Low-intensity Shock Wave Therapy for Erectile Dysfunction and the Influence of Disease Duration - Beyond the Abstract

Erectile dysfunction is a widely prevalent condition and efforts have been made in order to find a successful treatment. LiSWT is now a hot topic in this setting due to its proven results in the treatment of ED, although the mechanism of action is not well understood, treatment protocols are not well defined and the best candidate it not well established. Our study aimed to evaluate the results of LiSWT on patients treated for ED and the influence of ED duration in treatment outcomes, showing that LiSWT produced significative improvement in IIEF-5 and PDDU, irrespective of disease duration.

Another endpoint of our study was to evaluate the influence of LiSWT in PDE5i response and if patients were able to leave this medication after treatment. Significant results were seen in patients who still needed PDE5i after treatment, although their response to medication improved (overall improvement of 36%; p 0.004). Patients with longer ED responded better to PDE5i after LiSWT.

Our protocol included having tadalafil 5mg daily. Following the concept of angiogenesis and neovascularization, concomitant PDE5i produces a continuous local stimulus that might contribute to a synergic effect with LiSWT and potentiate global response in the best interest for the patient.

When stratified by type of ED, our results showed that patients with vasculogenic ED, presented the best results, and, patients with ED post radical prostatectomy, the worse results, suggesting that these patients aren´t good candidates, although LiSWT may have a role as adjunctive therapy in penile rehabilitation. When looking for the influence of ED risk factors on LiSWT outcomes, our study showed that diabetic patients also presented the worse results.

Overall, our results suggest that the length of disease duration doesn´t negatively influence treatment results, and the concomitant use of PDE5i should be considered.

Written by: Dr. Pedro Simoes de Oliveira, SCI-Centro de Urologia, Lisbon, Portugal

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