Frequently Asked Questions

Shockwave therapy is the latest treatment modality for patients suffering from erectile dysfunction and is one of the few treatments options that improves natural erections. It can bring lasting improvement, without the need for medications such as PDE-5 Inhibitors, vacuum pumps, injections and implants, allowing patients to enjoy renewed sexual spontaneity, harder erections, intimacy and a better sex life.

Focused and Radial shockwaves differ not only in regard to their physical properties and mode of generation, but also in terms of the magnitude of the standard parameters (pressure amplitude, pulse duration, impact) used and the therapeutic tissue penetration depths achieved. All the best evidence research utilized low- intensity Focal Shockwave to treat Men’s Health Conditions. The focal shockwave machine because of completely different technology are much more costly than the Radial.

Focused Shockwave is used for:

• Urological indications
• Delayed bone-non unions/bone healing
• Wound Healing and other dermatological and aesthetic indications
• Tendon Calcifications
• Tendon and Muscle injuries.

Radial Shockwave is used for:

• Tendon and Muscle injuries.

The Physiotherapist treating Men’s Health conditions with Shockwave have to develop advanced skills in this area of practice (Men’s Health conditions and Focal Shockwave Therapy). These skills require extra training in beyond those obtained in the undergraduate or immediate post-graduate training. This training is often given by a member of another discipline, i.e. medical practitioner, as these skills may have been previously performed by these professionals.

Shockwave is a non-invasive sophisticated therapy using specific low intensity focused shockwaves. Applied to the penis, breaks up the micro-plaque in existing vessels and stimulates the growth of new blood vessels, nerves, stem cells, improving blood supply, inducing body repair of smooth muscle in the penis, tissue remodeling and re-innervation helping man. A hand-held device is placed on the shaft of the penis and a series of low-level shock waves are administered.

Scientific evidence shows that shockwave therapy for ED can help in the following ways:

1- Promotes angio-genesis (development of new blood vessels), improve vasodilatation and reverse fibro-muscular obesity related pathological changes which lead to better blood flow to the penis and stronger erections.

2- Rejuvenation of penis smooth muscle, the majority of patients suffering from ED do so because the smooth muscle in their penile arteries has been damaged thus inhibiting the functioning of the so-called veno-occlusive mechanism. Shockwave therapy has been shown to induce the body to repair the smooth muscle in the penis and thus improve the function of the veno-occlusive mechanism.

3- Improve the recruitment and activation of intersticial tissue and nerves, pro-erectile effects of steam cells, increase cell survivor and tissue repair and re-innervation of nerves.

Low-intensity focused shockwave rejuvenates the erection mechanism and delays or prevents the deterioration of ED.

After the first few sessions (3-6), most men start noticing the improvement in the quality of their erections as well as better morning erections, better sexual function, better penile arterial improvement in eco-dopler test which indicate rejuvenation and also prevention of deterioration of ED symptoms.

Patients with mild to moderate ED that respond well to PDE-5 inhibitors might be able to regain their natural erections and no longer need – or reduce their dependence on medication.

Patients with moderate to severe ED that do not respond to PDE-5 medication and rely on injections or other topical treatments may become more respondent to PDE-5 medication after shockwave therapy.

Shockwave therapy will in most cases improve the outcomes of any other treatment modality.

Shockwave is a non-invasive procedure and no anesthesia is needed. Each treatment session lasts around 30 minutes. The treatment is performed in a relaxed private room, with only the Physiotherapist specialist in shockwave therapy present. Shockwave is applied with a specific probe on different parts of te penis and perineum, while you lie comfortably on a medical bed.

There is no one protocol that applies for everyone, each case is different and this will determine how many session are necessary. On our experience and in the studies up to date the number of sessions will depend on the severity and presence of comorbitidies.  In general we recommend a course of 6-12 treatments twice or once a week.

Most patients have reported noticeable improvements within three to six weeks of beginning the course. Others take up to 3-4 months before seeing a change in erectile performance.

There is usually a small disconfort during the treatment, most patient experience very little or no pain. If the patient is experience pain during the treatment there is adjustmentes that can be done to reduce it however having some pain during the session illustrate that shockwaves are having a positive effect.

€300 per session (or €250 euros discounted rate).

Package 6 sessions for with discounted rate €1500.

Unfortunately, most private insurance companies do not cover any sexual dysfunction issues so you would need to self finance the treatment and check with health provider if they cover you. We will provide a receipt with all information for you update your insurance provider.

Erectile dysfunction (ED) is simply the repeated inability to get or to keep an erection firm enough for sexual intercourse. You might find that you can’t get an erection at all, or you can get one only sometimes or you can only keep an erection for a brief period of time.

It is known that over 50% of men aged 40-70 suffer from some form of Erectile Dysfunction either permanently or occasionally.

ED is caused by various vascular, neuronal, hormonal and metabolic factors, mediated by endothelial and smooth-muscle dysfunction .Previous diseases may lead to ED. Likewise some prescription or other drugs might be a chemical cause.

