STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Ibis Ma. et al., 2024: Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study.

İbis MA, Ozkaya F, Tokatli Z, Akpinar C, Yaman O.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
2Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
3Department of Urology, Private Cankaya Yasam Hospital, Ankara, Turkey.

Abstract

Purpose: Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5 mg tadalafil daily versus LI-SWT plus 20 mg tadalafil alternate-day in PDE5i -resistant ED. MATERıALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5 mg tadalafil daily), and C (LI-SWT plus 20 mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment.

Results: After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6 months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSıON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.

Int Urol Nephrol. 2024 Feb;56(2):407-413. doi: 10.1007/s11255-023-03769-w. Epub 2023 Sep 26. PMID: 37751053

0
 

Comments 1

Jens Rassweiler on Thursday, 20 June 2024 11:00

Around 30% of patients do not respond to PDE5is, necessitating alternative treatments. The authors wanted to evaluate the efficacy of low-intensity shockwave therapy (LI-SWT) alone and in combination with different tadalafil regimens in patients with PDE5i-resistant ED.

For this, they used a retrospective cohort study: From January 1, 2018, to December 31, 2022 the included 105 male patients aged 45-65 (mean age 56.2 years) with PDE5i-resistant ED and classified them in three groups:
o Group A: LI-SWT only.
o Group B: LI-SWT + 5 mg daily tadalafil.
o Group C: LI-SWT + 20 mg tadalafil every alternate day
Patients with bleeding disorders, certain therapies, low testosterone, prostate cancer history, pelvic surgery, neurologic diseases, or penile deformities were excluded.
LI-ESWT administered at six locations on the penis, twice a week for three weeks with a total of 3000 shocks at 0.25 mJ/mm2 using the Duolith SD1 ultra (Storz Medical AG, Tägerwilen, Switzerland).
Outcomes were measured using International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) at baseline, 3 months, and 6 months post-treatment.
Results:
IIEF-5 Scores increased significantly more in Groups B and C than in Group A. Group C showed the highest increase, but not statistically significant compared to Group B.
EHS Scores were higher in Groups B and C compared to Group A with no significant difference between Groups B and C over time.
EHS ≥ 3 increased significantly post-treatment, with Groups B and C showing better results than Group A.
IIEF-5 ≥ 17 were achieved by more patients in Groups B and C compared to Group A.
Discussion:
Combination Therapy: LI-SWT combined with tadalafil (either regimen) more effective than LI-SWT alone.
Tadalafil Regimens: No significant difference between daily 5 mg and alternate-day 20 mg, though the latter showed a trend towards better improvement. Align with findings that combination therapies can enhance erectile function.
In summary, LI-ESWT enhances the response to PDE5 inhibitors by improving blood flow, promoting the regeneration of nerve and endothelial tissue, and increasing the production of nitric oxide. These effects collectively enhance the physiological mechanisms underlying erectile function, making PDE5 inhibitors more effective even in patients who were initially non-responsive to these medications.
Nevertheless, the study is limited by its non-randomized, retrospective design. the, small sample size and short follow-up.
Conclusion:
Combining LI-SWT with tadalafil is more effective for PDE5i-resistant ED than LI-SWT alone. While no significant difference was observed between the two tadalafil regimens, alternate-day 20 mg may show better outcomes with a larger sample size. Further studies are needed to validate these findings and optimize treatment protocols.

Jens Rassweiler

Around 30% of patients do not respond to PDE5is, necessitating alternative treatments. The authors wanted to evaluate the efficacy of low-intensity shockwave therapy (LI-SWT) alone and in combination with different tadalafil regimens in patients with PDE5i-resistant ED. For this, they used a retrospective cohort study: From January 1, 2018, to December 31, 2022 the included 105 male patients aged 45-65 (mean age 56.2 years) with PDE5i-resistant ED and classified them in three groups: o Group A: LI-SWT only. o Group B: LI-SWT + 5 mg daily tadalafil. o Group C: LI-SWT + 20 mg tadalafil every alternate day Patients with bleeding disorders, certain therapies, low testosterone, prostate cancer history, pelvic surgery, neurologic diseases, or penile deformities were excluded. LI-ESWT administered at six locations on the penis, twice a week for three weeks with a total of 3000 shocks at 0.25 mJ/mm2 using the Duolith SD1 ultra (Storz Medical AG, Tägerwilen, Switzerland). Outcomes were measured using International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) at baseline, 3 months, and 6 months post-treatment. Results: IIEF-5 Scores increased significantly more in Groups B and C than in Group A. Group C showed the highest increase, but not statistically significant compared to Group B. EHS Scores were higher in Groups B and C compared to Group A with no significant difference between Groups B and C over time. EHS ≥ 3 increased significantly post-treatment, with Groups B and C showing better results than Group A. IIEF-5 ≥ 17 were achieved by more patients in Groups B and C compared to Group A. Discussion: Combination Therapy: LI-SWT combined with tadalafil (either regimen) more effective than LI-SWT alone. Tadalafil Regimens: No significant difference between daily 5 mg and alternate-day 20 mg, though the latter showed a trend towards better improvement. Align with findings that combination therapies can enhance erectile function. In summary, LI-ESWT enhances the response to PDE5 inhibitors by improving blood flow, promoting the regeneration of nerve and endothelial tissue, and increasing the production of nitric oxide. These effects collectively enhance the physiological mechanisms underlying erectile function, making PDE5 inhibitors more effective even in patients who were initially non-responsive to these medications. Nevertheless, the study is limited by its non-randomized, retrospective design. the, small sample size and short follow-up. Conclusion: Combining LI-SWT with tadalafil is more effective for PDE5i-resistant ED than LI-SWT alone. While no significant difference was observed between the two tadalafil regimens, alternate-day 20 mg may show better outcomes with a larger sample size. Further studies are needed to validate these findings and optimize treatment protocols. Jens Rassweiler
Saturday, 13 July 2024