Shock Wave Therapy (ESWT) in Turkey

Shock Wave Therapy (ESWT) is a non-invasive treatment method that reduces pain and accelerates healing by applying high-energy acoustic waves to the target tissue. It increases circulation in musculoskeletal system diseases, supports cellular repair, and brings chronic inflammation under control.

The phrase how shock wave therapy is applied describes a procedure carried out in sessions and generally lasting 10–20 minutes. During the application, focused waves are delivered to the designated area with a special device, it does not require anesthesia, and patients can quickly return to their daily lives after the procedure.

Under the heading of which diseases ESWT is used for, conditions such as heel spur, tennis elbow, shoulder calcification, and tendinitis stand out. In addition, it is also effective in muscle spasms and connective tissue injuries and finds a place in clinical practice as an alternative to surgery.

When the side effects and effectiveness of shock wave therapy are evaluated, generally no serious complications are seen apart from mild redness and temporary sensitivity. Scientific studies show that when applied regularly, it provides a significant reduction in pain scores and functional improvement.

What Is Shock Wave Therapy (ESWT) in Urology?

In medical literature, the term extracorporeal means applied from outside the body. Shock waves, on the other hand, are high-energy acoustic vibrations characterized by sudden pressure increases that travel much faster than the speed of sound in air or liquid environments. Shock wave therapy used in the treatment of urological disorders is based on the principle that this powerful physical energy creates a controlled stimulus on biological tissues.

The historical development of this technology is quite impressive. High-energy systems were first developed in the 1980s to break up kidney stones and greatly eliminated the need for open surgery. However, scientists noticed that as these high-energy shock waves passed through the tissues around the kidney, they triggered the formation of new capillaries in those areas. This accidental finding opened a new horizon in medicine. When the energy level was lowered, it was understood that the waves awakened cellular regeneration mechanisms in the tissue instead of breaking the tissue apart.

In today’s urology clinics, this principle lies at the very center of the concept of “regenerative medicine.” Instead of giving the patient a drug that must be used continuously or planning a surgical operation that carries risks, the aim is to reconstruct the damaged area by using the body’s own healing potential. Fundamental problems such as inadequate blood flow, tissue hardening, or chronic inflammation are attempted to be resolved through these mechanical signals sent from outside the body.

What Biological Effects Does Shock Wave Therapy (ESWT) Create in the Body?

Our body has a tremendous repair system that is activated in the event of any trauma or damage. What shock wave therapy does is actually to activate the body’s dormant repair factories by creating a “false microtrauma” in the tissue. This process is called mechanotransduction in biology. In this process, where mechanical energy is transformed into a chemical healing signal at the cellular level, many different mechanisms are activated at the same time.

When these waves hit the tissue, the stretching and tension occurring in the cell membranes send a command to the cell nucleus to produce repair proteins. The most striking result of this command in the tissue is the formation of new vascular networks. Especially the microscopic vascular beds that are blocked, narrowed, or have lost their function due to causes such as diabetes, hypertension, or advanced age are revitalized again thanks to these stimuli.

The main mechanisms triggered at the cellular level are as follows:

• Angiogenesis
• Vasodilation
• Proliferation
• Anti-inflammation

The process of new vessel formation here begins with the secretion of a special protein called Vascular Endothelial Growth Factor (VEGF). This protein enables fresh, healthy new capillaries with a high blood-carrying capacity to sprout from the terminal parts of existing vessels. At the same time, the release of a highly critical molecule called nitric oxide from the inner surfaces of the vessels increases. Nitric oxide relaxes the smooth muscles in the vessel walls, making it easier for blood to surge into the tissues. In addition to all these vascular improvements, stem cells circulating from all over the body migrate to the area where the shock wave is applied and help build healthy cells in place of damaged tissues.

With Which Technologies Do Shock Wave Therapy (ESWT) Devices Work?

Systems that produce shock waves have different technological infrastructures depending on how they generate energy and how they transfer this energy to the tissue. According to the needs of the clinic and the depth of the tissue to be treated, these different systems have various advantages over one another. Basically, there are three main technologies used for medical purposes.

