06 LISWT Might Improve the Genitoperineal Sensation and Erectile Dysfunction in Neurogenic and Diabetic Patients

Abstract

Recent scientific studies have shown different mechanisms for Low Intensity Shock Wave Therapy (LISWT) in treating Erectile Dysfunction (ED) that can be explained shortly by the following pathways: mechanical effect, vasculogenic effect, neurogenic effect, and stem cells stimulation and proliferation; all mediated through different growth factors: TGF-D1, BDNF, VEGF, and nitric oxide. The role of BDNF (Brain-Derived Neurotrophic factor) in promoting Cavernous Nerve regeneration in rats via SC-dependent Janus kinase (JAK)/signal transducer and activator of transcription (JAK/STAT) pathways led us to question and test the role of LISWT in improving the male genitoperineal sensation and Neurogenic ED in diabetic and neurogenic patients. A 48 year old man known to have syringomyelia disease, dyslipidemia, hypertension, and diabetes; with history of bilateral lower extremities paresthesia since the age of 32, perineal and genital numbness since the age of 29, was presented with severe numbness and mild to moderate ED. Patient received six weekly sessions of linear low intensity shock wave therapy (PiezoWave2 from Richard WOLF) with an energy flux density of 0.16mj/mm2 and frequency set to 8 Hz, wave focus penetration depth set to 10mm. Patient received 6000 shocks/session, 2000 shocks on the perineum (1000 each crus penis), 2000 shocks on dorsum penis, 2000 shocks on lateral aspect of penis (1000 each side). The IIEF-5 score and percentage of improvement of numbness (subjective improvement of the touch sensation) in the genitoperineal were documented during each session, after 1 month, 3 months, and 8 months of receiving LISWT.