scholarly journals Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1670
Author(s):  
Kai-Yi Tzou ◽  
Su-Wei Hu ◽  
Oluwaseun Adebayo Bamodu ◽  
Yuan-Hung Wang ◽  
Wen-Ling Wu ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Erectile Function ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Therapeutic Modality ◽  
Function Evaluation ◽  
Shockwave Therapy ◽  
Low Intensity ◽  
Baseline Values

Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (p < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients’ pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (p = 0.04), uncontrolled diabetes mellitus (p = 0.04), and uncontrolled hyperlipidemia (p = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (p = 0.04) and uncontrolled hyperlipidemia (p = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.

scholarly journals Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 13 (2) ◽  
pp. 155798831984674 ◽  
Author(s):  
Liang Dong ◽  
Degui Chang ◽  
Xiaojin Zhang ◽  
Junjun Li ◽  
Fang yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Treatment Group ◽  
Erectile Function ◽  
Meta Analysis ◽  
Noninvasive Treatment ◽  
Shockwave Therapy ◽  
Low Intensity ◽  
Extracorporeal Shock Wave

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has been reported as a useful and noninvasive treatment for erectile dysfunction (ED). Systematic review and meta-analysis are utilized to evaluate the efficacy of Li-ESWT by comparing the changes in the International Index of Erectile Function erectile function domain (IIEF-EF) and the Erection Hardness Score (EHS) versus sham therapy in men with ED. A systematic search of the MEDLINE, EMBASE, ClinicalTrials.gov, CBM, CNKI, WANGFANG, and VIP was conducted to obtain randomized controlled trials (RCTs) published in peer-reviewed journals or presented in abstract forms of Li-ESWT for ED treatment from January 2010 to June 2018. If RCTs are published in peer-reviewed literature and IIEF-EF scores and EHS are used to assess erectile function outcomes, they are eligible for inclusion. A meta-analysis was used to summarize the estimates. The meta-analysis included seven RCTs involving 522 participants. The data revealed that men treated with Li-ESWT showed significant improvement in pooled mean IIEF-EF scores from baseline to follow-up compared with sham therapy (MD: 1.99 points; 95% CI [1.35, 2.63]; p < .00001). Changes in the IIEF-EF score increased significantly in the treatment group (MD: 3.62; 95% CI [2.99, 4.25]; p < .00001). The EHS increased significantly in the treatment group in four studies (OR: 16.02; 95% CI [7.93, 32.37]; p < .00001). Patients with moderate and/or severe ED reported better results in mean IIEF scores (MD: 3.95; 95% CI [2.44, 5.46]; p < .00001). In meta-analysis of seven RCTs with men who received Li-ESWT for ED, there was evidence that the IIEF-EF and EHS experienced improvements following Li-ESWT.

scholarly journals Low intensity Extra Corporeal Shock Wave Therapy in Patients with Erectile Dysfunction: Our experience in ACKU

2020 ◽  
Vol 23 (2) ◽  
pp. 176-180
Author(s):  
Md Fazal Naser ◽  
Mahmood Hasan ◽  
Md Waliul Islam ◽  
Tajkera Sultana Chowdhury ◽  
Md Shohrab Hossain
Keyword(s):  
Erectile Dysfunction ◽  
Erectile Function ◽  
Treatment Protocol ◽  
Phosphodiesterase Inhibitors ◽  
Shockwave Therapy ◽  
Low Intensity ◽  
Weekly Session ◽  
Linear Probe ◽  
Study Population ◽  
Energy Flux Density

Introduction: Oral 5-phosphodiesterase inhibitors (PDE5-I) is the main therapeutical options in erectile dysfunction (ED). It shows good results, but non-responders lack other effective options and its effect is also not long lasting. Since last few years, low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa showing promising results. This article presents our early experiences in Advanced Center of Kidney disease and Urology (ACKU) with the aim to evaluate clinical efficacy of Li-ESWT. Materials and methods: Thirty four patients with ED were prospectively included in the study during the period of January 2018 to Jun 2019.Treatment was performed using the PiezoWave2 (Richard Wolf, Germany) device with a linear probe. Treatment protocol included a weekly session for four weeks. Each session delivered 2000 shocks on the perineum plus 4000 shocks on dorsum penis with an energy flux density (EFD) of 0.160 mJ/mm2. Every patient has been re-evaluated 1.5 and 3 months after the last session. Pre- and post-procedure International Index Erectile Function – Erectile function domain (IIEF-EF) score, Erection Hardness Score (EHS) and Global Assessment Questionnaire-Question 1 (GAQ-Q1) answers were obtained. Results: Mean age of the study population was 39.4 (±12.9) years, 35.29% diabetic, 20.59% with hypertension and 55.85% smokers. Mean baseline IIEF-EF was 14.6, at 6 week post LiSWT was 16.4 (p >0.05) and at 3 months post LiSWT was 19.2 (p < 0.05). EHS was significantly improved at 3 month in comparison to baseline (p<0.05). 20.59% patients answered positively to GAQ-Q1 at 6 week and 61.76% at 3 months. IIEF-EF score change of >5 and increase of EHS >2 were observed in 62.88% and 70.59% study subjects respectively. Conclusions: Li-ESWT is a safe, harmless and repeatable treatment tool for ED with good outcomes reported. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.176-180

