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UPJ INSIGHT Shock Wave Therapy for Erectile Dysfunction: Marketing and Practice Trends in Major Metropolitan Areas in the United States
By: James M. Weinberger, MD, MBA; Gary K. Shahinyan, BS; Shangyang C. Yang, BS; Robert H. Shahinyan, MD; Jesse N. Mills, MD; Sriram V. Eleswarapu, MD, PhD | Posted on: 01 May 2022
Weinberger JM, Shahinyan GK, Yang SC et al: Shock wave therapy for erectile dysfunction: marketing and practice trends in major metropolitan areas in the United States. Urol Pract 2022; https://doi.org/10.1097/UPJ.0000000000000299.
Study Need and Importance
The market for erectile dysfunction (ED) therapies has flourished under the paradigm of direct-to-consumer (DTC) advertising. The DTC landscape has emboldened many for-profit men’s health clinics to expand beyond “low T [testosterone] therapy,” their traditional stock-in-trade, to experimental treatments like shock wave therapy (SWT) for ED, despite professional society guidelines designating SWT as “investigational” for ED. Little is known about these clinics, provider credentials, cost of treatment and treatment protocols. We used a “secret shopper” methodology to shed light on this area.
What We Found
SWT is offered primarily by nonurologists. Only 25% of providers offering SWT were urologists, while 13% were nonphysicians (eg chiropractors, advanced practice providers, naturopaths; see figure). Pricing was high across all 8 metropolitan areas, with an average price per treatment course of $3,338. There was no standardization regarding focused shock wave vs radial wave therapy, site of shock wave delivery or treatment protocol.
Limitations
The 8 populous metropolitan areas selected may not be representative of other large metropolitan areas nor small metropolitan or rural areas. Further, a fraction of the cohort (18%) indicated that a formal consultation with a provider was required before pricing and protocol could be determined. This may have biased the sample toward clinics offering more of a “one-size-fits-all” approach.
Interpretation for Patient Care
SWT, as a purported regenerative therapy for ED, is performed primarily by nonurologists and is not standardized. DTC marketing trends do not reflect the status of the evidence base; this comes at great financial cost to patients. ED can portend significant morbidities. Patients contending with ED should be evaluated by urologists who are equipped to conduct a formal men’s health evaluation and provide a data-driven and patient-centric discussion of treatment options.