Shockwave therapy not for prostate cancer cases

Q I am a 73-year-old man and I lead a good life.

About four years ago, I had my prostate removed due to cancer.

Since then, I have been suffering from erectile dysfunction and a shorter penis.

Since shockwave therapy has helped erectile dysfunction sufferers regain their sex lives, I wonder if it will help in my case?

A Approximately 20 per cent of men in Singapore suffer from erectile dysfunction .

The nature of erectile dysfunction following prostate cancer surgery is usually the neurogenic type... For this form of neurogenic erectile dysfunction, shockwave therapy is unlikely to yield good results as the problem lies mainly in the nerves.

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When a man is sexually aroused, the nerve terminals at the penis will stimulate relaxation of the arteries supplying blood to the penis.

This increases blood flow to the penis, causing the organ to be engorged with blood and achieving a hard and erected state.

So for erections to occur normally, both the nerves and arteries supplying the penis need to be functional.

Neurogenic erectile dysfunction refers to erectile dysfunction caused by disorders of the nerve, while vasculogenic erectile dysfunction refers to that caused by disorders of the blood vessels.

Most of the erectile dysfunction cases we see in patients with risk factors such as high blood pressure, high cholesterol and smoking are the vasculogenic type.

Low-intensity shockwave therapy of the penis is successful in treating vasculogenic erectile dysfunction because repeated exposure of the penis to shockwave energy creates an encouraging environment for new blood vessels to grow, through a process called angiogenesis.

The nature of erectile dysfunction following prostate cancer surgery is usually the neurogenic type.

In these situations, the nerves supplying the penis become affected because they run too close to the site of prostate cancer.

For this form of neurogenic erectile dysfunction, shockwave therapy is unlikely to yield good results as the problem lies mainly in the nerves.

If oral medications have not worked for you so far, do consider second-line therapies, which include either the use of injectables or special vacuum erection devices.

If these do not work, insertion of penile implants can be considered to restore an erection.

Dr Joe Lee

Consultant in the department of urology at the National University Hospital

A version of this article appeared in the print edition of The Straits Times on September 27, 2016, with the headline 'Shockwave therapy not for prostate cancer cases'. Print Edition | Subscribe