Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction.
BACKGROUND
Low-intensity extracorporeal shockwave therapy (LI-ESWT) is currently under investigation regarding its ability to promote neovascularization in different organs.


OBJECTIVE
To evaluate the effect of LI-ESWT on men with erectile dysfunction (ED) who have previously responded to oral phosphodiesterase type 5 inhibitors (PDE5-I).


METHODS
We screened 20 men with vasculogenic ED who had International Index of Erectile Function ED (IIEF-ED) domain scores between 5-19 (average: 13.5) and abnormal nocturnal penile tumescence (NPT) parameters. Shockwave therapy comprised two treatment sessions per week for 3 wk, which were repeated after a 3-wk no-treatment interval.


METHODS
LI-ESWT was applied to the penile shaft and crura at five different sites.


METHODS
Assessment of erectile function was performed at screening and at 1 mo after the end of the two treatment sessions using validated sexual function questionnaires, NPT parameters, and penile and systemic endothelial function testing. The IIEF-ED questionnaire was answered at the 3- and 6-mo follow-up examinations.


CONCLUSIONS
We treated 20 middle-aged men (average age: 56.1 yr) with vasculogenic ED (mean duration: 34.7 mo). Eighteen had cardiovascular risk factors. At 1 mo follow-up, significant increases in IIEF-ED domain scores were recorded in all men (20.9 +/- 5.8 vs 13.5+/- 4.1, p<0.001); these remained unchanged at 6 mo. Moreover, significant increases in the duration of erection and penile rigidity, and significant improvement in penile endothelial function were demonstrated. Ten men did not require any PDE5-I therapy after 6-mo follow-up. No pain was reported from the treatment and no adverse events were noted during follow-up.


CONCLUSIONS
This is the first study that assessed the efficacy of LI-ESWT for ED. This approach was tolerable and effective, suggesting a physiologic impact on cavernosal hemodynamics. Its main advantages are the potential to improve erectile function and to contribute to penile rehabilitation without pharmacotherapy. The short-term results are promising, yet demand further evaluation with larger sham-control cohorts and longer follow-up.
Vardi
Yoram
Y
Neuro-Urology Unit, Rambam Healthcare Campus and the Technion, Haifa, Israel. yvard@rambam.health.gov.il
Appel
Boaz
B
Jacob
Giris
G
Massarwi
Omar
O
Gruenwald
Ilan
I
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply; D010865:Pilot Projects; D013997:Time Factors