scholarly journals Combination Therapy Using Adipose-Derived Stem Cells And Low-Intensity Extracorporeal Shockwave Therapy On Erectile Dysfunction In Streptozotocin-Induced Diabetic Rats

2019 ◽  
Author(s):  
Dankang Li ◽  
Yongchao Ge ◽  
Quanliang Hou ◽  
Wenhua Wang ◽  
Chengda Zhang ◽  
...  
Keyword(s):  
Stem Cells ◽  
Erectile Dysfunction ◽  
Treatment Group ◽  
Erectile Function ◽  
Combined Treatment ◽  
Adipose Derived Stem Cells ◽  
Model Group ◽  
Extracorporeal Shockwave Therapy ◽  
Shockwave Therapy ◽  
Low Intensity

Abstract Background：Diabetes mellitus (DM) is an important risk factor for erectile dysfunction (ED). Adipose-derived stem cells (ADSCs) and low-intensity extracorporeal shockwave therapy (LI-ESWT) are two emerging therapies for ED. The efficacy of ADSCs combined LI-ESWT in the treatment of diabetes induced erectile dysfunction (DMED) was not completely elucidated. This study aim to investigate combined therapeutic efficacy of ADSCs and LI-ESWT in rat model of DMEDand whether they have interaction.Methods：Rats were randomly divided into 5 groups: control, erectile dysfunction group (ED), ADSCs treatment group(ADSCs), LI-ESWT treatment group (LI-ESWT) and ADSCs combined with LI-ESWT treatment (ADSCs+LI-ESWT). After 4 weeks, erectile function was assessed using intracavernous pressure (ICP) and mean arterial pressure (MAP), after that performed immunohistochemistry (IH).Results：Finally, a total of 98 rats completed the experiment. The ICP/MAP of five groups under the voltage stimulation of 10V was significantly different (P>0.05). ICP/MAP in ADSC group, LI-ESWT group and combined treatment group was significantly higher than that of ED model group; ICP/MAP in combined treatment group was higher than ADSC group and LI-ESWT group. Interaction between LI-ESWT and ADSCs therapy was not statistically significant (P＞0.05).The expression of -smooth muscle actin (-SMA), nerve nitricoxide synthase (nNOS) and von Willebrand factor (vWF) in ADSCs treatment group, LI-ESWT group and combined treatment group was higher than those in ED model group (P < 0.05).Conclusions：Both ADSCs and LI-ESWT therapy can improve the erectile function of rats. The combination of these two methods present better effect on ED than used individually. There is no positive interaction between ADSCs therapy and LI-ESWT. Both ADSCs and LI-ESWT can enhance the expression of α-SMA, nNOS and vWF in corpus cavernosum of ED rats.

scholarly journals Low-intensity extracorporeal shock wave therapy of vasculogenic erectile dysfunction - three-week treatment in a cohort of North Italian patients

2018 ◽  
Vol 146 (9-10) ◽  
pp. 549-553 ◽  
Author(s):  
Goran Arandjelovic ◽  
Fedra Gottardo ◽  
Ivan Ignjatovic
Keyword(s):  
Shock Wave ◽  
Erectile Dysfunction ◽  
Doppler Ultrasound ◽  
Erectile Function ◽  
Extracorporeal Shock Wave Therapy ◽  
Shock Wave Therapy ◽  
Low Intensity ◽  
Extracorporeal Shock Wave ◽  
Vasculogenic Erectile Dysfunction