The methods used in the production mechanisms of the devices are as follows:

• Piezoelectric
• Electromagnetic
• Electrohydraulic

In piezoelectric systems, there are many small crystal structures inside the device. When electric current is applied to these crystals, they suddenly expand and contract, creating acoustic waves in the surrounding water. These systems are extremely successful in focusing energy on a very narrow and specific point. They are especially preferred in situations where deep tissues need to be reached and the target is very small.

Electromagnetic systems work on the principle of an electromagnet. Electric current passes through a large coil, creating a magnetic field, and this field suddenly pushes a metallic membrane to generate the sound wave. These generated waves are then focused onto the target tissue with the help of acoustic lenses. This method ensures that the energy is spread homogeneously over a wider area within the tissue and is quite popular in current urological treatments in terms of ease of use.

Electrohydraulic systems are the oldest and most classical approach. A high-voltage electrical spark is generated between two electrodes inside a water-filled capsule. This spark creates an instant vaporization bubble in the water, and when the bubble bursts, a powerful shock wave is released. These waves hit a reflective surface and are directed toward the tissue. Although they have generally been used in stone breaking procedures requiring high energy, they are also used effectively in tissue regeneration with low energy settings.

What Are the Energy Levels Used During Shock Wave Therapy (ESWT)?

The most fundamental factor distinguishing shock wave therapy from breaking kidney stones or other orthopedic hard tissue interventions is the energy density parameter entered into the device. In medicine, this value is called “Energy Flux Density” and it refers to the amount of energy transferred to each square millimeter of tissue. Delivering the right energy to the right tissue is the key to treatment success.

The energy classifications used in clinical practice are as follows:

• Low
• Medium
• High

The low-density energy level is a very sensitive range that we use in urology for tissue regeneration purposes and generally varies between 0.08 and 0.15 mJ/mm². The energy at this level does not damage cells, does not cause pain to the patient, and does not cause any tearing or bleeding in the tissue. It only applies a controlled physical pressure to the outer membrane of the cell that is sufficient to initiate biological awakening.

If we increase the energy level to medium levels, the mechanical destructive properties of the shock waves begin to come into play gradually. This level is generally preferred for softening hard calcifications accumulated in the body or resolving chronic hardenings in tendons. The high levels, at which the energy is increased even more, are directly intended for stone breaking, and at these levels the aim is not tissue repair but mechanical fragmentation. Therefore, in urological regenerative treatments, it is of great importance that these parameters on the device screen are adjusted with millimetric precision.

How Is Shock Wave Therapy (ESWT) Applied in Erectile Dysfunction?

Erectile dysfunction, medically known as erectile dysfunction, is among the areas where shock wave therapy is most widely used worldwide and whose effectiveness has been proven by countless scientific studies. A healthy erection mechanism requires a perfectly functioning vascular network and sufficient blood pressure to fill these vessels. Factors such as advancing age, smoking, diabetes, high cholesterol, or cardiovascular diseases weaken the blood flow to the penis over time. Shock wave therapy comes into play to repair and rebuild this weakened vascular network from within.

The treatment process proceeds in an extremely comfortable way. The patient does not need to make any surgical preparation, remain hungry, or receive anesthesia. The procedure, which is performed in a special examination room or outpatient clinic setting, takes an average of twenty minutes. A standard ultrasound gel is applied to the treatment area to increase transmission. Then the treatment head of the device is placed in contact with specific points over the right and left spongy tissues (corpora cavernosa) of the penis.

The anatomical regions where the procedure is applied are as follows:

• Right
• Left
• Root
• Shaft

During each session, thousands of acoustic pulses are sent in total to these different points. The patient does not feel any pain or soreness during the procedure; only a slight clicking sound from the head of the device and small vibrations on the skin are perceived. When these vibrations reach the vascular beds under the skin, they initiate the cellular reconstruction process.

The effects of the treatment do not appear instantly like taking a painkiller. Because the sprouting of new vessels, the increase in tissue oxygenation capacity, and the repair of nerve endings require physiological time. Patients generally begin to notice a significant improvement in erection quality, the frequency of morning erections, and sexual performance from the fourth or sixth week after the start of treatment. It generally takes until the third month for the full effect to be seen and for regeneration in the tissue to reach its peak. The persistence of the effect may last for years depending on the patient’s lifestyle and whether the underlying health problems are under control.

