TL;DR: Erectile dysfunction (ED) is treated in Busan using a 4-tier ladder based on IIEF-5 score and penile Doppler ultrasound. Tier 1: PDE5i ($200–$400). Tier 2: LiSWT shockwave 6 sessions ($1,100–$1,400). Tier 3: ICI injection training ($350–$500). Tier 4: penile implant ($9,200–$12,000). English consultation direct with urologist.
ED Assessment — IIEF-5 and Penile Doppler
The IIEF-5 (International Index of Erectile Function) is the validated ED severity tool used at Busan urology clinics. Scores: 22–25 no ED, 17–21 mild, 12–16 mild-moderate, 8–11 moderate, 1–7 severe. Complete before your consultation — it determines first-line treatment.
Penile Doppler ultrasound identifies the cause: arterial insufficiency (PSV <25 cm/s — responds to shockwave), venous leak (EDV >5 cm/s — may require ICI or implant), psychogenic/neurogenic (normal Doppler — responds to PDE5i, less to shockwave). Doppler is performed in-clinic with pharmacological stimulation — 30 minutes.
The 4-Tier Treatment Ladder
Tier 1 — Oral Medication: PDE5 inhibitors (sildenafil, tadalafil, vardenafil). Effective in 70% of mild-moderate vascular ED. Daily tadalafil 5mg produces spontaneous erections without planning. USD $200–$400 for 3-month supply.
Tier 2 — LiSWT Shockwave Therapy (6 sessions): Low-intensity shockwave stimulates neoangiogenesis. 40–70% improvement in IIEF-5 scores at 3 months in published studies (Fojecki et al., J Urol 2017; results vary by study and patient selection). 15 minutes per session, no anaesthesia, no downtime. USD $1,100–$1,400 all-in.
Tier 3 — ICI Injection Training: Alprostadil injection into the corpora cavernosa. 70–85% response rate for most ED types; lower for severe neurogenic ED (Mulhall et al., J Sex Med 2006). Self-injection training provided. USD $350–$500.
Tier 4 — Penile Implant (AMS 700 CX): Definitive for severe or neurogenic ED. 92–95% satisfaction at 5 years (AMS/Boston Scientific post-market surveillance; Mulcahy et al., J Urol 2018). USD $9,200–$12,000. See penile implant guide →
LiSWT Shockwave — Foreign Patient Protocol
LiSWT sessions are 15 minutes with no downtime — you can sightsee after. Most foreign patients complete 3 sessions in Busan (5-day visit) then finish sessions 4–6 at a home-country clinic with a STORZ or BTL medical device. The treating urologist provides a written protocol for the home clinic.
Cost Comparison — Korea vs USA
| Procedure | Busan, Korea (USD) | USA Private | Saving |
|---|---|---|---|
| PDE5i prescription (3 months) | $200–$400 | $400–$800 | ~50% |
| LiSWT Shockwave (6 sessions) | $1,100–$1,400 | $3,000–$5,500 | ~65% |
| ICI Training + starter kit | $350–$500 | $600–$1,000 | ~45% |
| Penile Implant AMS 700 CX | $9,200–$11,500 | $20,000–$28,000 | ~55% |