Episode 10 – Shockwave Treatment for Erectile Dysfunction. Mechanisms and evidence
This week, I am joined by 2 Physios on the podcast, Yves de Vos and Benoy Mathew. Both of whom are founder members of EDClinics.co.uk which is a collaborative network of clinics specialising in this area.
They are enthusiastic advocates of treating vasculogenic ED with Focused Shockwave. They bring clarity and understanding to an otherwise complex specialist area.
Listen to Episode 10 – Shockwave Treatment for Erectile Dysfunction
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Research links discussed in the episode:
Episode 10 – Shockwave Treatment for Erectile Dysfunction links:
https://www.greeneseminars.physio/
https://pubmed.ncbi.nlm.nih.gov/22425129/
https://europepmc.org/article/med/32683417
Full Transcript from Shockwave Treatment for Erectile Dysfunction – mechanics and evidence podcast
This week, I am joined by 2 Physios on the podcast, Yves de Vos and Benoy Mathew. Both of whom are founder members of EDClinics.co.uk which is a collaborative network of clinics specialising in this area.
They are enthusiastic advocates of treating vasculogenic ED with Focused Shockwave. They bring clarity and understanding to an otherwise complex specialist area.
James Woledge:
Welcome to The Shockwave Therapy Podcast. My name is James Woledge, osteopath and clinical director at The Abbeyfields Clinic in Suffolk. We will be trying to demystify the concept of shockwave treatment, whilst bringing together experts in their field to discuss the latest research. If you are deciding on whether to add this modality into your clinic, or just improve the way you deliver it, then we hope this is the podcast for you.
James Woledge:
Today, we will be talking about erectile dysfunction. And this is a subject area that keeps coming up more and more because I think that there’s a growing knowledge base for this and a growing evidence base for this subject. So to help us navigate through some of that are two physiotherapists today, Yves de Vos is a clinic owner and physiotherapist down in Hampshire at thephysiotherapycentre.co.uk. He’s been using radial and focused shockwave for a number of years in men’s health. He’s a really enthusiastic advocate in this area, so I’m hoping he can bring some of his experiences to bear. And the other is Benoy Mathew who most people would have heard of as an excellent teacher, makes complex subjects and areas sort of digestible. And he’s really good at summarizing the research, particularly in this area. So hopefully, we will be learning lots over the next half an hour. So thanks for joining us, guys.
James Woledge:
So thank you for you two joining me this evening. This is a little different from our usual podcasts. It is basically shockwave orientated, but it’s on erectile dysfunction. For everyone else who’s listened to our podcast before, it’s usually about musculoskeletal pain, but a few people have asked me about whether I could tackle this as a topic because it’s ever evolving as a topic. And in North America, in Europe, it’s becoming much more part of the conversation that shockwave is used for erectile dysfunction or impotence. I know that, Ben, today you’ll be helping us navigate a little bit of the mechanisms and some of the research along with Yves. And this is slightly unusual because we’ve got three of us on here because I thought that was the best way to do it. So for all the listeners, bear with a few mixed words and we’ll try and make it as clear as possible.
So for those people that are listening in that haven’t come across this as a concept at all, this is based on the idea that shockwave is known to improve vascular supply, efficiency and health. So it was used as far back as probably 15 years ago now; some of the first trials were 2010. And the idea is that it’s treating organic or vasculogenic erectile dysfunction only, not the psychological causes or anything else. But the vast majority of erectile dysfunction is vasculogenic. So those patients that are at risk of general vascular poor health, those with high blood pressure, hypertension, cardiovascular disease, high BMI, high cholesterol, or history of cardiovascular disease, and smoking of course, those patients have poor vascular health, and the penis and its inability to engorge is one of the first symptoms you get with that. So in terms of how it actually works as a mechanism with shockwave, Ben, can you give us a bit of insight as to the proposed mechanisms and some of the proven mechanisms?
