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Assaly R. et al., 2019: Extracorporeal Shock Waves Therapy Delivered by Aries Improves Erectile Dysfunction in Spontaneously Hypertensive Rats Through Penile Tissue Remodeling and Neovascularization

Assaly R, Giuliano F, Clement P, Laurin M, Favier M, Teo P, Bernabe J, Alexandre L, Behr-Roussel D.
Pelvipharm, Montigny-le-Bretonneux, France; UMR1179, Université Versailles Saint Quentin en Yvelines, Montigny-le-Bretonneux, France.
Pelvipharm, Montigny-le-Bretonneux, France; UMR1179, Université Versailles Saint Quentin en Yvelines, Montigny-le-Bretonneux, France; AP-HP, Neuro-Uro-Andrology, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France.
Inserm, U1016, Institut Cochin, Paris, France.
Dornier MedTech GmbH, Wessling, Germany.
Pelvipharm, Montigny-le-Bretonneux, France.
Pelvipharm, Montigny-le-Bretonneux, France; UMR1179, Université Versailles Saint Quentin en Yvelines, Montigny-le-Bretonneux, France.

Abstract

BACKGROUND:
Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been reported to improve erectile function in patients with moderate-to-severe erectile dysfunction (ED) or even convert phosphodiesterase type 5 inhibitors nonresponders to responders. ED is highly prevalent in hypertensive patients. The effect of Li-ESWT on an animal model of hypertension-associated ED has not been reported.

AIM:
To investigate the effect of Li-ESWT on hypertension-associated ED and provide plausible mechanisms of action of Li-ESWT on local mechanisms of penile erection.

METHODS:
Spontaneously hypertensive rats (SHRs) in the active group (n = 13) received Li-ESWT at energy flux density 0.06 mJ/mm2 (Aries; Dornier MedTech, Wessling, Germany) twice weekly for 6 weeks. The emitter was set to zero for SHRs in the sham group (n = 12). Erectile function was assessed 4 weeks post-treatment by monitoring intracavernosal pressure (ICP) in response to electrical stimulation of cavernous nerve before and after single dose of 0.3 mg/kg intravenous sildenafil. Cavernosal tissue was then evaluated for collagen/smooth muscle content, neuronal nitric oxide synthase (nNOS), and vascular endothelial factor (CD31) expression.

OUTCOMES:
Erectile function was assessed with ICP, erectile tissue remodeling was studied by smooth muscle/collagen ratio, nNOS and CD31 were semiquantitatively evaluated on cavernosal sections.

RESULTS:
The improvement of ICP parameters was greater in Li-ESWT-treated rats compared with controls with and without sildenafil. Sildenafil led to 20% increase in area under the intracavernosal pressure curve measured during the entire response/mean arterial pressure at 10 Hz in ESWT_SHR + sildenafil compared with ESWT_SHR. The smooth muscle/collagen ratio increased 2.5-fold in Li-ESWT compared with sham. Expression of CD31 tended to be increased whereas nNOS was unchanged.

CONCLUSIONS:
Li-ESWT by Aries may represent an effective noninvasive therapeutic alternative and a relevant add-on therapy to phosphodiesterase type 5 inhibitors for ED in hypertensive patients, and it is suggested that it acts via remodeling of the penile tissue and promoting cavernosal vascularization. Assaly R, Giuliano F, Clement P, et al. Extracorporeal Shock Waves Therapy Delivered by Aries Improves Erectile Dysfunction in Spontaneously Hypertensive Rats Through Penile Tissue Remodeling and Neovascularization. Sex Med 2019;7:441-450.
Sex Med. 2019 Dec;7(4):441-450. doi: 10.1016/j.esxm.2019.08.006. Epub 2019 Sep 21. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Monday, April 20 2020 08:35

This article describes an animal experiment in hypertensive rats. Li-ESWT was administered to rats with or without simultaneous administration of Sildenafil and compared with sham-treated rats given the same medication. The most important message obtained from this article is that in addition to erection improvement there was an increased effect of Sildenafil when Li-ESWT was given,
Moreover, this article might be of interest for better understanding the mechanisms of ESWT and a number of histological effects are described.

This article describes an animal experiment in hypertensive rats. Li-ESWT was administered to rats with or without simultaneous administration of Sildenafil and compared with sham-treated rats given the same medication. The most important message obtained from this article is that in addition to erection improvement there was an increased effect of Sildenafil when Li-ESWT was given, Moreover, this article might be of interest for better understanding the mechanisms of ESWT and a number of histological effects are described.
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