Kohada Y. et al., 2023: Long-term efficacy of penile rehabilitation with low-intensity extracorporeal shock wave therapy for sexual and erectile function recovery following robotic-assisted radical prostatectomy: a single-cohort pilot study
Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Shobara Redcross Hospital, Hiroshima 723-0013, Japan.
Chuden Hospital, Hiroshima 734-8530, Japan.
Background: The long-term efficacy of low-intensity extracorporeal shock wave therapy (LIESWT) for penile rehabilitation after robot-assisted radical prostatectomy (RARP) has not yet been reported.
Aim: To assess the long-term efficacy of LIESWT for penile rehabilitation after RARP by evaluating the postoperative recovery of sexual and erectile functions following RARP.
Methods: Patients who underwent RARP at our institution were categorized into 2 groups: those who received LIESWT and those who underwent penile rehabilitation with a phosphodiesterase type 5 inhibitor (PDE5i). The control group included patients who did not undergo penile rehabilitation. Potency and scores on the Expanded Prostate Cancer Index Composite for sexual function and 5-item International Index of Erectile Function (IIEF-5) were evaluated preoperatively and over 60 months after RARP.
Outcomes: The LIESWT group had significantly higher postoperative sexual function and total IIEF-5 scores and potency than the control group over the long term, and its results were not inferior to those of the PDE5i group.
Results: The LIESWT, PDE5i, and control groups comprised 16, 13, and 139 patients, respectively. As compared with the control group, the LIESWT group had significantly higher sexual function scores at 6, 12, and 60 months after surgery (P < .05) and total IIEF-5 scores at 24 and 60 months (P < .05). The LIESWT group also had a significantly higher potency rate than the control group at 60 months (P < .05). For all time points after surgery, there were no significant differences between the LIESWT and PDE5i groups in terms of sexual function and total IIEF-5 scores and potency.
Clinical implications: LIESWT may be a new option for penile rehabilitation in patients with erectile dysfunction after RARP.
Strengths and limitations: This pilot study was performed at a single center and involved relatively few patients, which may have led to selection bias. Furthermore, the selection of this study for penile rehabilitation was not made randomly but by the patient's choice. Despite these limitations, our results provide evidence in support of LIESWT for penile rehabilitation after RARP because this is the first study to assess the long-term efficacy of LIESWT.
Conclusion: LIESWT can improve sexual and erectile functions in patients with erectile dysfunction after RARP, and its efficacy can be maintained over a long period after surgery.
Sex Med. 2023 May 22;11(2):qfad023. doi: 10.1093/sexmed/qfad023. PMID: 37228769; PMCID: PMC10204648.
This study investigates retrospectively the long-term efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) as a method of penile rehabilitation after robot-assisted radical prostatectomy (RARP), a treatment for localized prostate cancer. Patients who underwent RARP at Hiroshima University between June 2012 and June 2017 were enrolled in this study. Anterograde RARP was performed via the transperitoneal approach by the same surgeon for all patients.
The study categorizes patients into groups based on whether they underwent LI-ESWT (N=16), penile rehabilitation with a phosphodiesterase type 5 inhibitor (N= 13), or no penile rehabilitation (N=139). The researchers evaluated the postoperative recovery of sexual and erectile functions over a 60-month period.
The outcome could be distinguished by the treatment groups:
LI-ESWT group: Patients receiving LI-ESWT showed significantly higher postoperative sexual function scores and total International Index of Erectile Function (IIEF-5) scores, as well as potency, compared to the control group over the long term. The efficacy of LIESWT was comparable to the PDE5i group.
PDE5i group: Patients who underwent penile rehabilitation with PDE5i also exhibited improved sexual function and IIEF-5 scores, with potency rates higher than the control group.
Control group: Patients who did not undergo penile rehabilitation had lower sexual and erectile function scores.
The study demonstrates the long-term benefits of LI-ESWT for penile rehabilitation, particularly after RARP. It suggests that LI-ESWT may be an alternative to PDE5i for erectile dysfunction (ED) recovery.
LIESWT and PDE5i have different mechanisms for improving erectile function; thus, synergistic effects can be expected. LI-ESWT enhances tissue regeneration via its shear stress effect and improves blood flow through tissue neo-angiogenesis, whereas PDE5is inhibit the breakdown of cyclic guanosine monophosphate in penile tissues, prolonging smooth muscle relaxation and facilitating erection. Several randomized clinical trials comparing a penile rehabilitation protocol consisting of LI-ESWT + PDE5i vs PDE5i alone have reported better improvement in erectile function with the combination protocol. Based on the results of this study, the combination of LI-ESWT and PDE5i may be effective for ED after RARP over the long term.
The study is limited by its small sample size, being conducted at a single center, and potential selection bias due to non-randomized patient choices. Different LIESWT protocols and variations in PDE5i dosing may have influenced outcomes.
The study concludes that LIESWT can enhance sexual and erectile function in patients with ED following RARP, with sustained efficacy over the long term. The results also suggest that LIESWT is not inferior to PDE5i in terms of improving erectile function after surgery. The researchers propose further studies with larger samples and longer follow-up periods to confirm these findings