Abstract
ABSTRACTObjective: To evaluate the long-term (18 months) effectiveness, safety, and factors that may predict the success of low-intensity shockwave lithotripsy (Li-SWT) in patients with erectile dysfunction (ED) who fail to respond to oral phosphodiesterase type 5 inhibitors (PDE5i).Patients and Methods: This prospective study included 52 patients with ED of vascular origin who failed to respond to oral PDE5i. The International Index of Erectile Function-Erectile Function domain (IIEF-EF) and Erection Hardness Score (EHS) questionnaires were used to evaluate EF. Patients under went two Li-SWT treatment sessions per week for 3 weeks, followed by a 3-week treatment-free period, and the cycle was repeated until each patient received 12 treatment sessions. Patients were followed-up after Li-SWT at 3, 6, 12, and 18 months.Results: At the 18-month follow-up, 33 patients (63.5%) were able to achieve an erection sufficient for penetration with or without PDE5i (22 were maintained on oral PDE5i). The remaining 19 patients (36.5%) had a poor response to Li-SWT and oral PDE5i. The initial response showed some decline in 50% of the initial responders. Younger men (aged <45 years), short ED duration (<2 years), and moderate ED severity responded better to Li-SWT. There were no adverse side-effects.Conclusion: In the present study, Li-SWT was a safe and effective treatment in 63.5% of men with ED who failed to respond to oral PDE5i. Factors such as age (<45 years), ED duration (<2 years), and ED severity can predict treatment outcome in such patients.Abbreviations: CDU: colour Doppler ultrasonography; ED: erectile dysfunction; EDV: end-diastolic velocity; EF: erectile function; EHS: Erection Hardness Score; FU: follow-up; IIEF-EF: International Index of Erectile Function-EF domain; Li-SWT: low-intensity shockwave lithotripsy; PDE5i: phosphodiesterase type 5 inhibitors; PGE1: prostaglandin E1; PSV: peak systolic velocity; RI: resistive index; VOD: veno-occlusive dysfunction
Highlights
Erectile dysfunction (ED) is the persistent/recurrent inability to attain or maintain an erection sufficient to permit satisfactory sexual intercourse
We evaluated patients at 18 months for the longterm outcomes of Low-intensity shockwave therapy (Li-SWT); treatment success at 18 months was defined as an Erection Hardness Score (EHS) ≥3 with or without the use of oral phosphodiesterase type 5 inhibitors (PDE5i)
Baseline laboratory investigations were normal except in four patients who had pus cells in the urine, which yielded no growth of microbes and they were treated with oral ciprofloxacin (500 mg 12-hourly for 10 days)
Summary
Erectile dysfunction (ED) is the persistent/recurrent inability to attain or maintain an erection sufficient to permit satisfactory sexual intercourse. Non-surgical treatments for managing ED include: oral phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices, and intracavernosal injection of vasodilating agents. These treatments are relatively safe with few adverse effects; they share the same major setback in that they do not alter the under lying pathophysiology of the ED and their effects are essentially time limited. Low-intensity shockwave therapy (Li-SWT) induces cellular microtrauma, which in turn stimulates the release of angiogenic factors with the subsequent neovascularisation of the treated tissue. These findings led to the assumption that if Li-SWT was applied to the penis it could improve blood supply to the corpora cavernosa and improve erection. Many studies have been conducted assessing the safety, feasibility and effectiveness of penile Li-SWT for treating ED or converting men with ED who failed to respond to oral PDE5i [3–5]
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