Benoy Mathew:
So thanks, James, for inviting me on to the podcast. Like most things in science, it’s a trial and error and people always push the boundaries. So while I was reading up on the research, I think they tried this on animal studies for cardiac function. People, they created heart attacks in, I think it was pigs, and they did shockwave and they found it increased vascularity and reversed some of the damage. That led to the hypothesis, so if it could help in heart attack, it could have a similar effect on the penile structure. Because, if you look from a … You rightly pointed out that it could be a precursor of heart function, so if you look at the artery size in the penis, it’s around two to three millimetres, whereas in the heart it’s three to four, so it’s much smaller. So if you have any cardiac dysfunction, like diabetes, smoking, the first area you’re going to get that function is definitely from your penis. So it’s nothing to be laughed about. It’s definitely something patients have to take seriously.
And also, that’s one of the things we always encourage in the ED clinics, is to have a thorough investigation of basic stuff like … I would say most men after 40 should be doing it anyway, like blood pressure, your cholesterol, your basic blood markers, your blood … all the sort of things you would want to reduce your risk of stroke. So those factors are really important. When you talk about the mechanisms, what has been shown first is it improves endothelial function. So, in a very simplistic way, it improves your vascularity, and we know that neurogenesis happens anywhere from eight to 12 weeks. So the patients are going to see the improvement usually by the fourth session. But I say to the patient, it takes a good 8 to 12 weeks because new blood vessels take time. And the good news is it’s been shown, if you have access to … I do ultrasound, but I don’t do a penile Doppler ultrasound, which is basically a specific type of ultrasound to look for circulation.
So studies have shown like once you’ve completed the ED, there’s an increase in vascularity as shown by a non-invasive tool like a penile duplex Doppler ultrasound. So clearly, there’s a big effect on vascularity by new blood formation, new arteries. That could be one of the things we know with shockwave is there’s an increase in nitric oxide, which is important for vasodilation. That’s been shown in many studies in MSK. And that’s how one of the ways Viagra works is that nitric oxide release, so there’s definitely that nitric oxide effect.
James Woledge:
I’m sorry, Ben, was that … you mentioned, was that Viagra?
Benoy Mathew:
Viagra, yes.
James Woledge:
So all the medications have that common theme to them, is that they-
Benoy Mathew:
Yes, they have the common theme to really improve nitric oxide production, which is basically nitric oxide is produced by your endothelial cells, which sort of gets that local blood flow going. So you could say it has a similar … So if somebody had a good effect with Viagra, then you know that they’re going to have a good effect with shockwave. So it’s a good predictor. So if somebody had zero effect with any of the medications … More and more studies have shown, like in some chronic cases and severe cases, a combination of shockwave and medication might be a best option rather than just purely … It’s not this or other. Some people definitely need drugs. And we know that those group, that sildenafil, that group works about 50 to 60%. So it’s not a bad drug; it’s been around since 1998. Viagra, I think, came out 1998.
So it sort of has the vascular effect and the nitric oxide also helps. And there is also some effect on the nerve regeneration. We know that from studies on patients who had a surgery like prostate surgery, they have nerve damage, and that could be a neurological regeneration effect which could sort of also help that in the performance side as well. So in a simplistic way, the way to explain is, improves endothelial function through increased nitric oxide, angiogenesis, more blood flow, takes eight to 12 weeks, a good response in people who already had some response to some of the drugs, and there might be a muscular effect as well. So fortunately, we have got trials which have done sham controlled, placebo controlled, so I don’t think it’s just a placebo or a … because they’ve done studies where they’ve done on just dummy machines with just making noise.
So there’s a real physiology effect which has been shown with a penile duplex ultrasound as well. So we can measure blood flow in trained hands to see the changes in the vascularity. The point I would raise, which you mentioned, is actually we are treating it organically and we’re improving the structurally, so it’s not like just popping a pill or putting an injection. So a lot would argue that actually you’re treating the structure at a fundamental level, which is more lasting than just putting like a band aid. So, that’s more attractive to patients. So we’re improving it from a structural level.
