Karakose A. et al., 2021: Penile Rehabilitation with Low-intensity Extracorporeal Shock Wave Therapy in Patients After Prostate Cancer Surgery. Early Physiological Changes and Postoperative Follow-up Outcomes.
Karakose A, Yitgin Y.
Depatment of Urology, Istinye Universtiy Faculty of Medicine, Esenyurt/Istanbul, Turkey.
Introduction: To investigate the efficacy, safety and postoperative outcomes of using tadalafil and low-intensity extracorporeal shock wave therapy (Li-ESWT) on penile rehabilitation and preventing urinary incontinence after radical prostatectomy.
Methods: In total, we included 66 patients who used only tadalafil (n = 32) in group 1 and used tadalafil and treated by Li-ESWT (n = 34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularisation by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value < .05 was considered significant.
Results: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared with group 1. Also, there was a significant decrease in incontinence rate in group 2 compared with group 1 in the sixth month.
Conclusions: Combined use of tadalafil and Li-ESWT is highly effective and safe for the treatment of erectile dysfunction and for the prevention of urinary incontinence after prostate cancer surgery.
Int J Clin Pract. 2021 Sep 6:e14804. doi: 10.1111/ijcp.14804. Online ahead of print. PMID: 34487369
This is a retrospective study on 66 patients after nerve sparing laparoscopic radical prostatectomy. There is no information on the surgical details, e.g. how the nerve sparing was done and if it was done bilateral or unilateral. “The urethral catheter was removed 14 days after the surgery”, which is a very unusual long time and does not reflect a sophisticated surgical procedure.
The authors refer to a publication reporting an increasingly frequent application of Li-ESWT after RP (1). However, contrary to that, the lack of reliable data is pointed out there and also in another review quoted by the authors (2): “More large-scale, well-designed RCTs with long follow-up periods are essential before LI-ESWT can be recommended to post-RP ED patients confidently.”
These authors (1) searched ClinicalTrials.gov and identified three registered clinical trials: NCT02746094, an open label trial which was withdrawn, and NCT01317680, RCT and NCT02422277, both RCTs, the latter on nerve sparing radical cystoprostatectomy. Both studies have passed their completion dates in 2013 and 2017 resp. and their status have not been verified since then.
Based on what is known about the subject a retrospective study like the present one does not contribute to the solution of post-prostatectomy ED.