockwave Therapy

The realm of medical science has seen numerous advancements in therapeutic treatments over decades. One such groundbreaking innovation is the Low Intensity Shockwave Therapy (LiSWT) a modern non-invasive approach making significant strides in the field of cellular medicine.

What is Low-Intensity Shockwave Therapy (LiSWT)?

LiSWT is a revolutionary approach in the realm of cellular therapy. It is a non-invasive therapeutic modality that uses acoustic waves to initiate mechanotransduction. This results in the release of angiogenic factors leading to increased blood flow to the treated areas.

The process has been successfully applied in various medical fields such as cardiology, orthopedics, and more recently, urology, for the treatment of conditions like vasculogenic erectile dysfunction, a common ailment affecting a significant portion of the aging male population.

This treatment modality is often misunderstood or mistaken for other therapies due to the term ‘shockwave’. However, it’s crucial to clarify that the word ‘shock’ in LiSWT refers to an acoustic wave carrying energy, and not to an electric shock.

The Science Behind Low-Intensity Shockwave Therapy

The science behind LiSWT lies in the generation of low-intensity shockwaves. These shockwaves, when applied to local tissue, encourage blood vessel and nerve regeneration. The acoustic wave carries energy and propagates through a medium, causing local tissue compression followed by expansion. This process creates tissue stress, which is hypothesized to induce neovascularization and neuronal regeneration.

Moreover, LiSWT reportedly activates local penile progenitor cells, supporting another mechanism for tissue regeneration through vascular and neuronal regeneration. Collectively, these mechanisms suggest that LiSWT might have the potential to restore erectile function, a prospect quite distinct from our traditional treatment approaches.

Mechanism of Action of LiSWT

The shockwave in LiSWT is an acoustic disturbance carrying energy and propagating through a medium. The waveform features a high peak pressure achieved rapidly, followed by a pressure decay. This wave induces local tissue compression, followed by expansion related to the tensile force of the tissue, creating tissue stress.

This stress is believed to induce neovascularization and neuronal regeneration, partly through recruitment and activation of local progenitor cells. This mimics fluid shear stress, stimulating vascular endothelial growth factor (VEGF) and other local factor expression to enhance local angiogenesis, particularly at low energy settings.

Additionally, mechanical perturbations may also stimulate neuronal regeneration through local mechanisms. It is believed that LiSWT improves erectile function not only by increasing the generation of new blood vessels but also by penile nerve regeneration through increased number and proliferation of Schwann cells, which are critical for nerve growth and regeneration.

Technical Specifications of LiSWT

Shock waves are high-pressure acoustic waves characterized by a single rapid and focused pulse followed by a low-tensile phase. These waves are generated by lithotripters, which come in three types: electrohydraulic, electromagnetic, and piezoelectric. Each type of lithotripter machine differs regarding specific settings, namely energy flux density (EFD), penetration depth, and frequency.

An important aspect to note is the distinction between linear and radial wave application. Linear shockwave devices have a distinct focal point and a greater depth of penetration, making them the preferred choice for the treatment of conditions like erectile dysfunction.

Review of Clinical Data on LiSWT

Since its inception, numerous clinical trials have been conducted to evaluate the effectiveness of LiSWT in treating vasculogenic erectile dysfunction. The results from these studies, although somewhat mixed due to differences in patient populations, study design, outcomes assessed, follow-up duration, and the type of shockwave technology utilized, generally point towards a positive impact of LiSWT.

Who Can Benefit from This Treatment?

Determining who might benefit most from LiSWT is still a topic of discussion. From the available literature, it appears that patients with mild to moderate erectile dysfunction and few medical comorbidities are the most likely to benefit from LiSWT. There is also some evidence to suggest that LiSWT may optimize response to PDE5i or enhance medication response in PDE5i “non-responders”.

Longevity & Effects

A crucial aspect of any treatment is the duration of its effectiveness. While the majority of studies assess short-term outcomes (1-3 months post-treatment), a few have extended their follow-up period to evaluate the long-term effects of LiSWT. These studies reveal a gradual decrease in the effectiveness of LiSWT over time, emphasizing the importance of patient selection and pre-treatment counseling to ensure the highest likelihood of success.

Guidelines and Recommendations

Several national and international organizations have published guideline recommendations surrounding LiSWT, including the American Urological Association (AUA), Asia-Pacific Society for Sexual Medicine (APSSM), European Society of Sexual Medicine (ESSM), and European Association of Urology (EAU).

While they all acknowledge LiSWT as a potential treatment for erectile dysfunction with promising early clinical studies, they emphasize the need for further investigation before considering it as a “standard of care” outside the scope of clinical research.


Low Intensity Shockwave Therapy (LiSWT) offers a promising new approach for the treatment of vasculogenic erectile dysfunction. While the science behind it is sound, and early clinical studies show encouraging results, further research is needed to solidify its place in the standard treatment protocol. 

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