Abstract
The aim of this study was to expand existing literature on the effects of cardiovascular risk factors on the outcome of low-intensity extracorporeal shockwaves therapy (LIESWT), and to evaluate the role of hormone concentrations. Twenty patients with long-standing, PDE5i-resistant, vasculogenic erectile dysfunction (VED) were treated with six weekly sessions of LIESWT (9000 pulses). After a three-week break, four poor responders underwent another six weekly sessions. Rigidity score (RS) questionnaire was administered at baseline (T0), last session (T1), and three months after LIESWT (T2), while the Improvement component of the Clinical Global Impression of Change (CGIC-I) and the International Index of Erectile Function-5 (IIEF-5) questionnaires were administered at T1 and T2, and at T0 and T2, respectively. At T0 serum luteinizing hormone (LH), testosterone, sex hormone binding globulin (SHBG), calculated free testosterone, and prolactin levels were also recorded. At T1 and T2, 12/20 (60%) and 11/20 (55%) patients reached a RS ≥ 3; 16/20 (80%) and 13/20 (65%) improved their erections variably. Testosterone levels correlated positively with CGIC-I at T1. Patients < 65 years and those nonhypercholesterolemic had higher RS at T1 and T2. Age correlated negatively with RS at T1 and T2. At T0, diabetic patients had lower IIEF-5 scores, but those with RS ≥ 3 at T1 had higher IIEF-5 compared to those with RS < 3. Also, diabetes duration correlated inversely with IIEF-5 at T0. At T2, IIEF-5 improved significantly by an average of 2.8-points. We confirm safety and effectiveness of LIESWT for the treatment of VED. Age ≥ 65 years, diabetes, and hypercholesterolemia influence early and negatively the outcome of LIESWT.
Highlights
Erectile dysfunction is the inability to attain and maintain a penile erection hard enough for satisfactory sexual intercourse lasting at least 6 months [1]
Patients were divided into four groups based on the current use of drugs for diabetes, hypertension, hypercholesterolemia, and on past history of myocardial infarction
Several studies have shown the beneficial effects of low-intensity extracorporeal shockwaves therapy (LIESWT) for the treatment of phosphodiesterase type 5 inhibitors (PDE5i)-resistant erectile dysfunction [28]
Summary
Erectile dysfunction is the inability to attain and maintain a penile erection hard enough for satisfactory sexual intercourse lasting at least 6 months [1]. The prevalence of erectile dysfunction increases with age and is higher in patients with certain systemic diseases, such as diabetes mellitus, hypercholesterolemia, and hypertension [1]. One of the most frequent causes of erectile dysfunction is penile arterial insufficiency (vasculogenic erectile dysfunction), which can be caused by hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking, all of them having endothelial dysfunction as a common denominator [1]. Up to 40% of patients with vasculogenic erectile dysfunction do not respond or respond poorly to phosphodiesterase type 5 inhibitors (PDE5i) even at their maximum dose [8]. A number of men do not tolerate the bothersome side effects of PDE5i, rendering them drugs that are considered high-dropout-rate drugs [9]
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