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Reviewer's Choice 

Zewin TS et al, 2018: Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial.

Zewin TS, El-Assmy A, Harraz AM, Bazeed M, Shokeir AA, Sheir K, Mosbah A.
Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.

Abstract

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP).
MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients).
RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively).
CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.

Int Urol Nephrol. 2018 Sep 19. doi: 10.1007/s11255-018-1987-6. [Epub ahead of print]

 

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Comments 1

Peter Alken on Monday, 07 January 2019 15:25

All patients suffered from postoperative ED. In the Li-ESWT group patients received 12 sessions of penile within 9 weeks while the PDE5i-group patients had a longer treatment with 50 mg daily for 6 months. The control group had no therapy. At the follow-up examinations at 1, 3, 6, and 9-months postoperatively intracavernous penile injection of prostaglandin E1 was used to objectify the erection status among other examinations. The follow-up was for a mean ± SD of 21 ± 8 months (range 9–34).
There was no significant difference between the three groups during all follow-up periods but the control group had the lowest values during all FU-examinations. With larger groups the differences may become significant and Li-ESWT could be an option for those patients with contraindications to PDE5 inhibitors.

All patients suffered from postoperative ED. In the Li-ESWT group patients received 12 sessions of penile within 9 weeks while the PDE5i-group patients had a longer treatment with 50 mg daily for 6 months. The control group had no therapy. At the follow-up examinations at 1, 3, 6, and 9-months postoperatively intracavernous penile injection of prostaglandin E1 was used to objectify the erection status among other examinations. The follow-up was for a mean ± SD of 21 ± 8 months (range 9–34). There was no significant difference between the three groups during all follow-up periods but the control group had the lowest values during all FU-examinations. With larger groups the differences may become significant and Li-ESWT could be an option for those patients with contraindications to PDE5 inhibitors.
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