Assaly Rana, Giuliano François, Clement Pierre, Laurin Miguel, Favier Maryline, Teo Pearline, Bernabe Jacques, Alexandre Laurent, Behr-Roussel Delphine
Pelvipharm, Montigny-le-Bretonneux, France; UMR1179, Université Versailles Saint Quentin en Yvelines, Montigny-le-Bretonneux, France.
Pelvipharm, Montigny-le-Bretonneux, France; UMR1179, Université Versailles Saint Quentin en Yvelines, Montigny-le-Bretonneux, France; AP-HP, Neuro-Uro-Andrology, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France.
Sex Med. 2019 Dec;7(4):441-450. doi: 10.1016/j.esxm.2019.08.006. Epub 2019 Sep 21.
Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been reported to improve erectile function in patients with moderate-to-severe erectile dysfunction (ED) or even convert phosphodiesterase type 5 inhibitors nonresponders to responders. ED is highly prevalent in hypertensive patients. The effect of Li-ESWT on an animal model of hypertension-associated ED has not been reported.
To investigate the effect of Li-ESWT on hypertension-associated ED and provide plausible mechanisms of action of Li-ESWT on local mechanisms of penile erection.
Spontaneously hypertensive rats (SHRs) in the active group (n = 13) received Li-ESWT at energy flux density 0.06 mJ/mm (Aries; Dornier MedTech, Wessling, Germany) twice weekly for 6 weeks. The emitter was set to zero for SHRs in the sham group (n = 12). Erectile function was assessed 4 weeks post-treatment by monitoring intracavernosal pressure (ICP) in response to electrical stimulation of cavernous nerve before and after single dose of 0.3 mg/kg intravenous sildenafil. Cavernosal tissue was then evaluated for collagen/smooth muscle content, neuronal nitric oxide synthase (nNOS), and vascular endothelial factor (CD31) expression.
Erectile function was assessed with ICP, erectile tissue remodeling was studied by smooth muscle/collagen ratio, nNOS and CD31 were semiquantitatively evaluated on cavernosal sections.
The improvement of ICP parameters was greater in Li-ESWT-treated rats compared with controls with and without sildenafil. Sildenafil led to 20% increase in area under the intracavernosal pressure curve measured during the entire response/mean arterial pressure at 10 Hz in ESWT_SHR + sildenafil compared with ESWT_SHR. The smooth muscle/collagen ratio increased 2.5-fold in Li-ESWT compared with sham. Expression of CD31 tended to be increased whereas nNOS was unchanged.
Li-ESWT by Aries may represent an effective noninvasive therapeutic alternative and a relevant add-on therapy to phosphodiesterase type 5 inhibitors for ED in hypertensive patients, and it is suggested that it acts via remodeling of the penile tissue and promoting cavernosal vascularization. Assaly R, Giuliano F, Clement P, et al. Extracorporeal Shock Waves Therapy Delivered by Aries Improves Erectile Dysfunction in Spontaneously Hypertensive Rats Through Penile Tissue Remodeling and Neovascularization. Sex Med 2019;7:441-450.
据报道，低强度体外冲击波疗法（Li-ESWT）可改善中重度勃起功能障碍（ED）患者的勃起功能，甚至可使5型磷酸二酯酶抑制剂无反应者转变为有反应者。ED在高血压患者中非常普遍。Li-ESWT对高血压相关性ED动物模型的影响尚未见报道。
研究Li-ESWT对高血压相关性ED的影响，并探讨Li-ESWT对阴茎勃起局部机制的可能作用机制。
活动组自发性高血压大鼠（SHR，n = 13）接受能量通量密度为0.06 mJ/mm²的Li-ESWT治疗（Aries；德国韦斯林多尼尔医疗技术公司），每周2次，共6周。假手术组（n = 12）的SHR发射装置设置为零。治疗4周后，通过监测单剂量静脉注射0.3 mg/kg西地那非前后海绵体神经电刺激引起的海绵体内压（ICP）来评估勃起功能。然后评估海绵体组织的胶原/平滑肌含量、神经元型一氧化氮合酶（nNOS）和血管内皮生长因子（CD31）表达。
与使用和未使用西地那非的对照组相比，Li-ESWT治疗的大鼠ICP参数改善更大。与ESWT_SHR组相比，西地那非使ESWT_SHR + 西地那非组在10 Hz时整个反应期间测量的海绵体内压曲线下面积/平均动脉压增加了20%。与假手术组相比，Li-ESWT组的平滑肌/胶原比值增加了2.5倍。CD31表达有增加趋势，而nNOS无变化。
Aries的Li-ESWT可能是一种有效的非侵入性治疗方法，也是高血压患者ED的5型磷酸二酯酶抑制剂的相关辅助治疗方法，提示其通过阴茎组织重塑和促进海绵体血管生成发挥作用。Assaly R, Giuliano F, Clement P,等。Aries体外冲击波疗法通过阴茎组织重塑和新生血管形成改善自发性高血压大鼠的勃起功能障碍。性医学2019；7：441 - 450。
