New Frontiers of Extracorporeal Shock Wave Medicine in Urology from Bench to Clinical Studies

Abstract

A shock wave (SW), which carries energy and propagates through a medium, is a type of continuous transmitted sonic wave that can achieve rapid energy transformations. SWs have been applied for many fields of medical science in various treatment settings. In urology, high-energy extracorporeal SWs have been used to disintegrate urolithiasis for 30 years. However, at lower energy levels, SWs enhance the expression of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), proliferating cell nuclear antigen (PCNA), chemoattractant factors, and the recruitment of progenitor cells, and inhibit inflammatory molecules. Low energy extracorporeal shock wave (LESW) therapy has been used in urology for treating chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder, stress urinary incontinence, and erectile dysfunction through the mechanisms of anti-inflammation, neovascularization, and tissue regeneration. Additionally, LESW have been proven to temporarily increase tissue permeability and facilitate intravesical botulinum toxin delivery for treating overactive bladders in animal studies and in a human clinical trial. LESW assisted drug delivery was also suggested to have a synergistic effect in combination with cisplatin to improve the anti-cancer effect for treating urothelial cancer in an in vitro and in vivo study. LESW assisted drug delivery in uro-oncology is an interesting suggestion, but no comprehensive clinical trials have been conducted as of yet. Taken together, LESW is a promising method for the treatment of various diseases in urology. However, further investigation with a large scale of clinical studies is necessary to confirm the real role of LESW in clinical use. This article provides information on the basics of SW physics, mechanisms of action on biological systems, and new frontiers of SW medicine in urology.

Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis—Randomized Controlled Study

“…ESWT in recent years has emerged as a valuable treatment method for various neurological and musculoskeletal disorders [ 13 , 14 ]. Animal studies reported that ESWT produced chondroprotective [ 15 ], anti-inflammatory [ 16 ], neovascularization [ 17 ], anti-apoptotic [ 18 ], and tissue regeneration effects [ 19 ], which could be relevant in the treatment of OA. A recent systematic review and meta-analysis of 14 studies that included 782 participants with knee OA suggested that ESWT is an effective treatment for relieving pain and enhancing the functional status of knee OA patients without any significant adverse effects [ 20 ].…”

Impact of extracorporeal shockwave therapy for erectile dysfunction and Peyronie's disease on reproductive and hormonal testicular function

“…Acidic ejaculate (pH < 7.2) may be associated with obstruction of seminal vesicles, while alkaline ejaculate (pH > 8.0) may be related to MAGI and consequent inflammation 11 . The decrease in pH in our cohort could be explained by the anti‐inflammatory activity of the shock waves 31–33 . However, evidence on the correlation between seminal pH and other seminal parameters (e.g., number, motility) or clinical outcomes (e.g., pregnancy rate) is still limited 34–36 …”

“…11 The decrease in pH in our cohort could be explained by the anti-inflammatory activity of the shock waves. [31][32][33] However, evidence on the correlation between seminal pH and other seminal parameters (e.g., number, motility) or clinical outcomes (e.g., pregnancy rate) is still limited. [34][35][36]…”

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

“…LESW was shown to be effective for temporarily increasing tissue permeability and the intravesical delivery of Botox for the treatment of OAB in animal studies and in a human clinical trial [ 31 ]. Our preliminary study using LESW and intravesical BoNT-A instillation every week in OAB patients also demonstrated an improvement in the Global Response Assessment without any adverse events [ 32 ].…”