Abdelwehab IS. et al., 2025: Early low-intensity extracorporeal shockwave therapy for the preservation and restoration of erectile function after nerve-sparing radical prostatectomy: interim safety assessment.

Ibrahim Samy Abdelwehab, Piotr Sluzar, Findlay MacAskill, Tet Yap
J Sex Med. 2025 Nov 1:qdaf305. doi: 10.1093/jsxmed/qdaf305

Abstract

no abstract available

Comment Jens Rassweiler

Objectives

The article discusses an interim safety assessment of early low-intensity extracorporeal shockwave therapy (Li-ESWT) as a method for preserving and restoring erectile function after nerve-sparing radical prostatectomy (NS-RP) for localized prostate cancer. Despite advancements in robotic surgical techniques that enhance precision and functional outcomes, erectile dysfunction (ED) remains a common issue post-surgery due to unavoidable nerve and vascular trauma. Traditional therapies like phosphodiesterase type 5 inhibitors (PDE5is) do not directly address underlying neural injuries.

Li-ESWT has shown potential regenerative effects, such as promoting neovascularization and nitric oxide synthesis, which could be beneficial during the critical recovery phase post-prostatectomy. However, current rehabilitation practices vary widely and lack standardized protocols.

Material and Methods

In this double-blind, randomized controlled trial, 40 men aged ≤65 with good preoperative erectile function (IIEF-EF score ≥17) were enrolled and divided into two groups, receiving either active or sham Li-ESWT within a week after catheter removal. Treatment parameters included an energy flux density of 0.25 mJ/mm2 at a frequency of 5 Hz, delivered over 12 sessions. Shockwaves were applied to the penile shaft and crura in 6 focal zones; the crura were reached by application of the probe on the perineum. Each participant underwent weekly treatments for 12 weeks.

Results

Key findings indicate that early application of Li-ESWT is safe, with no serious adverse events reported. There were no significant differences in biochemical recurrence rates between groups, and treatment was well tolerated. It was quite obvious, that Li-ESWT should not have any negative effect on the early oncologic outcome of nerve-sparing radical prostatectomy. Nevertheless., the study focusses on this important issue.

While the interim analysis did not evaluate erectile function recovery directly, it sets the foundation for further study phases. Limitations include the small sample size and short follow-up period, but overall, the results suggest that early postoperative Li-ESWT is a feasible intervention that merits further investigation in larger trials.

Jens Rassweiler