Vita Roberto, Benvenga Salvatore, Giammusso Bruno, La Vignera Sandro
Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, 98125 Messina, Italy.
J Clin Med. 2019 Jul 11;8(7):1017. doi: 10.3390/jcm8071017.
The aim of this study was to expand existing literature on the effects of cardiovascular risk factors on the outcome of low-intensity extracorporeal shockwaves therapy (LIESWT), and to evaluate the role of hormone concentrations. Twenty patients with long-standing, PDE5i-resistant, vasculogenic erectile dysfunction (VED) were treated with six weekly sessions of LIESWT (9000 pulses). After a three-week break, four poor responders underwent another six weekly sessions. Rigidity score (RS) questionnaire was administered at baseline (T0), last session (T1), and three months after LIESWT (T2), while the Improvement component of the Clinical Global Impression of Change (CGIC-I) and the International Index of Erectile Function-5 (IIEF-5) questionnaires were administered at T1 and T2, and at T0 and T2, respectively. At T0 serum luteinizing hormone (LH), testosterone, sex hormone binding globulin (SHBG), calculated free testosterone, and prolactin levels were also recorded. At T1 and T2, 12/20 (60%) and 11/20 (55%) patients reached a RS ≥ 3; 16/20 (80%) and 13/20 (65%) improved their erections variably. Testosterone levels correlated positively with CGIC-I at T1. Patients < 65 years and those nonhypercholesterolemic had higher RS at T1 and T2. Age correlated negatively with RS at T1 and T2. At T0, diabetic patients had lower IIEF-5 scores, but those with RS ≥ 3 at T1 had higher IIEF-5 compared to those with RS < 3. Also, diabetes duration correlated inversely with IIEF-5 at T0. At T2, IIEF-5 improved significantly by an average of 2.8-points. We confirm safety and effectiveness of LIESWT for the treatment of VED. Age ≥ 65 years, diabetes, and hypercholesterolemia influence early and negatively the outcome of LIESWT.
本研究的目的是拓展现有关于心血管危险因素对低强度体外冲击波疗法（LIESWT）疗效影响的文献，并评估激素浓度的作用。20例患有长期、对磷酸二酯酶5抑制剂（PDE5i）耐药的血管性勃起功能障碍（VED）患者接受了为期六周的LIESWT治疗（9000次脉冲）。在为期三周的休息期后，4例反应不佳的患者又接受了为期六周的治疗。在基线期（T0）、最后一次治疗时（T1）以及LIESWT治疗后三个月（T2）进行硬度评分（RS）问卷调查，而临床总体印象变化量表（CGIC-I）的改善部分和国际勃起功能指数-5（IIEF-5）问卷分别在T1和T2以及T0和T2进行。在T0时还记录血清促黄体生成素（LH）、睾酮、性激素结合球蛋白（SHBG）、计算得出的游离睾酮和催乳素水平。在T1和T2时，分别有12/20（60%）和11/20（55%）的患者达到RS≥3；16/20（80%）和13/20（65%）的患者勃起功能有不同程度改善。睾酮水平在T1时与CGIC-I呈正相关。年龄<65岁和非高胆固醇血症患者在T1和T2时的RS较高。年龄在T1和T2时与RS呈负相关。在T0时，糖尿病患者的IIEF-5评分较低，但在T1时RS≥3的患者与RS<3的患者相比，IIEF-5评分更高。此外，糖尿病病程在T0时与IIEF-5呈负相关。在T2时，IIEF-5平均显著提高了2.8分。我们证实了LIESWT治疗VED的安全性和有效性。年龄≥65岁、糖尿病和高胆固醇血症对LIESWT的早期疗效有负面影响。
