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Oginski et al., 2022: Analysis of the Impact of Clinical Factors on Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction

Oginski N, Apel H, Richterstetter M, Lieb V, Fiebig C, Goebell PJ, Wullich B, Sikic D.
Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

Abstract

Introduction: Predictive factors for the treatment success of low-intensity extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) are still under debate.

Methods: Li-ESWT was performed in 50 patients suffering from ED by applying 3,000 shock waves once a week over a period of 6 weeks. Treatment success was defined as an increase in the International Index of Erectile Function 5 (IIEF-5) score by ≥5 points or an Erectile Hardness Score (EHS) of ≥3 points. IIEF-5 and EHS were measured at baseline and at 3 and 6 months of follow-up.

Results: Treatment success according to either the IIEF-5 score or EHS at any time of follow-up was achieved in 28 patients (56%). Twenty-five patients (50%) experienced an improvement during the first 3 months, which lasted for 6 months in 8 cases (16%). Three patients reported improved erectile function only after 6 months. When stratifying the cohort with regard to potential influencing factors, a significantly improved IIEF-5 score could be achieved in men with cardiovascular risk factors (p = 0.026) and in men with antihypertensive medication (p = 0.009). Men without cardiovascular risk factors showed no therapeutic benefit from Li-ESWT.

Discussion/conclusion: Li-ESWT is a valid but often short-lived treatment option for ED, especially in men with cardiovascular risk factors or controlled hypertension. Future studies should assess the feasibility and safety of repeated applications of Li-ESWT.
Urol Int. 2022 Feb 10;1-9. doi: 10.1159/000520705. Online ahead of print. PMID: 35144264

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Comments 1

Jens Rassweiler on Monday, 30 May 2022 10:30

Previous studies demonstrated a therapeutic benefit in patients with ED associated with cardiovascular risk factors. Given that erectile function can be affected by multiple other factors, such as diabetes, psychic or neurological conditions or certain medications, the aim of the current study was to examine the therapeutic benefit of Li-ESWT in a consecutive series of patients with ED irrespective of the underlying condition, comorbidities or medication to identify factors associated with the treatment success of Li-ESWT.

Li-ESWT was performed in 50 patients suffering from ED by applying 3,000 shock waves once a week over a period of 6 weeks using Duolith SD1 ultra (Storz Medical, Tägerwilen, Switzerland) with an Energy flux density ranging from 0.20 mJ/ mm2 to 0.25 mJ/mm2. Shock waves were applied to all sides of the penis to incorporate the whole corpora cavernosa by using 2 different transducer heads. With a linearly formed transducer head, we applied 2,000 pulses along the penis shaft to the glans. The remaining 1,000 pulses were delivered by a curved transducer head to the deep parts of the cru- ra along the pelvic bottom.

The clinical outcome was assessed using 3 validat- ed questionnaires: the International Index of Erectile Function 5 (IIEF-5), the Erection Hardness Score (EHS), and the Aging Males’ Symptoms (AMS) scale.

Treatment success according to either the IIEF-5 score or EHS at any time of follow-up was achieved in 28 patients (56%). Twenty-five patients (50%) experienced an improvement during the first 3 months, which lasted for 6 months in only 8 cases (16%). When stratifying the cohort with regard to potential influencing factors, a signifiantly improved IIEF-5 score could be achieved in men with cardiovascular risk factors (p = 0.026) and in men with anti- hypertensive medication (p = 0.009), whereas men without cardiovascular risk factors showed no therapeutic benefit from Li-ESWT.

This study demonstrates two interesting features of Li-ESWT for ED. Firstly, like in previous studies, the effect of a course of Li-ESWT treatments might be effective, but the effect does not last. This should lead to maintenance protocols for those patient who respond to Li-ESWT. Potentially also in combination with PDE5-inhibitors.

Secondly, Li-ESWT worked only in patients with hypertension and cardio-vascular risk factors. This matches well with the possible effects on penile vascularization triggered by the stimulation of VGEF. It shows also, that ESWT is not a placebo!

However, there remain also some questions to the authors. 86% of the patients took PDE5-inhibtors. Even if all were treatment failures, there should be an information on any discontinuation of washout period. Thus, there could be a bias according to the 43 patients that still took PDE5-inhibitors. Finally, there were no neurogenic / posttraumatic / postoperative ED-cases. Early results following RALP are promising.

Jens Rassweiler

Previous studies demonstrated a therapeutic benefit in patients with ED associated with cardiovascular risk factors. Given that erectile function can be affected by multiple other factors, such as diabetes, psychic or neurological conditions or certain medications, the aim of the current study was to examine the therapeutic benefit of Li-ESWT in a consecutive series of patients with ED irrespective of the underlying condition, comorbidities or medication to identify factors associated with the treatment success of Li-ESWT. Li-ESWT was performed in 50 patients suffering from ED by applying 3,000 shock waves once a week over a period of 6 weeks using Duolith SD1 ultra (Storz Medical, Tägerwilen, Switzerland) with an Energy flux density ranging from 0.20 mJ/ mm2 to 0.25 mJ/mm2. Shock waves were applied to all sides of the penis to incorporate the whole corpora cavernosa by using 2 different transducer heads. With a linearly formed transducer head, we applied 2,000 pulses along the penis shaft to the glans. The remaining 1,000 pulses were delivered by a curved transducer head to the deep parts of the cru- ra along the pelvic bottom. The clinical outcome was assessed using 3 validat- ed questionnaires: the International Index of Erectile Function 5 (IIEF-5), the Erection Hardness Score (EHS), and the Aging Males’ Symptoms (AMS) scale. Treatment success according to either the IIEF-5 score or EHS at any time of follow-up was achieved in 28 patients (56%). Twenty-five patients (50%) experienced an improvement during the first 3 months, which lasted for 6 months in only 8 cases (16%). When stratifying the cohort with regard to potential influencing factors, a signifiantly improved IIEF-5 score could be achieved in men with cardiovascular risk factors (p = 0.026) and in men with anti- hypertensive medication (p = 0.009), whereas men without cardiovascular risk factors showed no therapeutic benefit from Li-ESWT. This study demonstrates two interesting features of Li-ESWT for ED. Firstly, like in previous studies, the effect of a course of Li-ESWT treatments might be effective, but the effect does not last. This should lead to maintenance protocols for those patient who respond to Li-ESWT. Potentially also in combination with PDE5-inhibitors. Secondly, Li-ESWT worked only in patients with hypertension and cardio-vascular risk factors. This matches well with the possible effects on penile vascularization triggered by the stimulation of VGEF. It shows also, that ESWT is not a placebo! However, there remain also some questions to the authors. 86% of the patients took PDE5-inhibtors. Even if all were treatment failures, there should be an information on any discontinuation of washout period. Thus, there could be a bias according to the 43 patients that still took PDE5-inhibitors. Finally, there were no neurogenic / posttraumatic / postoperative ED-cases. Early results following RALP are promising. Jens Rassweiler
Sunday, 14 July 2024