Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients

Spivak, Leonid; Shultz, Tamar; Appel, Boaz; Verze, Paolo; Yagudaev, D D; Винаров, А.З.

doi:10.1016/j.sxmr.2019.06.007

Cited by 18 publications

(23 citation statements)

References 25 publications

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“…In addition, we demonstrated that Li-ESWT is therapeutically efficacious in Taiwanese patients regardless of their PDE5i response status, albeit slightly more so among PDE5i responders. Our findings are concordant with results reported by Spivak Leonid's team indicating that Li-ESWT is an effective and safe therapeutic modality for PDE5i responsive or non-responsive patients with ED, despite finding that the PDE5i responders outperformed the PDE5i non-responders, and that this was statistically significant [25]. This is corroborated by results from a double-blind, placebo-controlled study demonstrating that Indian men with vasculogenic ED who were PDE5i responders enjoyed long-term improvement in their EF following Li-ESWT, unlike the PDE5i non-responders [26].…”

Section: Discussionsupporting

confidence: 93%

Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Tzou

Bamodu

et al. 2021

Biomedicines

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Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (p < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients’ pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (p = 0.04), uncontrolled diabetes mellitus (p = 0.04), and uncontrolled hyperlipidemia (p = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (p = 0.04) and uncontrolled hyperlipidemia (p = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.

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Section: Discussionsupporting

confidence: 93%

Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Tzou

Bamodu

et al. 2021

Biomedicines

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“… 49 – 51 A 2019 study illustrated the efficacy of Li-ESWT in treating diabetic patients with ED. 52 Specifically, the researchers collected data from five double-blind, sham-controlled trials and subdivided patients into two groups, based on whether their ED had previously responded to treatment with PDE5i. A total of 350 PDE5i responders (PDE5i-R) with vasogenic ED were identified, 61 of which had diabetes.…”

Section: Low-intensity Extracorporeal Shockwave Therapymentioning

confidence: 99%

Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction

Drury

Natale

2021

Therapeutic Advances in Urology

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Erectile dysfunction (ED) is both a common and complex disease process. Existing ED treatments do not always achieve adequate results. There is clinical interest in employing regenerative therapies, including low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet rich plasma (PRP), and stem cell therapy (SCT), in the treatment of ED as adjunct or alternative treatments. Here, we present evidence for emerging shockwave- and cell-based regenerative therapies for the treatment of ED following a thorough review of the existing PubMed literature pertaining to Li-ESWT, PRP, and SCT in relation to the treatment of ED. Li-ESWT causes microtrauma in tissue that hypothetically upregulates angiogenesis and recruits stem cells. Several large-scale systematic reviews and meta-analyses have reported that Li-ESWT improved ED in humans. Additionally, evidence has commenced to show that Li-ESWT may be effective against two recognized and complex etiologies of ED: diabetic and neurogenic. PRP delivers an autologous sample rich in growth factors to damaged tissue. Animal model studies have demonstrated improved erectile function recovery as well as preservation of cavernous nerve axons. Studies with PRP in humans are limited. SCT utilizes the regenerative potential of stem cells for healing of damaged tissue. In the treatment of ED, SCT has been used in the setting of diabetic and post-prostatectomy ED. Results of human studies are varied, although SCT treatments did result in increased erectile rigidity with some patients recovering the ability to achieve penetration. While these regenerative therapies show potential to augment the current treatment regimen for ED, there is a paucity of evidence to support the safety and efficacy of these treatments. Further research is necessary to define the role of these alternative therapies in the treatment of ED.

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“…Recently, Li‐ESWT therapy was reported to be effective in patients with DM‐induced ED, whether they were responders or nonresponders to PDE5I. The authors observed clinical improvement of IIEF‐EF score at one month, and 6 and 12 months after treatment (Spivak et al., 2019). In the current study, all patients were confirmed to have diabetic polyneuropathy by nerve conduction.…”

Section: Discussionmentioning

confidence: 99%

“…ED is often harder to treat in diabetic men, probably due to the combination of microangiopathy and polyneuropathy that unfavourably affect the mechanism of erection. Several studies have reported a significant relation between diabetic neuropathy and ED in patients with type‐2 DM (Spivak et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Effect of low‐intensity extracorporeal shock wave therapy on diabetic erectile dysfunction: Randomised control trial

et al. 2021

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This study aimed to assess the effectiveness of low‐intensity extracorporeal shockwave therapy (Li‐ESWT) in the management of erectile dysfunction in diabetic patients with mixed vasculogenic and neurogenic causes as confirmed by nerve conduction and Doppler studies. This randomised controlled trial included 42 patients 41–55 years of age with a confirmed diagnosis of erectile dysfunction and diabetic polyneuropathy. They were randomly allocated to one of two groups: shock wave group (n = 21) treated with Li‐ESWT plus pelvic floor muscle training and control Group (n = 21) treated with pelvic floor muscle exercise and sham therapy by a shock wave. The erectile function was scored according to the five‐item version of the International Index of Erectile Function (IIEF‐5). Colour‐coded duplex sonography was used for the evaluation of penile perfusion of the two cavernous arteries. The assessment was done before and three months after treatment. IIEF‐EF increased significantly in the study group (p < .001), but not in the control group (p = .194). Peak systolic velocity increased significantly in the two groups; however, the post‐treatment peak systolic velocity was significantly higher in the study group compared to the control group (p < .001, for both arteries).

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Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients

Cited by 18 publications

References 25 publications

Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction

Effect of low‐intensity extracorporeal shock wave therapy on diabetic erectile dysfunction: Randomised control trial

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