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Cocci A. et al., 2021: Low-intensity extracorporeal shock wave therapy (Li-ESWT) for priapism-induced erectile dysfunction in young patients: the first case series.

Cocci A, Fassio G, Migliorini F, Cito G, Antonelli A, Verrienti P, Scandura C, Tuccio A, Minervini A, Masieri L, Tafuri A.
Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy.
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy.
Department of Urology, University of Catania, Catania, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy.

Abstract

No abstract available. 
Int J Impot Res. 2021 Apr 5. doi: 10.1038/s41443-021-00429-4. Online ahead of print. PMID: 33820979.

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Comments 1

Peter Alken on Friday, 26 November 2021 09:30

5 patients had low flow ischaemic priapism requiring the usual emergency therapy in these cases as described by the authors in the material and method section: “all the patients included in the study received the same following step-wise maneuvers, in order to correct the compartment syndrome, re-establish blood flow, and relieve pain. Penile cold compresses, blood aspiration with phenylephrine irrigation, using a 16-gauge needle, distal shunt by corpoglandular cannulation and incision under general anesthesia. In case of recurrent ischemic priapism, a re-shunt procedure was performed.” There are several surgical shunt techniques. It is not clear what kind of shunt was done. In addition there is an ambiguity in the text, as further on in the result section it is only stated “Firstly, all patients were treated with penile cold compression, intracavernosal injection of a sympathomimetic
agent and blood aspiration. Only one patient … needed a re-shunt procedure before priapism resolution.” Did all patients get a shunt (?) which can lead to ED in between 30 and 100%.
The long term outcome in cases like that depends on the time period between the onset of symptoms and the successful therapy. In this series neither the time nor the success of the therapy is clearly indicated.
In the present series “All patients were treated with Li-ESWT (Storz DUOLITH ® SD1 ultra), 45 days after the emergency management. Each patient received 3000 shocks (1500 shocks for each penile corpus cavernosum) at the energy of 0.25 (mJ/mm2) for about 15min. After 1 week, the procedure was then repeated other seven times, per 7 weeks (one treatment/a week) for a total amount of eight sessions.”

The pretherapeutic IIEF-5 score of 10 in the patients was low. However, a proper diagnostic evaluation was not done. The IIEF-5 score of 21(of 25 maximum) after 90 days was good.
The authors caution:” This is the first evidence sustaining the role of Li-ESWT in patients with ED following ischemic priapism events. It should be cautioned that the present study is still preliminary and requires higher-level investigations.”

Peter Alken

5 patients had low flow ischaemic priapism requiring the usual emergency therapy in these cases as described by the authors in the material and method section: “all the patients included in the study received the same following step-wise maneuvers, in order to correct the compartment syndrome, re-establish blood flow, and relieve pain. Penile cold compresses, blood aspiration with phenylephrine irrigation, using a 16-gauge needle, distal shunt by corpoglandular cannulation and incision under general anesthesia. In case of recurrent ischemic priapism, a re-shunt procedure was performed.” There are several surgical shunt techniques. It is not clear what kind of shunt was done. In addition there is an ambiguity in the text, as further on in the result section it is only stated “Firstly, all patients were treated with penile cold compression, intracavernosal injection of a sympathomimetic agent and blood aspiration. Only one patient … needed a re-shunt procedure before priapism resolution.” Did all patients get a shunt (?) which can lead to ED in between 30 and 100%. The long term outcome in cases like that depends on the time period between the onset of symptoms and the successful therapy. In this series neither the time nor the success of the therapy is clearly indicated. In the present series “All patients were treated with Li-ESWT (Storz DUOLITH ® SD1 ultra), 45 days after the emergency management. Each patient received 3000 shocks (1500 shocks for each penile corpus cavernosum) at the energy of 0.25 (mJ/mm2) for about 15min. After 1 week, the procedure was then repeated other seven times, per 7 weeks (one treatment/a week) for a total amount of eight sessions.” The pretherapeutic IIEF-5 score of 10 in the patients was low. However, a proper diagnostic evaluation was not done. The IIEF-5 score of 21(of 25 maximum) after 90 days was good. The authors caution:” This is the first evidence sustaining the role of Li-ESWT in patients with ED following ischemic priapism events. It should be cautioned that the present study is still preliminary and requires higher-level investigations.” Peter Alken
Saturday, 18 May 2024