title: Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction.
abstract: The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA.
  
  
  METHODS
  31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2).
  
  
  RESULTS
  At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering 'yes' to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2).
  
  
  CONCLUSIONS
  In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified.
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ruffo
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Capece
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Prezioso
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Romeo
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Illiano
authors.affiliation: Department of Urology, Hospital Santa Maria delle Grazie, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Romis
authors.affiliation: Department of Urology, Hospital Santa Maria delle Grazie, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Lauro
authors.affiliation: Department of Urology, Federico II University, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Iacono
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D019001:Nitric Oxide Synthase / Q000032:analysis; D017060:Patient Satisfaction; D010410:Penile Erection / Q000502:physiology; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D015203:Reproducibility of Results; D057566:Self Report; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis
chemical_list: D018809:Proliferating Cell Nuclear Antigen; D042461:Vascular Endothelial Growth Factor A; D019001:Nitric Oxide Synthase