James Woledge:
One of the mechanisms you sometimes read about that’s proposed, I guess, is that it can help break down some of the atherosclerotic plaques in the arteries? Is that still proposed or is there any evidence that that might actually be happening?
Benoy Mathew:
Not really, because I think what it does is it improves his collateral circulation. Like when you have heart block, you develop collateral circulation. There is no direct evidence it breaks down plaque, so I think it’s more about … The great thing about the human body is it can develop … It’s like when you have a blocked arteries, you start walking every day for about three months, your body will produce new blood vessels around it and bypass the block. So I think that’s what, in my opinion, is happening because when we scan people with penile, in the studies, they’ve shown increased vascularity. So the plaque might remain, but it doesn’t matter. The body gets the circulation in a different group, bypass route.
James Woledge:
Okay, fine. Yves, I know you treated a number of patients for this, and Ben just talked a bit about the neural regeneration, so could you just help those people that are listening exactly … I mean, it’s rather obvious where you put the probe, the focused shockwave particularly, because that’s got more of the evidence. Can you just tell people a bit of a summary about where you use it on the penis and indeed where you might use it in the region of the pudendal nerve?
Yves de Vos:
Sure. Yeah. So I tend to stick to the store sort of protocol of using about a set of 3,000 impulses. We divide that by doing 2,000 on the shaft, focusing on the base and then the top of the shaft, and also to do about 2,000 impulses and then treating each crura with about 500 impulses on each site, making sure that that everything is covered in the whole of that region there. The patients tolerate that extremely well.
James Woledge:
What sort of energy levels do you go to? Is it similar to tendinopathy? Do you take it to a point where it’s not uncomfortable but they’re feeling it? Is it guided by the patient?
Yves de Vos:
To a degree, it’s always based on tolerance. On the first session, I will start at a really low setting, communicate with a patient and gradually build it up ideally to about sort of 0.25 millijoules per square millimetre, as that’s been shown within erectile dysfunction to be one of the best sort of levels. Depending on tolerance, then obviously you could go higher if you wanted to, but there might not be necessarily any kind of greater effect by doing so. There’s also a couple of studies who’ve actually done 0.15 millijoules per square millimetre and still had good effects. Also, we tend to typically do six sessions over three weeks, so two sessions per week.
James Woledge:
Is that patient preference, do you find, that they want to get it done quite quickly? Or do you think, anecdotally, that you get a better response that way?
Yves de Vos:
I think there has been a few studies to support that sort of protocol. But again, I must say that due to logistics of patients attending the clinic, that some deviated from that. Because this is still sort of a treatment that’s not available in a lot of places in the country, sometimes people travel two to three hours for a treatment. So to do that twice a week can obviously, logistically, be virtually impossible. So with those patients, I’ve just done a single session per week and still have had a really good effect. So I think from a practicality perspective, I think, ideally you want to be doing those six sessions over three weeks, but I think you need to be governed by overall logistics and working with your patient.
James Woledge:
Right. I know some clinics, because we do it in clinic here, my physio does it, that some clinics will use some of the scorings that we might talk about in a minute to assess severity. And then they might say, “Look, actually, I think you need 12 instead of six,” whatever else. Both of you I ask this to, so what’s your take on whether you go straight in and say, “I think you need six,” or do we say, “Let’s try six and see if you are a good responder and then it’s worth,” quite frankly in private practice, “paying for another six if you want more of an effect”? How have you navigated that six versus 12, et cetera?
Yves de Vos:
Yeah. So what I tend to do is at the start of my assessment, all patients complete the International Index for Erectile Function score, which is a very easy five questions which basically can classify patients into having no erectile dysfunction, mild, moderate, and severe erectile dysfunction. Okay? I also use the Erection Hardness Score, which is, again, is more of a visual thing and can be quite easy to identify where people are within that. So it’s a very quick way of being able to assess exactly where they are. And then I tend to have the sort of typical conversation with patients to say that if they got mild to moderate erectile dysfunction, they’re more likely to be okay with six sessions. If you look at moderate to severe erectile dysfunction, they may well need 12 sessions.
