Introduction
Erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are among the most common urological conditions in men. According to epidemiological studies, more than 50% of Taiwanese men aged 40–70 experience varying degrees of erectile difficulties. The prevalence of chronic prostatitis has been reported at 5–8%, often causing recurrent pain in the lower abdomen or perineum, along with urinary symptoms and reduced sexual quality of life.
In addition to conventional medications, low-intensity extracorporeal shockwave therapy (Li-ESWT) has gained increasing attention in recent years, offering new treatment possibilities for both ED and chronic prostatitis.

I. Erectile Dysfunction and Chronic Prostatitis
Common causes of erectile dysfunction
●Cardiovascular disease (arteriosclerosis leading to insufficient penile blood flow)
●Endocrine disorders (e.g., diabetes, low testosterone)
●Psychological stress and anxiety
●Prostate-related conditions

Symptoms of chronic prostatitis
●Recurrent pelvic or perineal pain
●Urinary frequency, urgency, or difficulty voiding
●Painful ejaculation or decreased libido
●Persistent psychological stress and impaired quality of life

II. Limitations of Conventional Treatments
Common treatments for erectile dysfunction
●PDE5 inhibitors (e.g., sildenafil, tadalafil)
●Vacuum erection devices
●Penile injection therapy or prosthesis implantation

Although medications can improve erections, some men cannot use them long-term due to side effects (such as headache, flushing, low blood pressure) or underlying cardiovascular conditions.

Common treatments for chronic prostatitis
●Antibiotics (when infection is suspected)
●Anti-inflammatory or pain medications
●Alpha-blockers to improve urination
●Heat therapy or physical therapy
●Psychological support and lifestyle modification

Because the causes of chronic prostatitis are complex, treatment results are often temporary, and relapse is common.

III. Mechanism of Shockwave Therapy
Shockwave therapy applies low-intensity acoustic waves to the penis or surrounding prostate tissue, leading to multiple biological effects:
●Angiogenesis: Promotes new blood vessel growth, improving local circulation.
●Nerve regeneration: Stimulates repair factors, enhancing nerve function.
●Anti-inflammatory action: Reduces chronic inflammation and alleviates pain.
●Tissue activation: Improves metabolism and supports recovery of affected areas.

Thus, shockwave therapy not only relieves symptoms but also targets the underlying pathology by improving circulation and reducing inflammation.

IV. Application of Shockwave Therapy in Erectile Dysfunction
Clinical studies have shown that patients undergoing shockwave therapy demonstrate significant improvements in erectile rigidity and International Index of Erectile Function (IIEF) scores. It is especially beneficial for men who respond poorly to oral medications or are unable to take them.

Treatment protocol
●A linear probe is applied to the corpora cavernosa and penile crura.
●One to two sessions per week, typically 6–12 sessions total.
●Each session lasts about 15–20 minutes.

Key features
●No anesthesia required; patients can resume daily activities immediately.
●Enhances penile blood flow and restores natural erectile function.
●Results vary; men with severe vascular disease or diabetes may see less improvement.

V. Application of Shockwave Therapy in Chronic Prostatitis
In patients with chronic prostatitis, shockwave therapy has been shown to provide:
●Pain relief: Significant reduction in pelvic and perineal discomfort.
●Urinary improvement: Reduced frequency, urgency, and residual urine sensation.
●Better sexual quality of life: Less ejaculatory pain and reduced anxiety.

Treatment protocol
●A focused probe is applied to the perineum and pelvic region.
●Each session lasts 15–20 minutes, with 6–12 sessions recommended.

This offers a safe and sustainable option for patients who experience recurrent symptoms or limited response to medications.

VI. Possible Side Effects and Precautions
Shockwave therapy is generally safe, with only minor and temporary side effects such as:
●Local redness or soreness
●Mild numbness
●Rare, short-term increase in pain that resolves within hours


Not recommended for:
●Patients with prostate cancer
●Individuals with bleeding or clotting disorders

VII. Clinical Role of Shockwave Therapy
Shockwave therapy is not a replacement for medication but rather an alternative option. It is particularly suitable for:
●ED patients with limited drug efficacy or significant side effects
●Chronic prostatitis patients with recurrent or drug-resistant symptoms
●Men suffering from both conditions who wish to improve erectile function and pelvic pain simultaneously

VIII. Conclusion and Recommendations
With its non-invasive, safe, and quick-recovery charteristics, shockwave therapy is increasingly adopted in clinical urology. For men with erectile dysfunction or chronic prostatitis, it provides a promising pathway that combines safety with long-term benefit.

Recommendations for men:
●Seek medical evaluation if you have persistent pelvic pain or erectile difficulties.
●Consult your urologist to determine if shockwave therapy is appropriate.