Shockwave therapy for ED not living up to hype
DEAR DR. ROACH: I recently heard about a new treatment for erectile dysfunction using shockwave therapy.
Has there been enough research to know if it works? Can you comment on this and any other treatments besides pills? — D.P.
ANSWER: Male erectile function relies on multiple systems. First, the man must have interest and be stimulated. Second, there must be appropriate hormonal support (testosterone is the main issue). Third, the nerve impulse from the brain to the penis must be sent and received. Fourth, the blood flow into and out of the penis needs to be adjusted so that it fills with blood. Finally, the heart and circulatory system need to be strong enough to increase the blood flow to the penis.
Serious disturbances at any of these levels can cause erectile dysfunction. Pills like Viagra work only on the fourth possibility, at the level of blood vessel control. The letters I receive suggest that the other possibilities often are ignored by doctors.
Shockwave therapy, which is most commonly used for kidney stones, is an experimental treatment for ED. It is thought to work by improving blood flow inside the penis. Unfortunately, a trial published in March 2018 failed to show benefit of this procedure. Shockwave therapy is not recommended for treatment of ED at this time, outside of further clinical trials.
DEAR DR. ROACH: I am a 62-year-old male. My aortic valve was replaced with a Car pen tier Edwards bovine tissue valve, and my ascending aorta was replaced in 2005. My question is about competitive powerlifting.
I compete in the bench press. I lift and train with between 50 per cent and 100 per cent of my max lift three to four times a week. How high does blood pressure go when lifting to the max on the bench press? Does it reach dangerous levels? Is the risk of damaging the valve slight, moderate or severe? Is there a risk of developing a second aneurysm?
I want to compete, and I’m willing to accept some risks. What are your thoughts? — S.M.R.
ANSWER: In your case, you have two potential weaknesses. The first is the prosthetic aortic valve, but the Carpentier-Edwards valve in particular has a reputation for strength.
I think it is unlikely that you would damage the valve. It’s the abdominal aneurysm that concerns me.
Although the diseased part of the aorta has been replaced with a very strong graft, the attachment — where the graft is sewn onto your blood vessels — is a point of weakness. Also, it is possible that you have weaknesses in other blood vessels.
I can’t recommend powerlifting for you, competitive or not, as I think the risk is too great.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www. rbmamall.com.