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[No Abstract] Vieiralves RR., 2022: Editorial Comment: The effect of low-intensity shock wave therapy on moderate erectile dysfunction: A double-blind, randomized, sham-controlled clinical trial.

Vieiralves RR.
Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil.

Abstract

No abstract available.
Int Braz J Urol. 2023 Jan-Feb;49(1):152-154. doi: 10.1590/S1677-5538.IBJU.2023.01.05. PMID: 36512464. FREE ARTICLE. Clinical Trial.

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Comments 1

Jens Rassweiler on Monday, 13 March 2023 09:30

This is an interesting comment on a recently published study using Li-ESWT for moderate erectile dysfunction. The author focuses on various aspects of this very important study including 70 patients randomized to either Li-ESWT or sham-treatment. Overall, two third of the patients responded well. The following needs to be assessed closer:

- the diagnosis of vasculogenic ED was not based on Duplex Sonography.
- the application technique was not exactly described
- use of PDE5-inhibitors were prohibited
- only a single institution study

All these points might be fair arguments, however, apart from the correct diagnosis of vasculogenic ED (i.e. confirmed by Duplex Sonography), I disagree with the points risen by the author:

The application technique has been described previously. The main treatment parameters have been described (5000 impulses at five sites, 0.096 mJ/mm2 and a frequency of 5 Hz (level 7 at the ARIES 2 electromagnetic generator, Dornier MedTech, Wessling). Of course, there are other protocols applying 3000 impulses at 6 sites. But in these studies other types of shock wave devices have been used.

The authors wanted to proof the effect of Li-ESWT instead of PDE-5-inhibitors. Therefore, PDE-%-inhibitors were prohibited!
Of course, such a study design should now be applied in a multi-centric design. For me, the most important information and message of this trial was indeed, that Li-ESWT may obviate the need for PDE-5-inhibitors, because it may be possible to improve the quality of the cavernous tissue rather than supporting temporarily it`s function by medication.

Jens Rassweiler

This is an interesting comment on a recently published study using Li-ESWT for moderate erectile dysfunction. The author focuses on various aspects of this very important study including 70 patients randomized to either Li-ESWT or sham-treatment. Overall, two third of the patients responded well. The following needs to be assessed closer: - the diagnosis of vasculogenic ED was not based on Duplex Sonography. - the application technique was not exactly described - use of PDE5-inhibitors were prohibited - only a single institution study All these points might be fair arguments, however, apart from the correct diagnosis of vasculogenic ED (i.e. confirmed by Duplex Sonography), I disagree with the points risen by the author: The application technique has been described previously. The main treatment parameters have been described (5000 impulses at five sites, 0.096 mJ/mm2 and a frequency of 5 Hz (level 7 at the ARIES 2 electromagnetic generator, Dornier MedTech, Wessling). Of course, there are other protocols applying 3000 impulses at 6 sites. But in these studies other types of shock wave devices have been used. The authors wanted to proof the effect of Li-ESWT instead of PDE-5-inhibitors. Therefore, PDE-%-inhibitors were prohibited! Of course, such a study design should now be applied in a multi-centric design. For me, the most important information and message of this trial was indeed, that Li-ESWT may obviate the need for PDE-5-inhibitors, because it may be possible to improve the quality of the cavernous tissue rather than supporting temporarily it`s function by medication. Jens Rassweiler
Friday, 23 February 2024