How Does Shock Wave Therapy (ESWT) Benefit Peyronie’s Disease (Penile Curvature)?

Peyronie’s disease is a condition characterized by the formation of hard, fibrotic, and calcified plaques on the sheath tissue (tunica albuginea) located in the internal structure of the penis and having the ability to stretch. Because these plaques eliminate flexibility in that region of the penis, during erection the penis bends toward the side that cannot stretch, resulting in severe curvatures. The early stages of the disease are generally accompanied by severe pain. In this challenging condition, shock wave therapy is one of the most important interventions that change the course of the disease.

The treatment applied in this disease is somewhat different from the protocol applied in erectile dysfunction. Here, the aim is not only to increase blood circulation but also to force that hardened tissue block to reshape at the cellular level by shaking it.

The main conditions in which benefit is provided during the disease process are as follows:

• Pain
• Hardness
• Curvature
• Inflammation

The fastest and most obvious benefit offered by the treatment to patients is the control of pain. Especially in the first stages of the disease (acute phase), the severe pain that makes sexual intercourse impossible decreases dramatically within a few sessions thanks to the shock waves dispersing the inflammatory cells in the area and soothing the pain nerves.

After pain relief, the treatment focuses on the physical structure of the plaque. Acoustic waves disrupt the structure of the hardened collagen tissue at a microscopic level, helping to stop the plaque from progressing, growing further, and the curvature from worsening to a more severe angle. Although it is not possible to completely eliminate fully calcified, bone-hard advanced plaques with shock waves, some restoration of tissue flexibility can be achieved. Because it is more difficult to break the resistance of the tissue in Peyronie treatments, the number of sessions is generally kept longer and an intensive treatment schedule is planned according to the degree of the disease.

Is Shock Wave Therapy (ESWT) Effective in Chronic Prostatitis?

Chronic prostatitis, or with its full medical name chronic pelvic pain syndrome, is one of the most common conditions among men presenting to urology outpatient clinics, yet it is also one of the most challenging to treat for both the patient and the physician. Patients feel a dull, continuous pain that consumes their life energy in the groin area, testicles, lower back, and around the anus for months, sometimes years. This picture is accompanied by burning during urination, the need to go to the toilet frequently, and pain felt after ejaculation. Classical antibiotic courses or standard painkillers often do not provide a permanent solution.

This is exactly where shock wave therapy comes into play with the healing effect it creates in the depths of the tissue. In the treatment of this disease, the application is not made to the penis, but directly to the pelvic floor, that is, the area called the perineum located between the anus and the scrotum. The acoustic waves sent through the skin pass through the pelvic muscles and reach directly the inflamed and contracted prostate gland.

The main complaints in which improvement is seen thanks to this treatment are as follows:

• Spasm
• Edema
• Burning
• Aching

Shock waves disperse the edema accumulated around the prostate gland and stop the chronic inflammation process at the cellular level. At the same time, they stimulate the pelvic floor muscles, which remain contracted as if in a cramp due to constant pain, allowing them to relax. With the increase in tissue oxygenation and the regulation of blood flow, the constant feeling of heaviness and pressure felt by patients begins to disappear. In questionnaires measuring patients’ complaint scores, very high rates of reduction in pelvic pain have been detected after regularly applied shock wave sessions. The reduction of pain directly improves patients’ urination pattern, sleep quality, and psychological resilience.

What Are the Side Effects of Shock Wave Therapy (ESWT)?

Whenever any medical procedure is involved, reliability and side effects are among the most wondered-about topics. Shock wave therapy stands out as one of the most respectful methods toward body tissues and one with the lowest complication rates among holistic medical approaches. The fact that the procedure does not require anesthesia, does not create any incision in the skin, and does not carry a risk of infection are its greatest advantages.

After the application, patients can directly put on their clothes and return to their daily activities, work, or social life without needing to rest in the clinic. No special care, dressing, or recovery process is required after the procedure. However, as with any physical intervention, some extremely mild and entirely temporary reactions may be observed due to the mechanical effect of the shock waves on the tissue.

