Frey A et al, 2016: Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study.
Frey A, Sønksen J, Fode M.
Department of Urology , Herlev University Hospital , Copenhagen , Denmark.
OBJECTIVE: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP).
MATERIALS AND METHODS: Patients who had undergone robot-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment was evaluated 1 month (t1) and 1 year (t2) after the final treatment. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) scores.
RESULTS: Eighteen patients were included in the study. However, two patients breached the protocol and consequently 16 patients were included in the analysis at t1 and 15 patients were included in the analysis at t2. At baseline the median age was 62 years (range 51 to 70 years) and the median time since surgery was 24 months (range 12 to 54 months). The median preoperative IIEF-5 score was 25 (range 22 to 25) and the median baseline IIEF-5 score was 9.5 (range 5 to 20). The median change in IIEF-5 scores was +3.5 (range -1 to 8; p = 0.0049) and +1 (range -3 to 14; p = 0.046) at t1 and t2, respectively. No severe side-effects were reported.
CONCLUSIONS: LI-ESWT may improve erectile function after bilateral nerve-sparing RP. Based on these results, further studies in patients with ED after nerve-sparing RP are justified.
Scand J Urol. 2016 Apr;50(2):123-7. doi: 10.3109/21681805.2015.1100675. Epub 2015 Oct 23.
In this article LI-ESWT was used in a pilot study to treat patients with ED after bilateral nerve-sparing radical prostatectomy.
The patients were given 3000 SW at a frequency of 5Hz; 3 x1000 SWs with energy flux densities of 20, 15 and 12 mJ/mm2 at different spots of the penis. Following treatments every other week during six weeks the maximal effect was recorded after 1 month, but after 1 year the effect was back to the starting level.
The energy flux densities that the authors report are much higher than that in other reports of LI-ESWT [1,2] and possibly expressed in incorrect units?
1. Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF.Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis.Eur Urol. 2016 Jun 16. pii: S0302-2838(16)30259-7. doi: 10.1016/j.eururo.2016.05.050. [Epub ahead of print] Review
2. Zimmerman R. ESWT: Extracorporeal shock wave therapy in urology – current treatment indications, scientific background and new aspects. In: shock wave therapy in practice. Urology (Ed. HG Tiselius) Level 10, Damberg kommunikation