More than 80% of cases of ED are caused by physical factors:

• Poor blood flow circulation
• Nerve diases
• Psychological factors such as stress, depression, and performance anxiety

The risk factors for ED are similar to those for cardiovascular disease:

• Older age
• Sedentary lifestyle
• Obesity
• Dyslipidemia
• Metabolic syndrome
• Diabetes
• Smoking

Obtain a detailed description of the problem is essential in order to make an accurate diagnosis. This involves questionnaire administration; physical examination and further examination blood and image tests might be suggested

Oral medication such as PDE-5 inhibitors are widely used however we must differentiate between treating erectile dysfunction causes a as opposed to treating the underlying symptoms, the former leading to more permanent results.

Treatment options include:

• Medications
• Low-intensity Extracorporal Shockwave Therapy
• Pelvic Floor Exercises
• Life Style Modification
• Vacuum erection devices
• Intercavernous injection therapy
• Penile prosthesis

Low-intensity focused shockwave rejuvenates the erection mechanism and delays or prevents the deterioration of ED.

After the first few sessions (3-6), most men start noticing the improvement in the quality of their erections as well as better morning erections, better sexual function, better penile arterial improvement in eco-dopler test which indicate rejuvenation and also prevention of deterioration of ED symptoms.

Patients with mild to moderate ED that respond well to PDE-5 inhibitors might be able to regain their natural erections and no longer need – or reduce their dependence on medication.

Patients with moderate to severe ED that do not respond to PDE-5 medication and rely on injections or other topical treatments may become more respondent to PDE-5 medication after shockwave therapy.

Shockwave therapy will in most cases improve the outcomes of any other treatment modality.

Peyronie’s Disease, also known as Induration Penis Plastica, is a potentially progressive disease resulting in a penile curvature abnormality.

In most cases, men suffering will     present with formation of fibrous plaques in the tunica albuginea that can lead to penile deformities during erection such as curvature, shortening, indentations or an hour-glass deformity that may be complicated by painful erections and a variable degree of erectile dysfunction.

It is believed to occur as a result of aberrant penile wound healing in genetically susceptible individuals, with formation of fibrous inelastic plaque(s) within the bilayer of the tunica albuginea. The exact etiology is unknown.

The diagnosis of PD is usually apparent from a comprehensive clinical history and focused penile examination. Pertinent aspects to consider include the status of disease (acute or chronic), nature of the curvature, duration, change over time, prior treatments used, and the presence of complex penile deformity and other medical comorbidities. Further examination blood and image tests might be suggested.

Treatment plan should be individualized depending on patients on the benefits and risks of various treatment alternatives.

Treatment option includes:

• Medications
• Low-intensity Extracorporal Shockwave Therapy
• Intralesional Therapy
• Penile Traction
• Surgical Therapy

Pain reduction and stabilization in advancement of Penis curvature and plaque formation.

Chronic Pelvic Pain Syndrome CPPS  is also known as Male Pelvic Pain or Chronic Prostatitis?

CPPS, Male Pelvic pain and CP are non malignant pain that is perceived in structures related to the pelvis and lower abdomen and may be associated with urinary, bowel or sexual symptoms. There may also be associated negative cognitive behavioral, emotional consequences.

The most common symptom is pain or discomfort in one or multiple urogenital regions including the:

Perineum (the area between the anus and the scrotum)
Suprapubic region (the area above the pubic hair)
Testicles
Penis (especially penile tip pain)
Lower back, abdomen or rectum

The patients with CPPS, Male Pelvic pain and CP have some degree of sexual problems as result of pain, these problems can occur because of several causes such as:

Decrease in self-esteem
Depression
Anxiety
Fatigue
Nausea
Pain can contribute to sexual dysfunction

A high percentage of men’s with symptoms of CPPS /Male Pelvic Pain / CP don’t have one clear cause of their symptoms. Diagnosis is usually made with of application questionnaires, physical examination, blood test and ultrasound test.

The most common pharmaceutical treatment options CPPS have not proven very effective in alleviating pain.

Other treatments include:

• A course of Low-intensity Extracorporal Shockwave Therapy
• Pelvic floor massage
• Pelvic floor exercises

Significant improvement expected with reduction in prostate pain, ejaculation pain, improvement in urination condition, erectile function and sexual function.

Prostate cancer is the most commonly diagnosed solid organ malignancy in men. For early localized prostate cancer, radical prostatectomy (RP) using either open or robotic/laparoscopic techniques are widely employed as a first-line treatment option.

Although there have been significant advancements in the understanding of the prostate anatomy and the use of minimally invasive surgical techniques, erectile dysfunction secondary to RP continues to be a common and a challenging problem to manage. Despite the advent of nerve-sparing techniques, trauma to the neurovascular bundle during RP cannot be completely avoided. Incidence rates indicate that between 6-70% of men will have ED post prostatectomy.

Some degree of erectile function may return spontaneously after RP, however, it may take over 2 years in many cases. Studies have shown that <50% of patients return to baseline erectile function after surgery.

Traditional treatment for ED after prostatectomy involves:

• Oral medication
• Pelvic floor exercises
• Vacuum therapy

Recently, there is some emerging evidence for the use of Low-intensity focused shockwave therapy and it could be an alternative for early penis rehabilitation for patients who underwent prostatectomy.

Studies suggest that LI-ESWT may have a beneficial effect on erectile function in men with post-RP-related ED by augmenting neoangiogenesis and trophic effects on Schwann cells, synthesizing neurotrophic factors, as well as recruiting and activating progenitor stem cells within cavernosal tissue.