However, I’ve had patients with severe erectile dysfunction who’d done well after six sessions. So it’s not always a given that they have to go for the 12. So I tend to go for the six and then basically re-evaluate, see where they are, and then we have that conversation to see whether they want to have a further six, which, they can either immediately carry on with the treatment or we have a slight break and then carry on after that. So in that respect, again, you’re very much looking at your treatment response in order to then decide where you go from there.
James Woledge:
Okay. Have you done any … Because, I think some of the RCTs … I’m going to post three papers on here after the podcast. And one of the meta-analyses, I noted that half of those were RCT’s actually that were included. And most of them were doing follow-ups up to six months, which I think, when I talk about shockwave in teaching, one of the really compelling things about shockwave versus certainly steroid for tendinopathy is the long-term follow-up data of shockwave is so good. And actually, I think that some of that comes out in the research for erectile dysfunction is that it is quite expensive, I know, but actually the long-term follow-up studies up to six to 12 months are really good. I mean, you’ve not be doing too long, Yves, but have you found anyone coming back and saying, “Look, actually it’s not working after a month, it’s not two months …” or what are you putting in place for that?
Yves de Vos:
So far I’ve not had that, but then admittedly I’ve only really been working with patients for six months. There’s actually quite a good study by Olsen et al. who did follow up 24 weeks after their final treatment, and I think one of the statistics there was that 19% could still have intercourse without any medication. So, sort of implying a lasting effect following the treatment. I tend to follow all my patients up by phone six weeks after the last session and then again three months later. I plan to keep following them up to a year, just personally really, just to kind of get more anecdotal evidence of what my performance is within the clinic of doing this treatment.
James Woledge:
Yeah. Okay. Ben, does that ring true for you in terms of ideally six versus 12 sessions?
Benoy Mathew:
The thing is, I agree with Yves that people, if you’re planning to get involved, we always need a good objective score. And I use the simple IE International Erectile Dysfunction five questions as well. As the name suggests, you only have five questions, so the key thing is a spectrum. You get sort of 5 to 25, so anywhere from 20 to 25 is normal. So if somebody is on a very severe, like between 1 and 7, I tend to go straight to 12. I find if they are pretty much … These are people with hardly any spontaneous activity, lack of morning erections, maybe they are diabetic, so I tend to go for the full 12.
I only do that 12 for only people with severe erectile dysfunction, whereas the moderate cases I would go similarly like Yves, do the six and then the key thing I say to a patient is erectile dysfunction is a reflection of … In many cases, it’s a reflection of the lifestyle. So a common questions which people ask is, is there a top-up needed? And a couple of studies have shown that after six months, they’ve done another three or four, and then there are better outcomes in a year’s time. So in theory, after six months or a year, especially if they’re being more on the severe score level, there is an argument that you could repeat it.
And because vascularity can change if your diabetes is … I say to my patients, “If your diabetes is not well-controlled, if you don’t stop your smoking, then it’s not a guarantee … it might come back.” So I think we need to be aware of that, that it’s not a permanent one-off thing and some patients might need that follow-up. But at this point, I’ve not had any repetition. But as I said, similar like Yves, I’ve only been doing it less than a year, so we need to see that in the future. But for anyone severe, my preference would be go straight to 12 rather than six. So I guess it’s a different, individual ways of doing it, isn’t it?
Yves de Vos:
I think there’s also quite an important aspect that we can play as practitioners with regards to health education, because it isn’t just about doing the treatment with the shockwave. Similar to anybody working in musculoskeletal health, it’s not just about a tendon. It’s the fact that if they’ve got a metabolic disorder, then obviously you want to improve their health. You want to get them fitter, you want to get them stronger, you want to improve their general health because you know that that’s going to have a much better long-term effect. So I think with erectile dysfunction, again, as practitioners, I think we have a responsibility to make sure that we’re looking at a more holistic approach and actually trying to improve that person’s overall health.
