Musa ZS. et al., 2019: Long-term effectiveness and predictors of success of low-intensity shockwave therapy in phosphodiesterase type 5 inhibitors non-responders
Musa ZS, El-Assmy A, Shokry AM, Shokeir AA, Zween T, Al-Kenawy MR.
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
OBJECTIVE: To evaluate the long-term (18 months) effectiveness, safety, and factors that may predict the success of low-intensity shockwave lithotripsy (Li-SWT) in patients with erectile dysfunction (ED) who fail to respond to oral phosphodiesterase type 5 inhibitors (PDE5i).
PATIENTS AND METHODS: This prospective study included 52 patients with ED of vascular origin who failed to respond to oral PDE5i. The International Index of Erectile Function-Erectile Function domain (IIEF-EF) and Erection Hardness Score (EHS) questionnaires were used to evaluate EF. Patients under went two Li-SWT treatment sessions per week for 3 weeks, followed by a 3-week treatment-free period, and the cycle was repeated until each patient received 12 treatment sessions. Patients were followed-up after Li-SWT at 3, 6, 12, and 18 months.
RESULTS: At the 18-month follow-up, 33 patients (63.5%) were able to achieve an erection sufficient for penetration with or without PDE5i (22 were maintained on oral PDE5i). The remaining 19 patients (36.5%) had a poor response to Li-SWT and oral PDE5i. The initial response showed some decline in 50% of the initial responders. Younger men (aged <45 years), short ED duration (<2 years), and moderate ED severity responded better to Li-SWT. There were no adverse side-effects.
CONCLUSION: In the present study, Li-SWT was a safe and effective treatment in 63.5% of men with ED who failed to respond to oral PDE5i. Factors such as age (<45 years), ED duration (<2 years), and ED severity can predict treatment outcome in such patients.
ABBREVATIONS: CDU: colour Doppler ultrasonography; ED: erectile dysfunction; EDV: end-diastolic velocity; EF: erectile function; EHS: Erection Hardness Score; FU: follow-up; IIEF-EF: International Index of Erectile Function-EF domain; Li-SWT: low-intensity shockwave lithotripsy; PDE5i: phosphodiesterase type 5 inhibitors; PGE1: prostaglandin E1; PSV: peak systolic velocity; RI: resistive index; VOD: veno-occlusive dysfunction.
Arab J Urol. 2019 Nov 11;18(1):54-58. doi: 10.1080/2090598X.2019.1688072. eCollection 2020. FREE ARTICLE
Type of machine, way of application, drug responders or non-responders, patients’ age and comorbidities, sham vs. no sham, duration of effect, wife or girlfriend, … If such a bunch of different parameters would have had an influence on the effect, acceptance, general distribution, outcome and reimbursement of shock wave application in stone disease, it would never had made it into clinical application for extracorporeal lithotripsy - and subsequent use, to treat ED :-)