Kaynak Y. et al., 2023: Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study

Tuesday, 27 February 2024

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Kaynak Y, Gruenwald I.
Urology Clinic of Private Umit Visnelik Hospital, Eskişehir, Turkey.
Neuro-Urology Unit, Rambam Healthcare Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.

Abstract

This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group C (3 years), and Group D (4+ years) were treated patients' follow-up groups. The patients' International Index of Erectile Function-5 (IIEF-5) scores were gathered at the start of treatment via face-to-face interviews and at the end of follow-ups by telephone conversations. IIEF-5 scores and the minimal clinically significant differences were the main outcomes. Mean follow-up length, age, and IIEF-5 scores of the patients were 2 ± 1.16 years, 47.34 ± 12.65 years, and 12.09 ± 3.66 points, respectively. Compared to baseline, treatment increased the median IIEF-5 scores of patients in groups A, B, C, and D by 7 [3-12], 6 [0-8], 7 [1-9], and 6.5 [2.5-10] points, respectively (p = 0.001). 71%, 63%, 65.8%, and 65% of treated patients in groups A, B, C, and D met the minimal clinically significant differences criteria (n = 77). Mild disease patients were 9.14 times more likely to respond to treatment than severe illness patients (OR, 9.14; 95% CI, 1.28-65.46; P = 0.02). Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained outcomes. This treatment is optimal for mild illnesses.
Int J Impot Res. 2023 Aug 29. doi: 10.1038/s41443-023-00757-7. Online ahead of print. PMID: 37644168

Comments 1

Jens Rassweiler on Tuesday, 27 February 2024 09:50

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has beneficial effects and can enhance erectile function with minimal side effects, which has been shown in experimental and clinical studies. However, the long-term effects of Li-ESWT in combination with PDE5Is on men with ED have not been adequately explored.
This article discusses the use of a combination treatment approach for erectile dysfunction (ED) involving low-intensity extracorporeal shockwave therapy (Li-ESWT) and daily 5 mg tadalafil. The study, conducted over a 4-year period, included 116 participants with ED.
A specialized focused shockwave probe (Omnispec ED1000; Medispe Ltd., Yehud, Israel) that produces shocks with an energy density of 0.09 mJ/m2 was used to administer shockwaves on the proximal, mid, and distal penile shaft, as well as on the right and left sides of the penis. At each of the five treatment points, three-hundred shocks (1500 SW) were applied at a frequency of 160 shocks per minute (2.7 Hz). 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks (6 sessions), 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months.
Patients were divided into four groups based on the interval between treatment and the telephone call: group A (1-year follow-up), group B (2 years follow-up), group C (3 years follow-up), and group D (4 years or more follow-up).
The combination treatment resulted in a significant improvement in median International Index of Erectile Function-5 (IIEF-5) scores for all groups, with no significant differences between them. About 65% of patients remained responders for the entire duration, suggesting that the effects of the treatment persisted long-term.
Patient satisfaction rates were high, and adverse effects were minimal. The study suggests that the combination of Li-ESWT and tadalafil may be a safe and effective treatment for ED, even in cases where phosphodiesterase-5 inhibitors (PDE5Is) are not effective.
However, the article acknowledges the need for further research with larger samples and placebo-controlled designs to validate these findings. The need of maintenance therapy in patients with more severe ED or diabetes should be included.

Jens Rassweiler

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has beneficial effects and can enhance erectile function with minimal side effects, which has been shown in experimental and clinical studies. However, the long-term effects of Li-ESWT in combination with PDE5Is on men with ED have not been adequately explored. 
This article discusses the use of a combination treatment approach for erectile dysfunction (ED) involving low-intensity extracorporeal shockwave therapy (Li-ESWT) and daily 5 mg tadalafil. The study, conducted over a 4-year period, included 116 participants with ED. 
A specialized focused shockwave probe (Omnispec ED1000; Medispe Ltd., Yehud, Israel) that produces shocks with an energy density of 0.09 mJ/m2 was used to administer shockwaves on the proximal, mid, and distal penile shaft, as well as on the right and left sides of the penis. At each of the five treatment points, three-hundred shocks (1500 SW) were applied at a frequency of 160 shocks per minute (2.7 Hz). 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks (6 sessions), 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. 
Patients were divided into four groups based on the interval between treatment and the telephone call: group A (1-year follow-up), group B (2 years follow-up), group C (3 years follow-up), and group D (4 years or more follow-up). 
The combination treatment resulted in a significant improvement in median International Index of Erectile Function-5 (IIEF-5) scores for all groups, with no significant differences between them. About 65% of patients remained responders for the entire duration, suggesting that the effects of the treatment persisted long-term.
 Patient satisfaction rates were high, and adverse effects were minimal. The study suggests that the combination of Li-ESWT and tadalafil may be a safe and effective treatment for ED, even in cases where phosphodiesterase-5 inhibitors (PDE5Is) are not effective. 
However, the article acknowledges the need for further research with larger samples and placebo-controlled designs to validate these findings. The need of maintenance therapy in patients with more severe ED or diabetes should be included.

Jens Rassweiler

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has beneficial effects and can enhance erectile function with minimal side effects, which has been shown in experimental and clinical studies. However, the long-term effects of Li-ESWT in combination with PDE5Is on men with ED have not been adequately explored. This article discusses the use of a combination treatment approach for erectile dysfunction (ED) involving low-intensity extracorporeal shockwave therapy (Li-ESWT) and daily 5 mg tadalafil. The study, conducted over a 4-year period, included 116 participants with ED. A specialized focused shockwave probe (Omnispec ED1000; Medispe Ltd., Yehud, Israel) that produces shocks with an energy density of 0.09 mJ/m2 was used to administer shockwaves on the proximal, mid, and distal penile shaft, as well as on the right and left sides of the penis. At each of the five treatment points, three-hundred shocks (1500 SW) were applied at a frequency of 160 shocks per minute (2.7 Hz). 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks (6 sessions), 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Patients were divided into four groups based on the interval between treatment and the telephone call: group A (1-year follow-up), group B (2 years follow-up), group C (3 years follow-up), and group D (4 years or more follow-up). The combination treatment resulted in a significant improvement in median International Index of Erectile Function-5 (IIEF-5) scores for all groups, with no significant differences between them. About 65% of patients remained responders for the entire duration, suggesting that the effects of the treatment persisted long-term. Patient satisfaction rates were high, and adverse effects were minimal. The study suggests that the combination of Li-ESWT and tadalafil may be a safe and effective treatment for ED, even in cases where phosphodiesterase-5 inhibitors (PDE5Is) are not effective. However, the article acknowledges the need for further research with larger samples and placebo-controlled designs to validate these findings. The need of maintenance therapy in patients with more severe ED or diabetes should be included. Jens Rassweiler

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