Low-energy Shock Wave Therapy Ameliorates Erectile Dysfunction in a Pelvic Neurovascular Injuries Rat Model

Abstract

Introduction Erectile dysfunction (ED) caused by pelvic injuries is a common complication of civil and battlefield trauma with multiple neurovascular factors involved, and no effective therapeutic approach is available. Aims To test the effect and mechanisms of low-energy shock wave (LESW) therapy in a rat ED model induced by pelvic neurovascular injuries. Methods Thirty-two male Sprague-Dawley rats injected with 5-ethynyl-2′-deoxyuridine (EdU) at newborn were divided into 4 groups: sham surgery (Sham), pelvic neurovascular injury by bilateral cavernous nerve injury and internal pudendal bundle injury (PVNI), PVNI treated with LESW at low energy (Low), and PVNI treated with LESW at high energy (High). After LESW treatment, rats underwent erectile function measurement and the tissues were harvested for histologic and molecular study. To examine the effect of LESW on Schwann cells, in vitro studies were conducted. Main Outcome Measurements The intracavernous pressure (ICP) measurement, histological examination, and Western blot (WB) were conducted. Cell cycle, Schwann cell activation-related markers were examined in in vitro experiments. Results LESW treatment improves erectile function in a rat model of pelvic neurovascular injury by leading to angiogenesis, tissue restoration, and nerve generation with more endogenous EdU+ progenitor cells recruited to the damaged area and activation of Schwann cells. LESW facilitates more complete re-innervation of penile tissue with regeneration of neuronal nitric oxide synthase (nNOS)-positive nerves from the MPG to the penis. In vitro experiments demonstrated that LESW has a direct effect on Schwann cell proliferation. Schwann cell activation-related markers including p-Erk1/2 and p75 were upregulated after LESW treatment. Conclusion LESW-induced endogenous progenitor cell recruitment and Schwann cell activation coincides with angiogenesis, tissue, and nerve generation in a rat model of pelvic neurovascular injuries.

428 The Effect of Cavernous Nerve Traction on Erectile Function In Rats

“…Our results showed that the nNOS content in both the MPG and the dorsal penile nerve was reduced in the CN traction group, which is consistent with results in other CN injury models [9,24,25]. The number of neurofilament-positive nerve fibers in the dorsal penile nerve also declined, indicating that the axon contents were decreased after CN traction, which is also consistent with previous studies [26,27]. These findings suggest that CN traction could impair erectile function by reducing both the total number of nerve fibers and the number of nNOS-positive nerve fibers in the dorsal penile nerve.…”

Low intensity shock wave therapy for erectile dysfunction: 6 months followup results

“…Несмотря на то, что диабетическая и после-операционная ЭД известны среди специалистов как заболевания, трудно поддающиеся терапии и у ряда таких пациентов УВТ в нашем исследовании не изменила эректильную функцию, оказалось, что средние значения индексов МИЭФ и SHIM в обеих подгруппах сразу после завершения курса УВТ повысились. Наши результаты могут служить клиническим подтверждением целесообразности применения УВТ при этих патологических состо-яниях, возможности которой ранее были успешно проверены на экспериментальных моделях крыс с сахарным диабетом [8,16] и повреждениями со-судисто-нервных пучков таза [17].…”

Low-energy shock wave therapy ameliorates erectile dysfunction in a pelvic neurovascular injuries rat model

“…In this study (24), Tom Lue and his colleagues investigated the effects of two different treatment regimen using Li-ESWT (low energy: 0.06 mJ/mm 2 , 300 pulses, 3 Hz during 4 weeks and 1 week wash-out or high energy: 0.09 mJ/mm 2 , 1,000 pulses, 3 Hz during 4 weeks and 1 week wash-out) in a new experimental model of neurovascular ED produced by both bilateral cavernous nerve injury (CNI) and internal pudendal bundle (IPB) injury. This model is meant to mimic trauma-related ED that “ commonly occurs in the setting of pelvic surgery or as a result of local injuries such as improvised explosive device in battlefield […] ”.…”

“…As such, these data are a very valuable contribution in the understanding of the mechanistic actions of Li-ESWT in an experimental setting of ED. Thus, Li and co-workers (24) should be both congratulated for this work and encouraged to pursue this line of much-needed basic science research.…”