低能量體外震波治療可改善對第五型磷酸二酯酶抑制劑反應不佳患者的勃起功能
劉家駒1-3 蔡嘉駿1,4 耿俊閎1,5 王起杰1,2
1高雄醫學大學附設醫院 泌尿科;2高雄醫學大學 醫學院 醫學系 泌尿學科;3行政院 衛生福利部 屏東醫院;4高雄市立大同醫院 泌尿科; 5高雄市立小港醫院 泌尿科
Low intensity extracorporeal shockwave therapy can improve erectile function in patients who responded poorly to PDE5 inhibitors
Chia-Chu Liu1-3, Chia-Chun Tsai1,4 , Jiun-Hung Geng1,5, Chii-Jye Wang1,2
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3 Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan; 4Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 5Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
Purpose. Managing patients with erectile dysfunction (ED) who responded poorly to phosphodiesterase type 5 (PDE5) inhibitors is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LiESWT) has been proved to be able to improve ED by inducing neovascularization and enhancing perfusion of penis. Thus, we perform this study to evaluate whether LiESWT could be a salvage therapy in Taiwanese patients who responded poorly to PDE5 inhibitors.
Materials and Methods. This was an open-label single-arm prospective study conducted in Pingtung Hospital and Kaohsiung Municipal Ta-Tung Hospital. ED patients with erection hardness score (EHS)≦2 under maximal dosage of PDE5 inhibitors use were enrolled. Socio-demographic information, personal habits, and medical history of each patient were recorded. The treatment of LiESWT consists of 3000 shockwaves (1000 shockwaves to the distal penis, base of penis and corporal bodies at the perineum)(Storz, Duolith SD1 T-Top) once weekly for 12 weeks. During treatment, patients could keep using PDE5 inhibitors. International Index of Erectile Function-5 items version (IIEF-5) and EHS were used to evaluate the change of erectile function in each patient from baseline to 1 month after LiESWT.
Results: From April 2015 to March 2016, a total of 18 patients were enrolled. After 12 weeks treatment, 11 of 18 patients (61.1%) could achieve erection hard enough for intercourse (EHS ≥ 3) under PDE5 inhibitors use. The treatment was well tolerated and none of the men experienced treatment related discomfort or reported any adverse effects from the treatment.
Conclusions. In our initial experience, LiESWT could serve as a salvage therapy in Taiwanese patients who responded poorly to PDE5 inhibitors before. However, further large studies are still needed to evaluate the long term effect of LiESWT.