Tsai CC et al, 2017: Low-Intensity Extracorporeal Shockwave Therapy Can Improve Erectile Function in Patients Who Failed to Respond to Phosphodiesterase Type 5 Inhibitors.
Tsai CC, Wang CJ, Lee YC, Kuo YT, Lin HH, Li CC, Wu WJ, Liu CC.
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Management Offices, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Laboratory Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to improve ED by enhancing perfusion of the penis. The current study was performed to evaluate whether combined treatment with LI-ESWT and PDE5is can restore erectile function in patients who failed to respond to PDE5is alone. This was an open-label single-arm prospective study. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Sociodemographic information and detailed medical history were recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly for 12 weeks. All patients continued their regular PDE5is use. The EHS and the 5-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate the change in erectile function 1 and 3 months after LI-ESWT. A total of 52 patients were enrolled. After LI-ESWT treatment, 35 of the 52 patients (67.3%) could achieve an erection hard enough for intercourse (EHS ≧ 3) under PDE5is use at the 1-month follow-up. Initial severity of ED was the only significant predictor of a successful response (EHS1: 35.7% vs. EHS2: 78.9%, p = .005). Thirty-three of the 35 (94.3%) subjects who responded to LI-ESWT could still maintain their erectile function at the 3-month follow-up. LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of ED was an important predictor of a successful response.
Am J Mens Health. 2017 Sep 1:1557988317721643. doi: 10.1177/1557988317721643. [Epub ahead of print]. FREE ARTICLE
This study was conducted to find out if patients with erectile dysfunction in whom treatment with phosphodiesterase type 5 inhibitors (PDE5i) might benefit from combination with low intensity ESWT. The conclusion was that 67% of the 52 patients treated with 3000 SW once a week during 12 weeks reported a successful outcome after 1 month and 63% after 3 months.
It is of interest to note that IIEF5 (5-item version of the International Index of Erectile dysfunction) was increased from 10.4 to 17.4 and 17.7 after 1 and 3 months respectively. During the corresponding follow-up EHS (erection hardness score) increased from 1.9 to 3.2 and 3.1.
Although two thirds of the patients could remain only on PDE5i therapy after ESWT, the question is for how long periods the effect of the rather demanding ESWT will last? Only long-term follow-up can give an answer to that question.