Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction
Purpose: Physiological aging is associated with microvascular dysfunction, including in the penis, and this may contribute to age-related erectile dysfunction (ED). Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a non-invasive intervention for ED, but its effect on penile microvascula...
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Korean Society for Sexual Medicine and Andrology
2025-04-01
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| Series: | The World Journal of Men's Health |
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| author | Saager Tilak Chawla Jad Shahan Nolan Soutipan Samuel Ryan Sorkhi Yong Sun Choi Woong Jin Bae Sae Woong Kim Tung-Chin Hsieh Mahadevan Raj Rajasekaran |
| author_facet | Saager Tilak Chawla Jad Shahan Nolan Soutipan Samuel Ryan Sorkhi Yong Sun Choi Woong Jin Bae Sae Woong Kim Tung-Chin Hsieh Mahadevan Raj Rajasekaran |
| author_sort | Saager Tilak Chawla |
| collection | DOAJ |
| description | Purpose: Physiological aging is associated with microvascular dysfunction, including in the penis, and this may contribute to
age-related erectile dysfunction (ED). Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a non-invasive intervention
for ED, but its effect on penile microvascular function, remains unclear. Our objectives are to (i) evaluate the effect of Li-
ESWT (specifically radial type ESWT [rESWT]) on penile microvascular perfusion (PMP) in aging rats, (ii) elucidate a possible
mechanism, and (iii) evaluate its impact on angiogenic and smooth muscle biomarkers in cavernosal tissue.
Materials and Methods: Male rats (n=9; 15–18 months) were anesthetized and subjected to rESWT while monitoring PMP.
The nitric oxide (NO) pathway involvement was assessed by measuring the effect of rESWT on PMP following an intracavernosal
injection of N(G)-nitroarginine methyl ester (L-NAME) (NO synthase inhibitor). To elucidate the cellular mechanism,
another group of rats received repeated rESWT (n=4) or no treatment (n=4) three times/week for two weeks. Rats were euthanized
at the end of the study and penile tissues were analyzed for angiogenic markers (vascular endothelial growth factor-
A [VEGF-A], endothelial nitric oxide synthase [eNOS]) and smooth muscle content (α-actin) using immunostaining, Western
blot, and quantitative polymerase chain reaction (qPCR).
Results: rESWT resulted in more than a 2-fold increase in PMP (from 68.5 arbitrary units; 163.7 AU). L-NAME injection produced
a <40%–50% decrease (185.3 to 101.0 AU) in rESWT-induced PMP response. Immunostaining revealed increased
α-actin, eNOS, and VEGF-A in the cavernosum and these findings were confirmed by qPCR and Western blot results.
Conclusions: rESWT improved PMP, which may be mediated via increased VEGF expression, which stimulates the NO/cyclic
guanosine monophosphate pathway, resulting in sustained PMP. rESWT devices could offer a safe, non-invasive treatment for
age-related ED. |
| format | Article |
| id | doaj-art-4691fce3ffa741f58d1bcd75223858b6 |
| institution | DOAJ |
| issn | 2287-4208 2287-4690 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Korean Society for Sexual Medicine and Andrology |
| record_format | Article |
| series | The World Journal of Men's Health |
| spelling | doaj-art-4691fce3ffa741f58d1bcd75223858b62025-08-20T02:41:59ZengKorean Society for Sexual Medicine and AndrologyThe World Journal of Men's Health2287-42082287-46902025-04-0143239640610.5534/wjmh.240032Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile DysfunctionSaager Tilak Chawla0https://orcid.org/0009-0009-3864-4251Jad Shahan1https://orcid.org/0009-0006-5408-4125Nolan Soutipan2https://orcid.org/0009-0006-1456-8707Samuel Ryan Sorkhi3https://orcid.org/0000-0002-0454-3390Yong Sun Choi4https://orcid.org/0000-0003-2903-0812Woong Jin Bae5https://orcid.org/0000-0001-7703-1161Sae Woong Kim6https://orcid.org/0000-0002-9127-9400Tung-Chin Hsieh7https://orcid.org/0000-0002-4149-7610Mahadevan Raj Rajasekaran8https://orcid.org/0000-0003-4188-1628Department of