James Woledge:
And on that note, I think that there will be a few people listening to this and say, “Is it within the scope of practice?” What sort of clinical triaging are, or should, we be doing? I know the answer already to some of these questions, but for those people that might want to get into this, what would your advice be in terms of setting up a triage system so that they’re definitely sure they’re seeing patients that are right for this treatment? Because there are other causes of erectile dysfunction, so what is your advice, Ben?
Benoy Mathew:
I think before we go straight into ED, I think you should be, in my opinion, you should be a good shockwave practitioner because it’s an extension of your shockwave skills. So ideally, you must have had exposure with radial for a year or two, and definitely with the focused device for more than a year. Because, it’s like if you just … I can give an example from physio school. Once you graduate from a physio, in theory, you could go for an injection course within one month or two months, but most therapists will wait for three or five years before they’re going for injections and things like that. So I think this is definitely … I don’t want to make it complex, but it’s definitely an advanced skill. So it’s not something you’ve got a radial device, you shouldn’t really be thinking like, “Oh, I’m to start it.”
So first, in my opinion, you should be really comfortable with all the variations of shockwave, dabble with all the MSK stuff, your handling, and then the focus on your bone stress injuries. So once you’re confident on that, then I guess it’s a natural progression. Because again, it’s something which we have not touched is the evidence is clear that it favours the focused rather than the radial for this sort of treatment, because energy levels are not good enough to create that neovascularity and the agenesis with just radial. Although there’ve been some case studies, but none of the case studies with radial have had a placebo control or a control group, they’ve just been case studies.
So I think one of the things I want to make clear is, if you’re going to give erectile dysfunction treatment, in my opinion, and the evidence would support me, it has to be a focused device. I’m not saying a particular company, but it has to be something which has been published. And most publications will, I would say 99%, use a focused device. So if you’re not confident with your focused device, then I guess you will struggle with your [crosstalk 00:21:51].
So once you got that, then I guess it’s having that pathway where you get access to … So I think with ED clinics, we’ve got a very systematic method where they could have a prior diagnosis or we go through a set performer, give them access … We have access to in-house doctors who can do a screening blood test. So it’s not like a shock-and-go sort of approach really, because it’s sort of, it’s a holistic approach. So anything you would add there, Yves, on that?
Yves de Vos:
No, I think that’s very much what I would suggest as well, that that’s exactly what we need to do is to go through that triage process before we even conduct any kind of treatment, and making sure that what we do is safe. I am always very insistent on getting a diagnosis. Patients need to be seen by their GP or by a urologist, just to make sure that there’s no other underlying structural or sinister causes for their erectile dysfunction. And that then gives me the assurance that I am practicing safely. Obviously within ED clinics, we have got the ability for patients to be screened by one of the GPs that works for us. With which again, a lot of patients that phone up sometimes have not had that diagnosis. And once we start to sort of talk that that’s actually, in the first instance, a really good idea to make sure that nothing else is going on, sometimes they actually hadn’t thought that far themselves. So in that way, it all fits with us being safety-minded practitioners, and that’s really what I think is of uttermost importance.
Benoy Mathew:
And one thing I would add is to how also getting knowledge in male pelvic health or doing courses. So all of us, we have done courses on that sort of male pelvic health, so you need to have awareness and exposure because it’s looking at the holistic. They might have other conditions like [inaudible 00:24:05], pelvic pain syndrome; so it’s just not erectile dysfunction. So although we are just treating erectile dysfunction with shockwave at this stage, you need to be aware of other potential conditions which can happen in that area; so, basic awareness. I think there’s a lot of skills which needs to come together.
James Woledge:
On that note, Ben, can we just do a shameless plug of your physio colleague who is excellent at [inaudible 00:24:28]. I’ll put details on the podcast as well.
Benoy Mathew:
Yeah. So, nearly all the practitioners from ED Clinics have been attended course from Gerard Greene, who is international expert on male pelvic health. So, we decided to get the training from the best in the country. So really useful course, where he goes through the whole basics of understanding male pelvic health, pudendal neuralgia, because it’s a different new world, especially for somebody working like me in MSK. So if I can pick up other conditions, I’m not going to treat them, but I can refer them to other potential colleagues.
