Amid the growing market for shock wave therapy (SWT) as a treatment for erectile dysfunction (ED), a study published in Urology practice assessed emerging trends for treatment in 8 major US cities.1

The researchers identified 152 clinics across cities that offered SWT as an ED treatment. About two-thirds (65%) of clinics had complete information about their use of the SWT. Urologists made up only 25% of SWT providers in clinics, and 13% of providers were non-physicians.

Based on individual patient circumstances, therapy ranged from one treatment to indefinite treatments at an average price of $3,338.28 for a full treatment. The average cost for an individual session of a given SWT treatment course was $491.22.

“SWT, as a restorative therapy for erectile dysfunction, is mostly practiced by non-urologists and is not standardized. Direct-to-consumer marketing is used to target men in distress. This study highlights trends of concern in major metropolitan markets, given the substantial financial impact for patients and inconsistent referrals between providers. Additionally, these results suggest that patients frequently seek care for erectile dysfunction from non-urologists,” wrote the study authors.

The 8 US cities used for the study were Los Angeles, New York, Houston, Philadelphia, Atlanta, Boston, Dallas and Washington, DC. Google was used to identify SWT providers in these metropolitan areas. The search terms used were “Shockwave therapy for erectile dysfunction in [city]; » “Shockwave Therapy for ED in [city]; and “GAINSWave in [city]. To collect the data, investigators implemented a “secret client” approach, in which they called clinics to gather information about the provider, price and course of treatment.

The researchers found that there was a lack of standardization across clinics regarding the use of focused shockwave therapy (fSWT) versus acoustic or radial wave therapy (rWT), the location of shock wave delivery (eg, perineal, penile) and treatment. protocol. Treatment courses consisted of a wide variety of session totals, with 6 being the most common. There was no consistency regarding the devices used for the procedure, the number of shocks during each session, or the energy and frequency parameters.

There were 18 different provider types among physicians offering SWT. Investigators specifically drew attention to the fact that the fourth most common type of provider among physicians was those trained in obstetrics and gynecology. “These physicians see no male patients for the duration of their training, including any formal instruction in the pathogenesis and treatment of male sexual dysfunction,” the authors wrote.

In nearly half (n = 3) of cities, SWT was offered by as many or more non-physician providers as it was offered by urologists. Non-physician SWT providers included physician assistants, nurse practitioners, chiropractors, and naturopathic providers.

There was a wide variation in the cost of SWT treatment courses, from a low of $600 for all sessions at an Atlanta clinic to a high of $16,200 at a New York site.

In an accompanying editorial2 published concurrently with the article, Jonathan N. Rubenstein, MD, Chesapeake Urology Associates, emphasized the importance of urologists taking full responsibility for the evaluation and treatment of patients with erectile dysfunction.

“We all agree that urologists are best qualified to assess and appropriately treat patients with erectile dysfunction due to our advanced training and expertise in genitourinary physiology and pathophysiology,” Rubenstein wrote.

“We need to own this space,” Rubenstein added, “We need to understand which patients can benefit from which therapies, and do everything we can to bring patients into our offices for proper assessment and discussion of treatment options, even if it means offering alternative therapies. If we do, we must be honest with the patient’s risks (including financial risks) and explain if a therapy is unlikely to work for them and not offer if they are unlikely to receive it. We cannot control whether others do, and we cannot control whether a patient ultimately seeks care elsewhere or does not follow our recommendations. However, at least , we offered them the best possible medical advice and care based on our expertise.


1. Weinberger JM, Shahinyan GK, Yang SC, et al. Shockwave Therapy for Erectile Dysfunction: Marketing and Practice Trends in Major United States Metropolitan Areas. Urology practice. 2022;9(3)212-219. doi: 10.1097/UPJ.0000000000000299

2.Rubenstein JN. Editorial Commentary. Shockwave Therapy for Erectile Dysfunction: Trends in Marketing and Practice in Major United States Metropolitan Areas. Urology practice. 2022;9(3)218-219. doi: 10.1097/UPJ.0000000000000299.01