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Minerva Endocrinology 2021 Dec 21

DOI: 10.23736/S2724-6507.21.03686-1


language: English

Low-intensity shockwave treatment (liswt) improves penile rigidity in eugonadal subjects with erectile dysfunction: a pilot study

Walter VENA 1, Liborio VACCALLUZZO 1, Sandro LA VIGNERA 2, Emanuela MORENGHI 3, Cristina D’AGOSTINO 4, Anna PERRI 5, Bruno GIAMMUSSO 6, Andrea G. LANIA 1, Antonio AVERSA 5 , Alessandro PIZZOCARO 1

1 Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano, Italy; 2 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; 3 Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; 4 Extracorporeal Shock Wave Unit, Rehabilitation epartment, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy; 5 Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy; 6 Urology Clinic, Policlinic Morgagni, Catania, Italy


BACKGROUND: Since low-intensity shockwave treatment (LISWT) has putative effects on penile hemodynamics remodeling, the aim of this study was to evaluate any improvement of penile vascular flows after LISWT treatment in patients with erectile dysfunction (ED) and poor response to PDE5i.
METHODS: Twenty-one eugonadal patients with different ED severity underwent six weekly LISWT sessions (1500-4000 pulses) after 2 weeks withdrawal from PDE5i assumption. Once daily Tadalafil (2.5 mg daily) was reintroduced 4 weeks apart from LISWT termination and patients were evaluated at 1, 2 and 6 months follow-up (T1, T2, T6) by the International Index of Erectile Function-15 items questionnaire (IIEF-15) erectile function (EF) domain, Erection Hardness Score (EHS) and Global Assessment Questionnaires (GAQ). Basal Penile Color-Doppler Ultrasound parameters in the flaccid state (B-PCDU) were evaluated before, during and after interventional protocol.
RESULTS: Mean EHS score improved in 35% of patients at T1, and in up to 50 % of patients at T2 and T6 follow-up visits (p<0.05). We found 25% improvement of EF scores at T1 session, 43.75% at T2 and 62.5% at T6, respectively (p<0.05). No statistically significant differences in flow parameters, EF-domain and testosterone levels were found when baseline and last observation carried forward (LOCF) parameters were compared. The GAQ questionnaire scored higher satisfaction rates either at the end of the treatment (100%), or at LOCF (92.5%).
CONCLUSIONS: Despite the study limitations with respect to B-PCDU in this setting, our results confirm a trend toward improvement of erectile questionnaire scores after LISWT with higher overall satisfaction rates among patients with ED. We conclude that LISWT may be an effective option in some difficult-to-treat patients with ED by improving the erectile response to PDE5i.

KEY WORDS: Male sexual dysfunction; Erectile dysfunction; Shockwave treatment; Penile doppler

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