The possible temporary situations that may be encountered are as follows:

• Redness
• Tingling
• Sensitivity
• Bruising

These symptoms generally concentrate at the points where the acoustic wave contacts the skin. As a result of the new blood flow created under the skin in the treated area, a slight feeling of warmth or a pinkish redness may appear. In people with very sensitive skin, very small-scale cracks may occur in the capillaries due to the vibration created by the waves, and this may manifest as tiny red spots the size of a pinhead or very mild superficial bruising on the surface. It is entirely normal physiological reactions to feel slight numbness or extra sensitivity to touch in that region for a few hours after the procedure, and these usually disappear on their own within one or two days without requiring any medical intervention.

To Whom Should Shock Wave Therapy (ESWT) Not Be Applied?

Although shock wave therapy has an extremely safe and non-surgical procedure profile, due to its fundamental physical principles it is not considered medically appropriate for individuals with certain special health conditions. These conditions, called contraindications in medicine, are definite rules established with the aim of placing patient safety above everything else. During the urological evaluation, the physician decides on the suitability of the treatment by analyzing in detail the patient’s general medical history, the medications they use, and accompanying diseases.

The main patient groups in which the treatment may pose a risk are as follows:

• Hemophiliacs
• Those with infections
• Those with tumors
• Those with pacemakers

The first and most important restriction includes those with serious diseases related to the blood clotting system. In people with diseases such as hemophilia, where clotting factors are deficient, or in patients who use heavy anticoagulant drugs that thin the blood to a very high degree due to reasons such as heart valve surgery, the tissue pressure changes created by acoustic waves may lead to uncontrolled subcutaneous or deep tissue bleeding.

Another important rule concerns the health status of the area where the treatment is planned. If there is an active infection in the area to be treated or in the general body system, high fever, open skin wounds, or serious dermatological diseases, the treatment should be postponed until these conditions are completely healed. In addition, due to the cell proliferation-triggering effects created by shock waves, the use of this energy is absolutely inadvisable in the presence of a known or suspected tumor, cancerous tissue near the application area. Finally, because shock waves may create electromagnetic fields or disrupt sensitive electronic systems through mechanical vibrations, the use of the device in patients with pacemakers must be subjected to a very serious risk analysis.

What Should Be Done to Increase the Success of Shock Wave Therapy (ESWT)?

Low-intensity shock wave therapy is a wonderful accelerator used to awaken damaged tissues and initiate the reconstruction process; however, seeing this technology as a magical wand rather than accepting it as a powerful part of the healing process is a much more accurate approach. In order for new and healthy capillaries to form in your body, for nerve endings to be repaired, and for the oxygenation capacity of the tissue to increase, the waves coming from the machine alone are not sufficient. For these awakened cells to proliferate in a healthy way, the internal environment of the body, that is, your blood values, hormones, and lifestyle habits, must also support this reconstruction.

The most critical lifestyle factors that will support this process are as follows:

• Exercise
• Nutrition
• Sleep
• Hydration

The use of cigarettes and tobacco products is the greatest enemy that disrupts the healthy structure of the inner surface of the vessels (endothelium) and prevents blood flow by constricting the capillaries. While shock wave therapy is trying to open new pathways inside, nicotine entering the body can instantly block these pathways and nullify the entire effect of the treatment. Therefore, staying absolutely away from smoking during and after the treatment process is the most fundamental key to success.

Similarly, the lack of control of blood sugar prevents the formation of new vessels, especially in diabetic patients. Regular and brisk walking and aerobic exercises that increase the heart rate provide tremendous support to the angiogenesis (new vessel formation) process created by the shock wave by accelerating the general blood circulation in the body. As for nutrition, it is necessary to adopt a vessel-friendly approach.

The food sources that should be preferred during the treatment process are as follows:

• Vegetables
• Fruits
• Fish
• Nuts

A Mediterranean-type diet, rich in olive oil, fresh vegetables, and fruits, and far from refined sugar and processed foods, provides the quality building blocks needed by the cells in the repair process. Especially in stubborn cases, physicians may also plan shock wave therapy simultaneously with other modern methods that support tissue repair, for example platelet-rich plasma (PRP) applications obtained from blood, in order to maximize the effect of the treatment. When all these components come together, shock wave therapy turns into a very long-lasting and permanent success story in regaining urological health.