James Woledge:
On the subject of the research, so the one thing since we started doing it in the clinic and in some of the teaching, and because it’s quite novel at the moment, it’s a very easy thing for people to say, “Well, it clearly hasn’t got much evidence,” this, that and the other, when in fact, actually you look at the evidence and the evidence is really compelling. And like all the things that I sort of mentioned earlier, when you’ve got a choice for a patient to go from non-responding medication and their next choice, quite frankly, is a pump or-
Benoy Mathew:
Or injection.
James Woledge:
To the penis. And that doesn’t sound very pleasant, so why wouldn’t you try non-invasive shockwave before that? I think that is really a no-brainer when you look at the weight of evidence. And I think that the evidence started off, as I said, in 2010 with the Vardi paper that was, I think, just 25 patients that were seen that were already responders, but they could reduce their dosage. In fact, some of them actually got spontaneity without medication. And it was always accepted that that was pretty much your gold standard cohort, were those that were already responding, that could remove some of their medication when they had shockwave.
And then this recent trial in 2016, the meta-analysis and the Palmieri trial just this year, were saying actually we can also pick up on those patients that are not responding at all to medication. And they were put on medication and had shockwave, and then they allowed them to use medication and be under the control of the medication, but they weren’t getting any response to the medication before. I think that’s a really compelling as a group of people that were definitely looking at the very severe types of treatment. Have either of you treated any … I think you said earlier that you’ve treated some … Have you treated some non-responders and they’ve actually responded?
Yves de Vos:
Yes. So I’ve had one particular gentlemen that I treated who had severe ED, and he basically went from having severe erectile dysfunction to no erectile dysfunction within his 12th session.
James Woledge:
And he was non-responding to medication?
Yves de Vos:
He had tried Viagra for years and it just wasn’t doing anything for him at all. And, so he then had his course of treatment and basically he found that the change happened between the seventh and the ninth treatments. So for the first six there wasn’t much, and then seven to nine, things started to change and his IIEF score literally went from something like 22 to 3, so a massive change.
James Woledge:
Did that allow him to then respond to Viagra?
Yves de Vos:
He just didn’t need it anymore.
James Woledge:
So he was a poor respondent to Viagra, he was non-responding, to a normal spontaneous erection.
Yves de Vos:
That’s right.
James Woledge:
And can I ask how old he was?
Yves de Vos:
He was 72.
Benoy Mathew:
That’s quite interesting.
James Woledge:
Extraordinary, isn’t it?
Benoy Mathew:
Yeah.
Yves de Vos:
Yes. The thought was that he had developed erectile dysfunction as a result of radiotherapy, which was quite an interesting case, but-
James Woledge:
It is, yes.
Yves de Vos:
… this gentleman was, as you can imagine, delighted with the result of the treatment. So again, these are the kind of people that we have to keep following up, basically to see where their journey goes from here really.
James Woledge:
Yes sure. I mean, my physio colleague has seen four patients in practice so far, and I mean, certainly, I didn’t mention it earlier, but obviously age is also an influencer on erectile dysfunction; I would imagine that your vascular health is going to subsequently be poorer. But we had an 85-year-old in practice that was non-responding, and within four or five treatments, he responded really well. He was very comical with what he said; I won’t repeat it, but he was over the moon. I mean, 85! He didn’t expect much, and he had very low … not trust in the mechanisms, but he’d tried lots of things. He wasn’t price averse, as I would say. He was quite a wealthy chap. He had been on a full journey over decades of Harley Streets and everything else, and nothing had worked. And then four or five treatments into his six treatments and-
Benoy Mathew:
And I think, practically, it’s such a simple treatment to give as its virtually painless, quick, non-invasive, so there’s hardly any argument against it, rather than putting … Because I can see in Harley Street, there are a lot of options, like PRP injections, this injections, penile implant; that’s so aggressive and so invasive. So I guess you want to exhaust shockwave and your drugs first, before you go into those sort of more irreversible sort of treatments. So it’s sort of a logical thing for me because hardly any people complain of any pain; a bit of soreness can be there, but nothing to really talk about.
