Andrology Unit, Department of Urology and Renal Transplantation, University of Foggia, Foggia 71122, Italy.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 17177, Sweden.
Asian J Androl. 2024 Jul 1;26(4):344-348. doi: 10.4103/aja202384. Epub 2024 Mar 5.
Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy (Li-ESWT). However, the clinical significance of these findings remains unclear, and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established. This was an observational study of 113 patients with ED, evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation, University of Foggia (Foggia, Italy). Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction (IIEF-5) questionnaire was administered to assess the severity of ED. This was repeated 1 month after treatment. Patients with a peak systolic velocity (PSV) <30 cm s -1 were considered eligible for Li-ESWT. Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis. After treatment, a significant mean (±standard deviation [s.d.]) PSV increase of 5.0 (±3.4) cm s -1 was recorded and 52/113 (46.0%) patients reached a PSV >30 cm s -1 at posttherapeutic penile dynamic Doppler. A clinically significant IIEF-5 score improvement was observed in 7 patients, 21 patients, and 2 patients with mild-to-moderate, moderate, and severe pretreatment ED, respectively. No different outcomes were assessed based on smoking habits, previous pelvic surgery, or use of oral phosphodiesterase-5 inhibitor (PDE5i). On the other side, only 1 (6.7%) in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT. Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients. This advantage seemed particularly evident for moderate ED and was not affected by smoking habits, previous pelvic surgery, and use of PDE5i. Conversely, diabetic patients did not benefit from the treatment.
先前的研究表明，低强度体外冲击波治疗（Li-ESWT）可改善阴茎血流动力学参数。然而，这些发现的临床意义尚不清楚，并且基于现有合并症的 Li-ESWT 的明确选择标准尚未建立。这是一项观察性研究，共纳入了 113 名 ED 患者，研究于 2019 年 1 月至 2021 年 12 月在意大利福贾大学泌尿科和肾脏移植科的男科进行。通过阴茎动态多普勒评估血管参数，并用国际勃起功能指数（IIEF-5）问卷的 5 项版本评估 ED 的严重程度。治疗后 1 个月重复进行。将峰值收缩速度（PSV）<30cm/s 的患者视为适合 Li-ESWT。我们的方案包括 8 周 1500 次冲击，分布在阴茎的 5 个不同部位。治疗后，PSV 平均（±标准差[s.d.]）增加了 5.0（±3.4）cm/s，并且在治疗后的阴茎动态多普勒检查中，52/113（46.0%）名患者的 PSV >30cm/s。治疗后，7 名、21 名和 2 名分别有轻度至中度、中度和重度 ED 的患者的 IIEF-5 评分显著改善。根据吸烟习惯、先前的骨盆手术或使用口服磷酸二酯酶-5 抑制剂（PDE5i），未评估出不同的结局。另一方面，在 15 名糖尿病患者中，只有 1 名（6.7%）在 Li-ESWT 后 IIEF-5 评分有所改善。冲击波治疗可显著提高 PSV，并与 ED 患者的 IIEF-5 改善相关。这种优势在中度 ED 中尤为明显，并且不受吸烟习惯、先前的骨盆手术和 PDE5i 的使用影响。相反，糖尿病患者并未从治疗中获益。
