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Tzou KY. et al., 2021: Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction.

Tzou KY, Hu SW, Bamodu OA, Wang YH, Wu WL, Wu CC.
Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan.
TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Division of Hematology and Oncology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan.
Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan.

Abstract

Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients' dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus.

Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED.

Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model.

Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (p < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients' pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (p = 0.04), uncontrolled diabetes mellitus (p = 0.04), and uncontrolled hyperlipidemia (p = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (p = 0.04) and uncontrolled hyperlipidemia (p = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others.

Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.
Biomedicines. 2021 Nov 12;9(11):1670. doi: 10.3390/biomedicines9111670. PMID: 34829899. FREE ARTICLE

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Comments 1

Peter Alken on Tuesday, 26 April 2022 10:30

I guess I have recently concluded not to review publications of non- randomized, retrospective studies on Li-ESWT for erectile dysfunction because they do not add to an understanding of the condition and its therapy but only on that bias can influence the results.

The paper is published in “Biomedicines”. This “s an international, scientific, peer-reviewed, open access journal on biomedicines published monthly online by MDPI. The Society for Regenerative Medicine (Russian Federation) (RPO) is affiliated with Biomedicines and its members receive discounts on the article processing charges. “ The impact factor indicated on the journals’ home page is 6,081 rising. An article processing charge (APC) of 2200 CHF (Swiss Francs) applies to papers accepted after peer review. The journal is one of the 379 journals of the open access publisher MDPI (https://www.mdpi.com/about) located in Switzerland.
See also the comment to: Jung HD, Hong Y, Lee JY, Lee SH.
A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size.
Medicina (Kaunas). 2021 Dec 16;57(12):1369. doi: 10.3390/medicina57121369.PMID: 34946314 Review.

Peter Alken

I guess I have recently concluded not to review publications of non- randomized, retrospective studies on Li-ESWT for erectile dysfunction because they do not add to an understanding of the condition and its therapy but only on that bias can influence the results. The paper is published in “Biomedicines”. This “s an international, scientific, peer-reviewed, open access journal on biomedicines published monthly online by MDPI. The Society for Regenerative Medicine (Russian Federation) (RPO) is affiliated with Biomedicines and its members receive discounts on the article processing charges. “ The impact factor indicated on the journals’ home page is 6,081 rising. An article processing charge (APC) of 2200 CHF (Swiss Francs) applies to papers accepted after peer review. The journal is one of the 379 journals of the open access publisher MDPI (https://www.mdpi.com/about) located in Switzerland. See also the comment to: Jung HD, Hong Y, Lee JY, Lee SH. A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size. Medicina (Kaunas). 2021 Dec 16;57(12):1369. doi: 10.3390/medicina57121369.PMID: 34946314 Review. Peter Alken
Saturday, 18 May 2024