And so it’s such a simple treatment that once they see it, most people are really surprised that why … So one of the guys said like, “There’s nothing really; I should have done it long time ago.” So they’re really surprised how easy the treatment is and they can feel that benefit within like three, four weeks.
James Woledge:
I think that as far as my crib sheet over here looks, I think we’ve covered most things today. Is there anything else you wanted to say? Bear in mind this goes out to people that are using shockwave already. Is there anything else that we’re missing today that you think might be helpful for anyone listening in, thinking about doing this?
Benoy Mathew:
I think the one thing I would say is like the outcome’s similar, like our conventional shockwave, because you need the time for the neovascularization, and so the score sometimes can take month by month. So I tell my patient, “You’re going to see some improvement usually by the fourth and sixth week.” Obviously, some will have much earlier, so it’s not a quick process, and the peak takes around eight to 12 weeks for the new vascularity. And so I guess most of the effects initially is neural, but the true blood flow and the longevity, there’s a difference between getting a morning erection, but also doing performance without problems. So there’s usually they get the morning erections much earlier, but able to last, that takes time. So we need to inform the patient, it’s not something you just zap it and then in two days, you’re able to do everything you want.
So it’s relatively … can take time, and obviously, some people are much quicker. So, that’s pretty much the whole story with shockwave, isn’t it? We know that it works, but it’s not like an instant fix cure. So, that what I would emphasize with people is it’s … And there’s a lot of debate, especially in social media, where it’s pushed as an performance element. We sometimes get queries from young men in their eighteens and twenties who want to use this as a performance tool, who already have good erections.
So I’m doubtful whether we should, as a professional, get involved in that, because that is not really evidence-based. If somebody already has good erection, but they want to prolong it or things like that, I won’t feel comfortable in treating. What’s your opinion, Yves? Is that something, from a performance area, is that something you would get involved in?
Yves de Vos:
I’ve not had any inquiries like that, but I think, again, I think when we’re looking more at performance, I think it doesn’t kind of … it doesn’t quite sit right with me as a person to start with. As you said, it doesn’t become evidence based. The big problem we have as well is that these people would also probably fall outside of our sort of tools that we have in order for us to see whether there’s actually a change in the treatment that we do, which then makes it very difficult for us to justify doing that sort of treatment.
I went into this profession to improve people’s quality of life, and shockwave for erectile dysfunction can improve people’s quality of life, and I think that that’s an important thing. Performance, I think, is just not something that sits comfortably with me.
Benoy Mathew:
Yes. I agree. Because those young guys, many of them are taking drugs, so I decline because it’s not really a toy to be used for … It’s got a scientific purpose and we want to treat people who have diagnosed erectile dysfunction for a medical purpose. It’s a medical device for medical purposes, isn’t it?
James Woledge:
Okay, guys. I think that I’ll draw a line under that. I think that’s been really informative. It has for me, anyway, because I don’t actually treat it myself, my physio does. But we have chats about this, and I think that was a nice summary of everything we’ve always talked about.
James Woledge:
So thanks again for joining us, and for those listeners here, I’ll put on the details afterwards for the edclinics.co.uk, which I know you guys are a part of. It’s got some really useful information and links on there. And the papers we talked, the research stuff, and Gerard Greene’s details for his courses if anyone wants to do the course. So I’ll put a link up to that afterwards as well on the podcast. So thanks a lot for joining us. Cheers.
Benoy Mathew:
Thanks.
Yves de Vos:
Thanks, James.
About The Shockwave Therapy Podcast
James Woledge aims to demystify the use of shockwave therapy in MSK conditions.
James will be interviewing the experts to gain insights that will help industry professionals on whether they should introduce this shockwave therapy into their own clinics and how to maximise its potential.
The podcast is aimed at healthcare professionals interested in Extracorporeal Shockwave Therapy.
View our previous episodes here
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