ESWT techniques

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FocusWaveClinic

Using shockwave therapy starts first with having the correct technology.
Understanding Focused vs. Radial is most important.

But it's clear that technique also plays a critical role in determining success in treatment.
You can't just hold the wand on the plaque for Peyronies Disease - you have to go at it from different angles, targeting different areas, etc.
Like anything - there are crafty and advanced techniques for sending shockwaves to the right place (at the right frequency, correct EFD, etc.), correct numbers of shocks, frequency per week/month, etc..

Does anyone have any ESWT techniques that they are willing to share?
Be they for ED, Peyronies Disease, CPPS?

Thanks!
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blex

Let me get this straight:

You are running an ESWT clinic and ask some guys in a forum about the proper technique on how to use it?
36 years old, married
---
Symptoms since trauma in July 21:
First calcified nodule in septum near glans
Multiple calcified plaques developed on top
Pain (flaccid/erect), 75° upwards curvature, hourglassing
---
Nothing helped, looking for surgery now

FocusWaveClinic


I don't operate the equipment - I have an MD who is a vascular surgeon who is great at it.
But like any practice - there are the experiences of others which we cannot discount.
We don't know it all.  
We've treated hundreds upon hundreds of men and spoken to thousands.  
There is no perfect solution.  Sharing information is how we can all improve.  
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projectpd

How would you use the feedback though , you can't really risk to try something just because someone here suggested it...
Age 57, Onset 2010, 2" shortening, shrinking and angulation of glans, weaker erections, 30 degree bend. Mild pain few months, but far from worst symptom. Tried many ideas, not just from here, but not consistently. Moderate improvement, maybe 40%

Bud luck

FocusWavesClinic, so you came here to this forum saying that all the guys that are using your incredible machines got better, now you are asking random guys with no Medical degrees for advise on how to use the Waves?, Do you really have a clinic or you are just a sellsman?
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My ED is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

FocusWaveClinic

Quote from: projectpd on January 14, 2023, 10:44:46 AM
How would you use the feedback though , you can't really risk to try something just because someone here suggested it...
Medicine is a practice.  
Shockwave technology is continuing to expand and there is both an art and a science to it.  
And thus if we want to be forever students of the human body and to continue to increase our knowledge about medical technology, it behooves us to always seek to improve our skills by practicing what we do.
Wouldn't you agree?

I have no idea who is on this forum.  
Could be 100 guys with ED/Peyronies Disease - Could be some clinic owners - could be some Pharma reps - could be some pervs - could be some shockwave technicians.  
That's why I'm asking.  
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FocusWaveClinic

Quote from: Bud luck on January 14, 2023, 11:06:17 AM
FocusWavesClinic, so you came here to this forum saying that all the guys that are using your incredible machines got better, now you are asking random guys with no Medical degrees for advise on how to use the Waves?, Do you really have a clinic or you are just a sellsman?
Is this really what you took away from my posts?
Did I ever say 'all the guys got better'?
Cmon dude - I know you are frustrated with things but you aren't thinking clearly by making these comments.  

I'm not asking YOU how to use shockwave.
I'm asking anyone out there who has experience administering them if they are willing to share and discuss technique and openly discuss this evolving technology.  
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projectpd

Quote from: FocusWaveClinic on January 14, 2023, 03:44:27 PM
Medicine is a practice.  
Shockwave technology is continuing to expand and there is both an art and a science to it.  
And thus if we want to be forever students of the human body and to continue to increase our knowledge about medical technology, it behooves us to always seek to improve our skills by practicing what we do.
Wouldn't you agree?
No, it's not clear how one can risk "practising" to improve your skills.  What is your take on the study (20) in your 2nd reference, that said,
Penile deviation was not reduced by ESWT (P=0.66) but worsened in 20/50 (40%) and 12/49 (24.5%) patients of the ESWT and placebo-group, respectively (P=0.133). Plaque size reduction was not different between the two groups (P=0.33). Additional, plaque size increased in five patients (10.9%) of the ESWT group only.
Quote from: FocusWaveClinic on January 14, 2023, 03:44:27 PM
I have no idea who is on this forum.
That's why I'm asking.
that was why *I* was asking  
Age 57, Onset 2010, 2" shortening, shrinking and angulation of glans, weaker erections, 30 degree bend. Mild pain few months, but far from worst symptom. Tried many ideas, not just from here, but not consistently. Moderate improvement, maybe 40%

Bud luck

If these studies prove that ETSW are not helping anyone and made it worse to some, why are there still clinics all over the world promoting the Shockwaves for penis fibrosis?, why nobody is holding accountable for lying and damaging we sufferers of this awful disease?I got damaged twice and they all denied any wrong doing, so many lies on the Medical business.
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My ED is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

blex

Quote from: FocusWaveClinic on January 14, 2023, 03:55:08 PM
I'm asking anyone out there who has experience administering them if they are willing to share and discuss technique and openly discuss this evolving technology.

