Wu Shannon S, Ericson Kyle J, Shoskes Daniel A
Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA.
Transl Androl Urol. 2020 Oct;9(5):2122-2128. doi: 10.21037/tau-20-911.
Low-intensity shockwave therapy (SWT) is an emerging treatment for erectile dysfunction (ED). Devices used for SWT include focused shockwave therapy (fSWT) or radial wave therapy (rWT), which differ in how the waves are generated, their tissue penetration, and the shape of their pressure waves. Most studies of SWT for ED to date have utilized fSWT. Although widely used, the efficacy of rWT for ED is unknown. Our objective is to compare the efficacy of rWT and fSWT for ED at our institution.
A retrospective chart review was performed to identify all men with ED treated by fSWT or rWT. Men with history suggesting non-vasculogenic ED were excluded. All men received 6 consecutive weekly treatments. The fSWT group received 3,000 shocks per treatment at 0.09 mJ/mm. The rWT group received 10,000 shocks per treatment at 90 mJ and 15 Hz. Pre-treatment and 6-week post-treatment Sexual Health Inventory in Men (SHIM) scores were measured. Treatment response was categorized on a scale of 1-3 (1 if no improvement, 2 if erections sufficient for intercourse with phosphodiesterase 5 inhibitors (PDE5i), or 3 if sufficient erections without PDE5i). Primary endpoint was self-reported improvement score of 2 or greater.
A total of 48 men were included: 24 treated by fSWT and 24 by rWT. There were no significant differences in age, duration of ED, pre-treatment PDE5i use, or pre-treatment SHIM scores between the groups. Following treatment with rWT, the mean SHIM score improved from 9.3 to 16.1 (P<0.001). The mean SHIM following fSWT improved from 9.3 to 15.5 (P<0.001). The mean improvement in SHIM score did not differ between rWT (6.8) and fSWT (6.2) (P=0.42). 54% of men treated by fSWT experienced a significant clinical improvement (≥ grade 2 response) compared to 75% in the rWT group (P=0.42). There were no reported side effects with either device.
In our patient population, both fSWT and rWT were moderately effective treatments for arteriogenic ED with no observable difference in efficacy between the two modalities.
低强度冲击波疗法（SWT）是一种治疗勃起功能障碍（ED）的新兴疗法。用于SWT的设备包括聚焦冲击波疗法（fSWT）或径向波疗法（rWT），它们在波的产生方式、组织穿透力以及压力波形状方面存在差异。迄今为止，大多数关于SWT治疗ED的研究都采用了fSWT。尽管rWT已被广泛使用，但其治疗ED的疗效尚不清楚。我们的目的是比较在我们机构中rWT和fSWT治疗ED的疗效。
进行一项回顾性病历审查，以确定所有接受fSWT或rWT治疗的ED男性患者。排除有非血管源性ED病史的男性。所有男性均接受连续6周的每周一次治疗。fSWT组每次治疗接受3000次冲击波，能量为0.09 mJ/mm。rWT组每次治疗接受10000次冲击波，能量为90 mJ，频率为15 Hz。测量治疗前和治疗后6周的男性性健康量表（SHIM）评分。治疗反应分为1 - 3级（无改善为1级；使用磷酸二酯酶5抑制剂（PDE5i）时勃起足以进行性交为2级；无需PDE5i即可获得充分勃起为3级）。主要终点是自我报告的改善评分为2或更高。
共纳入48名男性：24名接受fSWT治疗，24名接受rWT治疗。两组在年龄、ED持续时间、治疗前PDE5i使用情况或治疗前SHIM评分方面无显著差异。rWT治疗后，平均SHIM评分从9.3提高到16.1（P<0.001）。fSWT治疗后的平均SHIM评分从9.3提高到15.5（P<0.001）。rWT组（6.8）和fSWT组（6.2）的SHIM评分平均改善值无差异（P = 0.42）。接受fSWT治疗的男性中有54%经历了显著的临床改善（≥2级反应），而rWT组为75%（P = 0.42）。两种设备均未报告有副作用。
在我们的患者群体中，fSWT和rWT对动脉源性ED均为中度有效的治疗方法，两种方式在疗效上无明显差异。
