Shockwave therapy for ED is 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? DEAR READER » 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 pub- lished 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 Carpentier-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 percent and 100 percent 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? DEAR READER » Maintaining an active lifestyle can help prevent many diseases, and it’s useful as treatment for many more. The side effects generally are small. However, there are some exceptions, and this is one of them.

In powerlifting, many parts of the body are pushed to their physio- logical limits. In a maximum lift, part of the pressure of the weight is transmitted throughout the chest, which forces the heart to increase its pressure in order to continue blood flow. Measurements of elite-level lifters show that blood pressure can reach or exceed 300 mmHg (!) during a maximal lift. It is not uncommon to see bleeding from the nose or another body part as blood vessels burst under the pressure. Powerlifters are at increased risk for some kinds of heart damage and stroke during these lifts, but the risk for young, healthy lifters is not large, and bad outcomes are rare.

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.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.