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SPOTLIGHT -

ESMO 2023

| Urology Times Journal

| Case-Based Peer Perspectives

| UroView

| Viewpoints



STUDY CHARACTERIZES TRENDS IN SHOCK WAVE THERAPY FOR ERECTILE DYSFUNCTION

April 26, 2022
Jason M. Broderick
Publication
Article
Urology Times JournalVol 50 No 7
Volume 50
Issue 07



Amid the growing direct-to-consumer market for shock wave therapy (SWT) as a
treatment for erectile dysfunction (ED), a study published in Urology Practice
assessed emerging trends for the treatment across 8 large US cities.1

The researchers identified 152 clinics across the cities that offered SWT as an
ED treatment. Roughly two-thirds (65%) of the clinics had comprehensive
information available on their SWT usage. Urologists made up only 25% of SWT
providers at the clinics and 13% of the providers were not physicians.

Based on individual patient circumstance, therapy ranged from 1 treatment course
to indefinite treatment courses at an average price of $3,338.28 for a full
treatment course. The average cost of 1 individual session of a given SWT
treatment course was $491.22.

“SWT, as a restorative therapy for ED, is performed primarily by non-urologists
and is not standardized. Direct-to-consumer marketing is used to target
distressed men. This study highlights concerning trends in major metropolitan
markets, given the substantial financial impact for patients and inconsistent
credentials among providers. Further, these findings suggest that patients are
frequently seeking care for ED from non-urologists,” the study authors wrote.

The 8 US cities used for the study were Los Angeles, New York, Houston,
Philadelphia, Atlanta, Boston, Dallas, and Washington, DC. Google was used to
identify SWT providers in these metropolitan areas. The search terms used were,
“Shockwave therapy for erectile dysfunction in [city];” “Shockwave therapy for
ED in [city];” and “GAINSWave in [city].” To gather the data, the investigators
implemented a “secret shopper” approach, whereby they called the clinics to
collect provider, price, and treatment course information.

The researchers found that there was a lack of standardization across the
clinics with regard to use of focused shock wave therapy (fSWT) vs acoustic or
radial wave therapy (rWT), location of shock wave administration (eg, perineal,
penile), and treatment protocol. Treatment courses consisted of a wide variety
of session totals, with 6 being the most common. There was no consistency
regarding the devices used for the procedure, the number of shocks during each
session, or the energy and frequency settings.

There were 18 different provider types among the physicians offering SWT. The
investigators specifically drew attention to the fact that the fourth most
common provider type among physicians were those trained in obstetrics and
gynecology. “These physicians see no male patients throughout the entirety of
their training, including no formal instruction in the pathogenesis and
treatment of male sexual dysfunction,” the authors wrote.

In almost half (n = 3) of the cities, SWT was offered by as many or more
non-physician providers as it was offered by urologists. Non-physician SWT
providers included physician assistants, nurse practitioners, chiropractors, and
naturopathic providers.

There was high variation in the cost of SWT treatment courses, from a low of
$600 for the set of sessions at one Atlanta clinic to a high of $16,200 at a New
York City location.

In an accompanying editorial2 published simultaneously with the article,
Jonathan N. Rubenstein, MD, Chesapeake Urology Associates, stressed the
importance of urologists fully taking charge across the board in the evaluation
and treatment of patients with ED.

“We all agree that urologists are best qualified to appropriately evaluate and
treat patients with ED due to our advanced training and expertise in
genitourinary physiology and pathophysiology, wrote Rubenstein.

“We must own this space,” added Rubenstein, “We must understand which patients
may benefit from which therapies, and do everything we can to get patients into
our offices for a proper evaluation and discussion of treatment options, even if
it means offering alternative therapies. If we do, we must be honest with
patient risks (including financial risks) and explain if a therapy is unlikely
to work for them and not offer it to them if they are unlikely to benefit. We
can’t control if others do so, and we can’t control if a patient ultimately
seeks care elsewhere or does not follow our recommendations. However, at least
we afforded them with the best possible medical advice and care based upon our
expertise.”

References

1. Weinberger JM, Shahinyan GK, Yang SC, et al. Shock Wave Therapy for erectile
dysfunction: marketing and practice trends in major metropolitan areas in the
United States. Urology Practice. 2022;9(3)212-219. doi:
10.1097/UPJ.0000000000000299

2. Rubenstein JN. Editorial commentary.Shock Wave Therapy for erectile
dysfunction: marketing and practice trends in major metropolitan areas in the
United States. Urology Practice. 2022;9(3)218-219. doi:
10.1097/UPJ.0000000000000299.01

Download Issue PDF
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Sexual Dysfunction
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Cleveland Clinic trial compares shockwave vs radial wave therapy for ED in
prostate cancer survivors


December 14th 2023
Article



Novel research to evaluate noninvasive treatments in erectile dysfunction and
chronic pelvic pain




--------------------------------------------------------------------------------

The urologist's role in dispelling men's health myths


May 10th 2022
Podcast



“I think it's really important to understand the role of prevention and early
detection,” says Michael Lutz, MD.




--------------------------------------------------------------------------------



Michigan Institute of Urology Opens New Sexual Wellness and Aesthetics Center
for Men and Women called REDEEM


November 2nd 2023
Article



“Sexual wellness is critical to overall health and happiness. That’s why you see
more men and women turning to specialty health clinics for solutions to problems
they consider more aesthetic versus medical,” said Mitchell Hollander, MD.




--------------------------------------------------------------------------------

Destigmatizing Urology: Dr. Espinosa discusses lifestyle changes


March 7th 2022
Podcast



“I think that the audience should know that there is a movement going on,” says
Geo Espinosa, ND.




--------------------------------------------------------------------------------

Experts assess the psychological aspect of erectile dysfunction


October 4th 2023
Article



"Psychological factors often have an important role [in erectile dysfunction],
and psychological treatment options are available that have been found to
improve outcomes," said Mark S. Allen, PhD.




--------------------------------------------------------------------------------

Study suggests broader use of anastrozole for male infertility


September 28th 2023
Article



If replicated with further study, the finding potentially expands noninvasive
fertility treatment options and may minimize the need for expensive reproductive
technology, according to lead author Scott D. Lundy, MD, PhD, of Cleveland
Clinic’s Department of Urology.




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