Research Service, San Diego VA Healthcare System, San Diego, CA, USADepartment of Research Service, San Diego VA Healthcare System, San Diego, CA, USADepartment of Research Service, San Diego VA Healthcare System, San Diego, CA, USADepartment of Research Service, San Diego VA Healthcare System, San Diego, CA, USADepartment of Urology, College of Medicine, The Catholic University of Korea, Seoul, KoreaDepartment of Urology, College of Medicine, The Catholic University of Korea, Seoul, KoreaDepartment of Urology, College of Medicine, The Catholic University of Korea, Seoul, KoreaDepartment of Urology, University of California, San Diego, CA, USADepartment of Research Service, San Diego VA Healthcare System, San Diego, CA, USAPurpose: Physiological aging is associated with microvascular dysfunction, including in the penis, and this may contribute to age-related erectile dysfunction (ED). Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a non-invasive intervention for ED, but its effect on penile microvascular function, remains unclear. Our objectives are to (i) evaluate the effect of Li- ESWT (specifically radial type ESWT [rESWT]) on penile microvascular perfusion (PMP) in aging rats, (ii) elucidate a possible mechanism, and (iii) evaluate its impact on angiogenic and smooth muscle biomarkers in cavernosal tissue. Materials and Methods: Male rats (n=9; 15–18 months) were anesthetized and subjected to rESWT while monitoring PMP. The nitric oxide (NO) pathway involvement was assessed by measuring the effect of rESWT on PMP following an intracavernosal injection of N(G)-nitroarginine methyl ester (L-NAME) (NO synthase inhibitor). To elucidate the cellular mechanism, another group of rats received repeated rESWT (n=4) or no treatment (n=4) three times/week for two weeks. Rats were euthanized at the end of the study and penile tissues were analyzed for angiogenic markers (vascular endothelial growth factor- A [VEGF-A], endothelial nitric oxide synthase [eNOS]) and smooth muscle content (α-actin) using immunostaining, Western blot, and quantitative polymerase chain reaction (qPCR). Results: rESWT resulted in more than a 2-fold increase in PMP (from 68.5 arbitrary units; 163.7 AU). L-NAME injection produced a <40%–50% decrease (185.3 to 101.0 AU) in rESWT-induced PMP response. Immunostaining revealed increased α-actin, eNOS, and VEGF-A in the cavernosum and these findings were confirmed by qPCR and Western blot results. Conclusions: rESWT improved PMP, which may be mediated via increased VEGF expression, which stimulates the NO/cyclic guanosine monophosphate pathway, resulting in sustained PMP. rESWT devices could offer a safe, non-invasive treatment for age-related ED.erectile dysfunctionextracorporeal shockwave therapyfibrosislaser speckle contrast imagingmicrocirculationpenis |
| spellingShingle | Saager Tilak Chawla Jad Shahan Nolan Soutipan Samuel Ryan Sorkhi Yong Sun Choi Woong Jin Bae Sae Woong Kim Tung-Chin Hsieh Mahadevan Raj Rajasekaran Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction The World Journal of Men's Health erectile dysfunction extracorporeal shockwave therapy fibrosis laser speckle contrast imaging microcirculation penis |
| title | Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction |
| title_full | Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction |
| title_fullStr | Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction |
| title_full_unstemmed | Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction |
| title_short | Radial Type Low-Intensity Extracorporeal Shockwave Therapy Enhances Penile Microvascular Perfusion in an Aging Rat Model: A Novel Interventional Strategy to Treat Erectile Dysfunction |
| title_sort | radial type low intensity extracorporeal shockwave therapy enhances penile microvascular perfusion in an aging rat model a novel interventional strategy to treat erectile dysfunction |
| topic | erectile dysfunction extracorporeal shockwave therapy fibrosis laser speckle contrast imaging microcirculation penis |
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