Nikolaos Pyrgidis et al., 2024: The recommended treatment protocol for low-intensity shockwave therapy based on the severity of erectile dysfunction
Nikolaos Pyrgidis 1 2, Dimitrios Kalyvianakis 3 4, Ioannis Mykoniatis 3 4, Dimitrios Hatzichristou 3 4
1Institute for the Study of Urological Diseases, Thessaloniki, Greece.
2Department of Urology, University Hospital, LMU Munich, Munich, Germany.
3Institute for the Study of Urological Diseases, Thessaloniki, Greece.
4Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Abstract
no Abstract available
IJIR: Your Sexual Medicine Journal; https://doi.org/10.1038/s41443- 024-00959-7
PMID: 39107452
Comments 1
This study investigates low-intensity shockwave therapy (LiST) as a treatment for vasculogenic erectile dysfunction (ED), tailoring protocols based on ED severity—mild, moderate, or severe. It consolidates findings from three parallel, double-blind, randomized, sham-controlled clinical trials. Key highlights include:
Treatment Protocols:
1. Mild ED (IIEF-EF 17–25):
o 6 LiST sessions (twice weekly for 3 weeks).
o Combined with daily 5 mg tadalafil for 4 weeks or placebo.
o Outcome: Both groups showed improvement, with combination therapy (LiST + tadalafil) yielding better results.
2. Moderate ED (IIEF-EF 11–16):
o 12 LiST sessions (twice weekly for 6 weeks).
o No adjunctive tadalafil used.
o Outcome: LiST significantly improved IIEF-EF scores and treatment satisfaction compared to sham therapy.
3. Severe ED (IIEF-EF 1–10):
o 12 LiST sessions (three times per week for 4 weeks).
o Combined with daily 5 mg tadalafil.
o Outcome: Combination therapy significantly improved erectile function versus sham therapy with tadalafil.
Findings:
• Effectiveness: LiST demonstrated efficacy in all severity groups, either as monotherapy or combined with tadalafil. Combination therapy appeared more effective, especially for mild and severe ED.
• Safety: LiST was well-tolerated, with minor adverse effects.
• Clinical Implications:
o Mild ED patients benefit most from combination therapy.
o Moderate ED patients may use LiST alone as an alternative to PDE5 inhibitors.
o Severe ED patients may consider LiST with tadalafil if invasive options (e.g., intracavernosal injections) are undesirable.
Recommendations:
• Larger, multicenter trials with diverse populations and longer follow-ups are essential.
• Further research into the synergistic mechanisms of LiST and tadalafil is recommended.
This study provides a roadmap for LiST implementation based on ED severity, highlighting its potential as a safe and effective treatment option.
Jens Rassweiler