低能量體外震波治療應用於根除性攝護腺手術後的勃起功能障礙
吳子翔1、何肇晏1 、黃一勝1,2
1財團法人新光吳火獅紀念醫院外科部泌尿外科
2天主教輔仁大學醫學院泌尿外科
Low intensity extracorporeal shockwave therapy for post laparoscopic radical prostatectomy erectile dysfunction
Tzu-Hsiang Wu 1、Chao Yen Ho1、Thomas I.S. Hwang1,2
1 Division of Urology, Department of Surgery, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan
2Department of Urology, Fu Jen Catholic University School of Medicine, Taipei, Taiwan
Purpose:
Erectile dysfunction is one of the major long-term complications after radical prostatectomy, and it’s related to the preservation of neurovascular bundle. Low intensity extracorporeal shockwave therapy (LIEST) has been recently reported to increase local metabolism and angiogenesis, then to improve erectile dysfunction.We herein report the outcomes of treated ED patientswho had received laparoscopic prostatectomy in our institution.
Materials and Methods:
Patients received laparoscopic radical prostatectomy, and had regular OPD follow-up for PSA level at least 2 years. The PSA level was all within nadir without hormone therapy. Patients received two LIEST treatment sessions per week for 3 weeks, and started another course after 2 weeks interval period.Between December 2015 to November 2016, 8 patients with ED who has poor PDE5 inhibitor response has received LIEST. ED period, comorbidity, testosterone, lipid profile, EHS, IIEF-5 were collected.
Results:
Among the 8 patients, all has undergone laparoscopic radical prostatectomy and all received at least unilateral neurovascular bundle preservation. All had undergone 6 treatment sessions and ongoing the second course, however, 5 patients completed total treatment sessions. The mean age is 67.33 ± 5.03 years old in 6 sessions group, and63.2 ± 5.97 in the 12 sessions group. Average ED period is 60 ± 31.75 months in 6 sessions group and 48 ± 25.46. Average testosterone level is 3.64 ± 0.69ng/mL and 3.0 ± 0.93 in 6 and 12 sessions group. All patients has PSA level < 0.008. All patients hadpoor or minimal response to PDE5 inhibitor. Pre-treatment EHS and IIEF is 1and 3.67 ±3.05 respectively in 6 sessions group, 1.2 ± 0.27 and 4.4 ± 4.10 in 12 sessions group. In 6 sessions group, post LIEST EHS and IIEF increases to 2.33 ± 1.25 and 11 ± 8.54; in 12 sessions group, EHS and IIEF was increased to 2.7 ± 0.57 and 11.2 ± 5.20.
Conclusion:
The new treatment modality for ED,low intensity extracorporeal shockwave therapy, has therapeutic effect for post-laparoscopic radical prostatectomy patients with poor response to PDE5 inhibitor. However, further study with larger patient group and long-term follow-up is mandatory.