Focused Shockwave Therapy (Li-ESWT) | REVIVO

Mechanism of action

How does focused shockwave work?

The erectile tissue (corpus cavernosum) works like a sponge, threaded with roughly one million tiny blood vessels. During an erection, those vessels fill with blood. As you age, vessels are gradually lost and the sponge fills less effectively. Shockwave therapy stimulates the formation of new blood vessels, restoring the network so the tissue can fill optimally again.

Neovascularisation

Formation of new blood vessels in the treated tissue, structurally improving blood flow.

Angiogenesis

Stimulation of growth factors (VEGF) that promote the development of vascular networks.

NO pathway activation

Activation of the nitric oxide pathway, essential for vasodilation and erectile function.

Stem cell activation

Mobilisation of endogenous stem cells to the treated area for tissue regeneration.

Fibrosis reduction

Breakdown of fibrotic (hardened) tissue that restricts blood flow and elasticity.

Treatment protocol

Your pathway in detail

A standardised protocol based on available clinical evidence. Every session is performed under the responsibility of the physician.

6-12

Sessions, depending on indication and response

1-2x

Per week, spread over 6-12 weeks

Minutes per session, without anaesthesia

0.09

mJ/mm² energy density per pulse

Equipment: Storz Medical Duolith SD1 T-Top "ultra"

We work exclusively with the Storz Duolith SD1 T-Top, the device used in the majority of clinical studies. Medically certified, focused, and proven in urological practice. Not a generic wellness device.

Timeline

When can you expect results?

Regenerative therapy does not work like a pill. The body needs time to form new vascular tissue. This is the expected progression.

Week 2-4

First subtle improvements. Some men report improved morning erections and sensitivity.

First signs

Month 3-6

Clear improvement in erectile function for responders. Measurable in IIEF score and EHS. This is when we formally evaluate.

Clear improvement

Month 6-12

Optimal results. Neovascularisation is at its strongest. After 12 months, the final evaluation uses the same baseline measurements.

Optimal results

Evidence

What the evidence says

We always distinguish between what we know, what we suspect, and where the evidence is still insufficient.

21 RCTs

Cochrane Systematic Review 2025: 21 randomised controlled trials with a total of 1,357 patients. IIEF improvement of 3 to 5.25 points.

Recognised as a treatment option by the EAU (2024). 7+ meta-analyses confirm significant improvement. Long-term data beyond 12 months are limited.

How much improvement can I expect?
On average 3 to 5.25 points on the IIEF scale. For the individual patient, this can mean the difference between "it doesn't work" and "it works again". In well-selected patients, we see that the majority experience noticeable improvement.
How strong is the scientific evidence?
More than seven international meta-analyses show significant improvement in erectile function. The European Association of Urology (EAU) recognises LI-ESWT as a treatment option for vasculogenic ED. The evidence is growing, but long-term data beyond 12 months are not yet available.
Is this a proven therapy?
It is a therapy with growing scientific support: recognised by the EAU, backed by multiple meta-analyses, and applied daily in urological clinics worldwide. Not every man responds equally strongly. That is why we measure individually and advise based on your own response.

Comparison

Focused vs. radial

Not all shockwave is the same. The difference between focused and radial equipment is clinically relevant.

Feature

Focused (Li-ESWT)

Radial (rESWT)

Penetration depth

Up to 12 cm. Reaches cavernous tissue

3-4 cm

CLINICAL DIFFERENCE

Clinical evidence

Majority of RCTs conducted with focused equipment

Limited

Classification

Medical device, class IIb

Often wellness

Precision

Targeted at specific anatomical locations

Superficial, dispersed

Indication

Who is shockwave most suitable for?

Shockwave therapy does not work equally well for everyone. The outcome strongly depends on the cause and severity of your symptoms.

Best indication IIEF 11-17

Vasculogenic erectile symptoms, moderate severity. This is the group for which the most evidence is available. The chance of clinically relevant improvement is greatest here.

Good indication IIEF 17-21

Mild erectile symptoms. Men in this group often notice subtle but valuable improvements: more spontaneous erections, less dependence on medication.

Limited indication IIEF <11

Severe erectile symptoms. The evidence for this group is limited. A combination therapy or alternative treatment may be more appropriate. We discuss this at the intake.

Prostate application NEW

Shockwave can also be targeted at the prostate for chronic prostate inflammation. In that case, it is combined with our prostate treatment for optimal effect.

Safety

Side effects and risks

Shockwave therapy is a non-invasive treatment with a favourable safety profile. No serious side effects have been reported in the clinical literature.

Mild pain during the session, disappears immediately

Temporary bruising, disappears within days

Serious side effects reported in clinical studies

Frequently asked questions

What men ask about shockwave therapy

Most men experience no significant pain. About 8% report mild pain during the session, which disappears on its own. No anaesthesia is needed and you can go home right after the session.

Initial improvements are typically noticeable after 2 to 4 weeks. Clear improvement builds over 3 to 6 months. Optimal results are achieved at 6 to 12 months. We measure at baseline and at 1, 3, 6 and 12 months.

Yes, but you don't have to. Many men stop their medication from day one to experience the treatment effect in its pure form. For mild to moderate symptoms, this is often perfectly feasible. Others keep their medication and gradually taper off. Shockwave and PDE5 inhibitors also work well together. The physician discusses what suits your situation at the intake.

Focused shockwave penetrates up to 12 cm deep and reaches the cavernous tissue precisely. Radial devices only reach 3-4 cm. Virtually all clinical studies have been conducted with focused equipment. We exclusively use the Storz Duolith SD1 T-Top: a medical device, not a wellness device.

The physician treats five to six locations on the erectile tissue with focused shockwave. In addition, trigger points in the perineum and pelvic floor are treated directly. At a trigger point you may feel a brief, sharp pressure. The physician stays on that spot until the tension releases. After the session, you can exercise, work and be sexually active straight away. There are no restrictions.

Yes. Before we apply shockwave to the prostate, your PSA level (prostate-specific antigen) must be known. An elevated PSA may indicate an underlying issue that needs to be ruled out first. The physician discusses this at the intake and requests blood work if necessary.

Yes. Supplements such as omega 3/6/9 fatty acids, zinc, L-arginine and L-carnitine support circulation and the recovery process. Our physician takes these himself and recommends them six to eight months per year. On top of that: stand up every two to three hours if you sit a lot, and do twenty squats. Those small breaks noticeably improve blood flow in the pelvic area.

After the course we measure at set intervals whether the result holds. Some men choose a preventive maintenance session every six months, similar to a dental check-up. That is not mandatory, but it can help maintain the result long term.