There is no magic technique to it I guess.
I suggest you refer to the manufacturer of your device who should offer training for this
36 years old, married
---
Symptoms since trauma in July 21:
First calcified nodule in septum near glans
Multiple calcified plaques developed on top
Pain (flaccid/erect), 75° upwards curvature, hourglassing
---
Nothing helped, looking for surgery now

projectpd

Maybe, find out the details of the technique used in that study  ( Hatzichristodoulou 2013) and make sure not to use anything too similar. E.g. What was the focal point depth and maximum energy flux. Was the device focused only in the plaque or could other areas have been included.

Peyronies is I think, thought to possibly result from a pathological inflammatory cascade, yet the proposed mechanism of ESWT is thought to involve inflammation  and i believe ED patients are supposed to avoid anti inflammatories such as NSAIDs . What advice would you propose... what was the advice for the Hatzichristodolou study.

You referred to, radiative ESWT negatively, but the Gainswave content describe it as safer than focused. Presumably focused by definition could direct higher energy into a healthy area and so have more potential for damage. how do you address this?

Age 57, Onset 2010, 2" shortening, shrinking and angulation of glans, weaker erections, 30 degree bend. Mild pain few months, but far from worst symptom. Tried many ideas, not just from here, but not consistently. Moderate improvement, maybe 40%

Trapper

Quote from: projectpd on January 15, 2023, 12:53:43 PM


Peyronies is I think, thought to possibly result from a pathological inflammatory cascade, yet the proposed mechanism of ESWT is thought to involve inflammation  and i believe Erectile Dysfunction patients are supposed to avoid anti inflammatories such as NSAIDs .

ProjectPD, I feel like from previous penile injuries I have healed better and faster when not taking NSAIDS but interestingly Dr. Trost says there is weak evidence for their us. So who really knows. But they have been shown to have a depressant effect on wound healing while simultaneously decreasing the granulocytic inflammatory reaction. So the trade off is to decrease inflammation but slow wound healing.

Also, the guy asking patients how to do ESWT is 2nd funniest thread after the cabbage leaf thread lol
33 years old, symptoms started early 20's but never really bothered me until the last two years
Trimix worked well but caused more scarring. 
Titan 24CM XL+ 1 CM RTE'S Dr. Hakky 4/4/23
Hyaluronic acid penis filler by Dr. Hakky June 2023

FocusWaveClinic

Quote from: projectpd on January 14, 2023, 07:39:22 PM
No, it's not clear how one can risk "practising" to improve your skills.  What is your take on the study (20) in your 2nd reference, that said,
Penile deviation was not reduced by ESWT (P=0.66) but worsened in 20/50 (40%) and 12/49 (24.5%) patients of the ESWT and placebo-group, respectively (P=0.133). Plaque size reduction was not different between the two groups (P=0.33). Additional, plaque size increased in five patients (10.9%) of the ESWT group only.that was why *I* was asking
sorry can you link the study?
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blex

I think he refers to this study:

https://pubmed.ncbi.nlm.nih.gov/23898925/

QuoteConclusions: Despite some potential benefit of ESWT in regard to pain reduction, it should be emphasized that pain usually resolves spontaneously with time. Given this and the fact that deviation may worsen with ESWT, this treatment cannot be recommended.

I saw Dr. Hatzichristodoulou in person, he has done a lot of Peyronie's research and may be the most experienced Peyronie's surgeon in Germany/Europe. He is skeptical about eswt, but it is not all black and white. It didn't help me though...
36 years old, married
---
Symptoms since trauma in July 21:
First calcified nodule in septum near glans
Multiple calcified plaques developed on top
Pain (flaccid/erect), 75° upwards curvature, hourglassing
---
Nothing helped, looking for surgery now

projectpd

 I already referred exactly to the study linked in his own references , if he has no clue about what he's posted or has no interest it,  it does no good for us to provide the link.  
Age 57, Onset 2010, 2" shortening, shrinking and angulation of glans, weaker erections, 30 degree bend. Mild pain few months, but far from worst symptom. Tried many ideas, not just from here, but not consistently. Moderate improvement, maybe 40%

projectpd

Interesting Blex, did you get the impression he was skeptical from before his study or after it ?
Age 57, Onset 2010, 2" shortening, shrinking and angulation of glans, weaker erections, 30 degree bend. Mild pain few months, but far from worst symptom. Tried many ideas, not just from here, but not consistently. Moderate improvement, maybe 40%

Bud luck

FocusWavesClinic came to the forum saying that his waves were making men with penis fibrosis better, then he changed his mind and said that some men get better, then he is asking for advice to random guys on the forum on how to use the ESWT, then.....
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My ED is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

LWillisjr

Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

Trapper

Haha Idk about ESWT but I think I'll add FocusWave clinic on things NOT to try.
33 years old, symptoms started early 20's but never really bothered me until the last two years
Trimix worked well but caused more scarring. 
Titan 24CM XL+ 1 CM RTE'S Dr. Hakky 4/4/23
Hyaluronic acid penis filler by Dr. Hakky June 2023

FocusWaveClinic

Quote from: projectpd on January 15, 2023, 12:53:43 PM
Maybe, find out the details of the technique used in that study  ( Hatzichristodoulou 2013) and make sure not to use anything too similar. E.g. What was the focal point depth and maximum energy flux. Was the device focused only in the plaque or could other areas have been included.

