The Low-Intensity Shock Wave Therapy for Erectile Dysfunction
Shin-ichi Hisasue, M.D. Ph.D.
Department of Urology, Juntendo University Graduate School of Medicine
Phosphodiesterase type 5 inhibitors (PDE5i) revolutionized the treatment of erectile dysfunction (ED). However, even in vasculogenic ED patients, one fifth of them showed poor response to PDE5i. Low-intensity shock wave therapy (LI-ESWT) is a novel and promising modality for the patients with mild to moderate erectile dysfunction (ED).
In this study, we assessed the efficacy and the predictors for the recovery after LI-ESWT in Japanese patients. This study included patients with ED whose history lasted more than 6 months, sexual health inventory for men (SHIM) score of ≤ 12 without PDE5 inhibitor, EHS grade 1 or 2, mean penile circumferential change (MPCC) by erectometer for sleep related erection (SRE) of ≤25mm.
Patients were treated by a low energy shockwaves generator (ED1000, MEDISPEC, MD, USA). We examined the predictors for the functional recovery by multivariate analysis with logistic regression. Of 52 patients treated by LI-ESWT, we analyzed the 41 patients whose data were available at 4 weeks after treatment. Median age was 64 years (range; 37-83). SHIM after the treatment was significantly increased from 5 to 9 (p<0.001, Wilcoxon signed-rank test). Baseline EHS was 1 in 22, and 2 in 19 patients, and EHS after LI-ESWT was 1 in 8, 2 in 10, 3 in 20 and 4 in 3 patients. Median MPCC was increased from 11.7 mm to 19.0 mm after LI-ESWT (p<0.001).
The multivariate analysis was done to determine the predictors of the sufficient erection for the penetration (EHS≥3) after LI-ESWT. It revealed that the age and the baseline MPCC were the significant predictors for the recovery after LI-ESWT. In this study, patients’ age and baseline erectile function are the independent predictors for the effectiveness of LI-ESWT. We should thoroughly discuss with the older patients with severe ED before LI-ESWT.