Introduction/Objective. Although phosphodiesterase 5 (PDE 5) inhibitors represent the gold standard for medical treatment of erectile dysfunction (ED), they are not curative. Over the recent years, low-intensity extracorporeal shock wave therapy (LI-ESWT) has been proposed as a valid non-invasive therapy approach for ED. The aim of our work is to assess the shortened, three-week low-intensity extracorporeal shock wave therapy of vasculogenic ED. Methods. The study involved 32 patients with an International Index of Erectile Function (IIEF) score between 5 and 20, and whose vasculogenic ED had been proven through Doppler ultrasound. All the patients had a washout period of one month after previous therapy and agreed to discontinue the PDE5-I therapy during the follow-up. The LI-ESWT was applied for three weeks, twice weekly, without repeating. The patients were evaluated at baseline, after one, three, and six months with the IIEF, Doppler ultrasound, and the Beck Depression Inventory. Results. All investigated parameters (International Index of Erectile Function, Beck Depression Inventory and penile Doppler ultrasound parameters) showed statistically significant improvement just one month after the treatment, compared to pre-treatment values, in all investigated domains. The international index of erectile function passed from baseline values of 12.75 ? 4.62 to 14.87 ? 5.04 at one month after treatment (p < 0.01). This trend remained positive in IIEF and all the parameters tested at the three-month and six-month follow-up. Conclusion. The shortened three-week low-intensity shock wave treatment of vasculogenic erectile dysfunction proved to be clinically effective.

scholarly journals Effect of Physical Exercise Combined with Shockwave Therapy on Erectile Dysfunction in Diabetic Patients

2021 ◽  
Author(s):  
Amr Salama ◽  
Mohamed Samy Abdrabo ◽  
Walid A Abouelnaga
Keyword(s):  
Erectile Dysfunction ◽  
Physical Exercise ◽  
Group Treatment ◽  
Erectile Function ◽  
Diabetic Patients ◽  
Emission Frequency ◽  
Shockwave Therapy ◽  
End Of Treatment ◽  
The Mean

IntroductionThe aim of this study was to evaluate whether physical exercise (PE) in addition to shockwaves therapy (ESWT) is more effective in improving erectile function as compared to PE and ESWT alone in diabetic patients with erectile dysfunction (ED).Material and methodsForty-five patients with type 2 diabetes mellitus (DM) and ED were divided into three equal groups: group1 (ESWT group) received treatment with ESWT twice weekly for 6 weeks, comprising 3000 shockwaves at an energy density of 0.25 mJ/mm2 and an emission frequency of 6 Hz; group2 (PE group) received treatment with physical exercise three times per week for 12 weeks; and group3 (combined group) was treated using physical exercise in the form of the program followed by the PE group, plus ESWT in the form of the same parameter and protocol as that of the ESWT group. Treatment outcomes were measured by International Index of Erectile Function-5 (IIEF-5) score variations recorded at 4 and 12 weeks after the end of treatment with respect to the baseline.ResultsThe mean IIEF-5 scores significantly improved in all groups at the 4-week follow-up without intergroup differences. At the 12-week follow-up, the mean IIEF-5 improvement and durability were significantly higher among patients in combined groups.ConclusionsThe conclusion of this study combined approach of ESWT and PE provides significant advantages in erectile dysfunction improvement and durability as compared to ESWT or PE alone in diabetic patients with ED.

scholarly journals Low-Intensity Extracorporeal Shockwave Therapy Can Improve Erectile Function in Patients Who Failed to Respond to Phosphodiesterase Type 5 Inhibitors

2017 ◽  
Vol 11 (6) ◽  
pp. 1781-1790 ◽  
Author(s):  
Chia-Chun Tsai ◽  
Chii-Jye Wang ◽  
Yung-Chin Lee ◽  
Yen-Ting Kuo ◽  
Hsiao-Hua Lin ◽  
...  
Keyword(s):  
Erectile Function ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Low Intensity ◽  
Detailed Medical History ◽  
Initial Severity ◽  
Phosphodiesterase Type

Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to improve ED by enhancing perfusion of the penis. The current study was performed to evaluate whether combined treatment with LI-ESWT and PDE5is can restore erectile function in patients who failed to respond to PDE5is alone. This was an open-label single-arm prospective study. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Sociodemographic information and detailed medical history were recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly for 12 weeks. All patients continued their regular PDE5is use. The EHS and the 5-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate the change in erectile function 1 and 3 months after LI-ESWT. A total of 52 patients were enrolled. After LI-ESWT treatment, 35 of the 52 patients (67.3%) could achieve an erection hard enough for intercourse (EHS ≧ 3) under PDE5is use at the 1-month follow-up. Initial severity of ED was the only significant predictor of a successful response (EHS1: 35.7% vs. EHS2: 78.9%, p = .005). Thirty-three of the 35 (94.3%) subjects who responded to LI-ESWT could still maintain their erectile function at the 3-month follow-up. LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of ED was an important predictor of a successful response.

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