低能量體外震波治療對第五型磷酸二酯酶抑制劑反應不佳勃起功能障礙患者的六個月追蹤研究
蔡嘉駿1,2、劉家駒1,2,3、王起杰1、李永進1,4、耿俊閎1,4、羅英襄1
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
高雄市立小港醫院 泌尿科4
The 6 months follow-up of the low-intensity extracorporeal shockwave therapy in the treatment of patients with erectile dysfunction who failed to respond to phosphodiesterase type 5 inhibitors
Chia-Chun Tsai1,2, Chia-Chu Liu1,2,3, Chii-JyeWang1, Yung-Chin Lee1,4, Jiun-Hung Geng1,4, Ing-Shiang Lo1
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
4 Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
Purpose: Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to improve ED by inducing neovascularization and enhancing perfusion of the penis. The current study was performed to evaluate the efficacy of LI-ESWT in the treatment of patients with ED who failed to respond to PDE5is at 6 months follow-up.
Materials and Methods: This was an open-label single-arm prospective study. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Sociodemographic information and detailed medical history were recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly (1000 shockwaves to the distal penis, base of penis and corporal bodies at the perineum) (Storz, Duolith SD1 T-Top) for 12 weeks. All patients continued their regular PDE5is use. The EHS and the 5-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate the change in erectile function 1, 3 and 6 months after LI-ESWT. Success of treatment was defined as EHS 3 or greater, which indicated the regaining of an erection sufficient for vaginal penetration.
Results: A total of 65 patients were enrolled. After LI-ESWT treatment, 45 of the 65 patients (69.2%) could achieve an erection hard enough for intercourse (EHS≧3) under PDE5is use at the 1-month follow-up. 35 of the 59 patients (59.3%) could still maintain EHS≧3 at the 6-month follow-up (missing cases: 6 of 65, 9.2%). In 42 patients with successful response at the 1-month follow-up, 34 patients could maintain their response at the 6-month follow-up (81.0%). Initial severity of ED and history of diabetes were the significant predictors of a successful response.
Conclusions: LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. A significant portion of patients who responded to LI-ESWT could maintain their effect up to 6-months follow-up. Initial severity of ED and history of diabetes were the main predictors of a successful response. Further longer follow-up studies are still needed to eradicate the long-term effect of LI-ESWT in the treatment of ED.