Zou ZJ et al, 2017: Low-intensity extracorporeal shock wave therapy for erectile dysfunction after radical prostatectomy: a review of preclinical studies.

Monday, 26 March 2018

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Zou ZJ, Liang JY, Liu ZH, Gao R, Lu YP.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China.

Abstract

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel treatment for erectile dysfunction (ED). Its ability to improve erectile function has been shown in patients with vasculogenic ED by many randomized-controlled trials against sham procedures. However, the role of LI-ESWT in ED caused by radical prostatectomy (RP) is still questionable because this type of ED was excluded from nearly all clinical studies; it has been investigated in only a few small single-arm trials. This review summarizes preclinical studies on mechanisms of action of LI-ESWT for ED and neurological diseases to explore the potential of this treatment for nerve-impaired ED after RP.

Int J Impot Res. 2017 Nov 27. doi: 10.1038/s41443-017-0002-6. [Epub ahead of print] Review.

Comments 1

Peter Alken on Monday, 26 March 2018 11:54

An interesting review on experimental studies on the possible mechanisms of how LI-ESWT could help in post-prostatectomy ED which is - after nerves and vessels have been cut - of neurogenic and vasculogenic origin. “Post-RP ED is mainly characterized by pelvic neurovascular injury. Therefore, the pelvis seems to be a logical treatment site. ... In the referred animal studies, shock waves were delivered to the pelvic region.” I agree to the first part of the statement by the authors but not to the second “Although we expect that ED secondary to non-NSRP (Non Nerve Sparing Prostatectomy) would probably not benefit from LI-ESWT, an experiment is still needed to prove it.”
A problem in the clinical studies is that the surgeon may wrongly claim to have preserved the neurovascular bundles not being aware of the fact that his surgical technique indeed did not cut them but severely traumatized them. In these cases LI-ESWT even to the penis could help by preventing or ameliorating secondary penile tissue reactions.

An interesting review on experimental studies on the possible mechanisms of how LI-ESWT could help in post-prostatectomy ED which is - after nerves and vessels have been cut - of neurogenic and vasculogenic origin. “Post-RP ED is mainly characterized by pelvic neurovascular injury. Therefore, the pelvis seems to be a logical treatment site. ... In the referred animal studies, shock waves were delivered to the pelvic region.” I agree to the first part of the statement by the authors but not to the second “Although we expect that ED secondary to non-NSRP (Non Nerve Sparing Prostatectomy) would probably not benefit from LI-ESWT, an experiment is still needed to prove it.” 
A problem in the clinical studies is that the surgeon may wrongly claim to have preserved the neurovascular bundles not being aware of the fact that his surgical technique indeed did not cut them but severely traumatized them. In these cases LI-ESWT even to the penis could help by preventing or ameliorating secondary penile tissue reactions.

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