低能量體外震波能改善對PDE5i無效的患者之勃起功能
蔡嘉駿1,2、劉家駒1,2,3、王起杰1、郭嫣婷4、李永進1、李經家1,2、吳文正1,2
高雄醫學大學附設中和紀念醫院 泌尿科1
高雄市立大同醫院 泌尿科2
衛生福利部 屏東醫院 泌尿科3
高雄市立大同醫院 管理室4
Low-intensity extracorporeal shockwave therapy can improve erectile function in patients who failed to response to phosphodiesterase type 5 inhibitors
Chia-Chun Tsai1,2, Chia-Chu Liu1,2,3, Chii-JyeWang1, Yen-Ting Kuo4, Yung-Chin Lee1, Ching-Chia Li1,2, Wen-Jeng Wu1,2
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
2Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
3Department of Urology, Ministry of Health and Welfare Ping-Tung Hospital, Pingtung, Taiwan
4Management Offices, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Purpose: Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5inhibitors (PDE5is) is a challenging task. Low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported recently to be able to improve ED by inducing neovascularization and enhancing perfusion of the penis. We therefore performed this study to evaluate whether combined treatment with LI-ESWT and PDE5is can restore erectile function in patients who failed to respond to PDE5is.
Materials and Methods: This was an open-label single-arm prospective study conducted in Kaohsiung Medical University-affiliated hospitals. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Socio-demographic information, personal habits, and detailed medical history were recorded. LI-ESWT treatment consisted of 3000 shockwaves once weekly for 12 weeks (Duolith SD1 T-Top). All patients continued their regular PDE5is use. The EHS and International Index of Erectile Function-5 items version (IIEF-5) were used to evaluate the change in erectile function 1 and 3 months after LI-ESWT.
Results: A total of 37 patients were enrolled. After LI-ESWT treatment, 24 of the 37 patients (64.8%) could achieve an erection hard enough for intercourse (EHS ≥3) under PDE5is use at the 1-month follow-up. Initial severity of ED was the only significant predictor of a successful response (EHS 1: 36.4% vs EHS 2: 76.9%, p=0.028). Twenty-two of the 24 (91.7%) subjects who responded to LI-ESWT could still maintain their erectile function (EHS≧3) at the 3-month follow-up.
Conclusions: LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of ED was an important predictor of a successful response. Further studies are needed to compare the efficacy of different generators of LI-ESWT and to determine an adequate therapeutic protocol and important predictors in patients with different etiologies of ED.