Peyronies is I think, thought to possibly result from a pathological inflammatory cascade, yet the proposed mechanism of ESWT is thought to involve inflammation  and i believe Erectile Dysfunction patients are supposed to avoid anti inflammatories such as NSAIDs . What advice would you propose... what was the advice for the Hatzichristodolou study.

You referred to, radiative ESWT negatively, but the Gainswave content describe it as safer than focused. Presumably focused by definition could direct higher energy into a healthy area and so have more potential for damage. how do you address this?
Radial or acoustic waves aren't BAD - they just aren't very useful for sexual dysfunction conditions.  Plus they are painful and require numbing creams for a majority of patients (this is what I've heard from other clinics using these devices to treat ED and Peyronies Disease).
That's because radial cannot achieve the depths required to create the neovascularization required, or the power required to safely break up plaque/scar tissue.
This is the mistake that most men make - they don't do the research to realize that these cheap devices are mostly ineffective in treating ED/Peyronies Disease.
Even focused, while generally painless and side effect free, is not a guarantee that it will improve your condition.  
I have zero experience in hearing patients getting worse post treatment.  Perhaps unchanged, but not worse.  
I think there is always risk to damage healthy areas with poor technique but as the treatment itself if regenerative, it seems highly unlikely.  
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FocusWaveClinic

Quote from: projectpd on January 17, 2023, 05:42:46 PM
I already referred exactly to the study linked in his own references , if he has no clue about what he's posted or has no interest it,  it does no good for us to provide the link.
I didn't link this study.
Probably not enough shocks - only 2,000 per treatment.  This is about half of what we use in our clinic per treatment.

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FocusWaveClinic

Quote from: Trapper on January 15, 2023, 01:40:57 PM
ProjectPD, I feel like from previous penile injuries I have healed better and faster when not taking NSAIDS but interestingly Dr. Trost says there is weak evidence for their us. So who really knows. But they have been shown to have a depressant effect on wound healing while simultaneously decreasing the granulocytic inflammatory reaction. So the trade off is to decrease inflammation but slow wound healing.

Also, the guy asking patients how to do ESWT is 2nd funniest thread after the cabbage leaf thread lol
LOL - I'm not asking how to do it.  
You do realize that medical professionals share information, technique, strategy, etc.  
I guess these forums don't have any such professionals...
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blex

Quote from: projectpd on January 17, 2023, 05:51:39 PM
Interesting Blex, did you get the impression he was skeptical from before his study or after it ?
I honestly can't comment much on this. Had an appointment for 30 mins and we mostly talked about surgery.
But it should be noted that he did a meta-analysis in 2019 about ESWT for ED Treatment with following positive result:
QuoteIn conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.

So it seems he does not think ESWT is damaging per se. So always remember to take single studies with a grain of salt, this goes in either direction.
36 years old, married
---
Symptoms since trauma in July 21:
First calcified nodule in septum near glans
Multiple calcified plaques developed on top
Pain (flaccid/erect), 75° upwards curvature, hourglassing
---
Nothing helped, looking for surgery now

blex

Quote from: FocusWaveClinic on January 19, 2023, 08:11:45 PM
LOL - I'm not asking how to do it.  
You do realize that medical professionals share information, technique, strategy, etc.  
I guess these forums don't have any such professionals...

I wish you and especially your patients all the success in the world.
But to be honest, your demeanor does not inspire confidence.
36 years old, married
---
Symptoms since trauma in July 21:
First calcified nodule in septum near glans
Multiple calcified plaques developed on top
Pain (flaccid/erect), 75° upwards curvature, hourglassing
---
Nothing helped, looking for surgery now

FocusWaveClinic

Quote from: blex on January 20, 2023, 08:53:37 AM
I wish you and especially your patients all the success in the world.
But to be honest, your demeanor does not inspire confidence.
All I want is to help.  Honestly.  
My demeanor has been clear - I'm not pushing some magic beans here - and I'm ok with being attacked by frustrated guys - I can handle it.  I talk with hundreds of them every month.  
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LWillisjr

Continuing this topic is not going anywhere and I think points on EWST have been made. I am going to lock this topic from further posting and any further contacts can be made through personal messages.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History