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Usta MF et al., 2019: Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review

Usta MF, Gabrielson AT, Bivalacqua TJ
Department of Urology, Section of Andrology, Akdeniz University School of Medicine, Dumlupinar Bulvari, Kampus, 07070, Antalya, Turkey. Department of Urology, Tulane University School of Medicine, New Orlans, LA, USA. Johns Hopkins School of Medicine, James Buchanan Brady Urological Institute, Baltimore, MD, USA.

Abstract

Low-intensity extracorporeal shockwave therapy (LI-ESWT) to the penis has recently emerged as novel therapeutic option in the treatment of erectile dysfunction (ED). Randomized-controlled studies investigating the effect of this new treatment modality revealed promising results in men with vasculogenic ED. However, the efficacy of LI-ESWT in men who develop ED following radical prostatectomy (RP) remains obscure due to the exclusion of this group in nearly all clinical trials. In this review, the authors synthesize the findings from available preclinical and clinical studies that examine the potential utility of LI-ESWT in men with post-RP ED.

Int J Impot Res. 2019 Feb 1. doi: 10.1038/s41443-019-0121-3. [Epub ahead of print]

 

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Commenti 1

Hans-Göran Tiselius il Venerdì, 05 Luglio 2019 08:50

The authors of this review give a comprehensive overview of the biochemical, physiological and histological effects of LI-ESWT based on animal and clinical studies. Such effects are thought to be attained by restoration of vascular and neurogenic functions.

Although promising results have been obtained clinically in patients with ED of different causes, both in randomized studies and in meta-analyses the clinical significance of LI-ESWT varies considerably. A positive and promising clinical effect has been demonstrated in some studies whereas no or weak and clinically insignificant effect was the outcome in others. One problem is that ESWT has been carried out with different devices and with different treatment protocols as well as in patients with different pathology.

The focus of this article is to establish if LI-ESWT has a role in restoring the vascular and neurogenic injuries caused by radical prostatectomy. The reports so far are considered as inconclusive and the need of large studies with strictly formulated treatment programs is emphasized. The pronounced lack of information in patients with ED after radical prostatectomy is explained by the fact that this group of patients has been excluded from most LI-ESWT studies so far.

The bottom-line of this report is that there is no “level one (L1)” evidence for the effect of LI-ESWT, neither for ED as a consequence of radical prostatectomy or for ED of other etiology. Conclusions from ongoing studies will be highly interesting regarding the effect of LI-ESWT with or without pharmacological treatment.

The authors of this review give a comprehensive overview of the biochemical, physiological and histological effects of LI-ESWT based on animal and clinical studies. Such effects are thought to be attained by restoration of vascular and neurogenic functions. Although promising results have been obtained clinically in patients with ED of different causes, both in randomized studies and in meta-analyses the clinical significance of LI-ESWT varies considerably. A positive and promising clinical effect has been demonstrated in some studies whereas no or weak and clinically insignificant effect was the outcome in others. One problem is that ESWT has been carried out with different devices and with different treatment protocols as well as in patients with different pathology. The focus of this article is to establish if LI-ESWT has a role in restoring the vascular and neurogenic injuries caused by radical prostatectomy. The reports so far are considered as inconclusive and the need of large studies with strictly formulated treatment programs is emphasized. The pronounced lack of information in patients with ED after radical prostatectomy is explained by the fact that this group of patients has been excluded from most LI-ESWT studies so far. The bottom-line of this report is that there is no “level one (L1)” evidence for the effect of LI-ESWT, neither for ED as a consequence of radical prostatectomy or for ED of other etiology. Conclusions from ongoing studies will be highly interesting regarding the effect of LI-ESWT with or without pharmacological treatment.
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