Low-Intensity Extracorporeal Shockwave Therapy – A New Approach in the Treatment of Erectile Dysfunction after Radical Prostatectomy

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Summary

The experience accumulated with low-intensity extracorporeal shock wave therapy (LI-ESWT) from international clinical trials has demonstrated its safety, efficacy and good tolerance in treatment of erectile dysfunction (ED). The aim of this retrospective study was to investigate the effect of LI-ESWT in patients with ED after bilateral nerve sparing radical surgery for prostate cancer. Twenty-seven patients underwent bilateral nerve sparing radical retropubic prostatectomy (BNSRRP) at the clinic of urology of the university hospital in Pleven between January 2016 and December 2016. Twenty-one of these patients had pre-operative preserved erectile function (EF), as reported according to the International Index of Erectile Function (IIEF-5). Postoperatively, these 21 patients experienced a mild (18-21 points) impairment of EF. In 10 patients (group 1), LI-ESWT was performed. The procedure was performed once a week for 6 weeks with a LI-ESWT (BTL 6000 SWT Topline) instrument. The reading was obtained with IIEF-5 on the third and sixth month after the end of therapy. The other 11 patients (group 2) were used as a control group and did not receive treatment. In 5 patients in group 1, a recovery of EF (> 21 points) as per IIEF-5 was recorded at the third month after treatment. In two patients, the same score was recorded at the sixth month. No improvement was seen in three men in group 1. In the controls (group 2), a spontaneous EF improvement in four patients at sixth month was registered. Despite the small number of patients and their short-term follow-up, our initial results indicate that LI-ESWT is effective, safe and well-tolerated. It could be an alternative for early penis rehabilitation in patients who have undergone BNSRRP.

1. Hatzimouratidis K, Burnett AL, Hatzichristou D, McCullough AR, Montorsi F, Mulhall JP. Phosphodiesterase type 5 inhibitors in postprostatectomy erectile dysfunction: a critical analysis of the basic science rationale and clinical application. Eur Urol. 2009;55(2):334-47.

2. Dimitrov P, Panchev P, Simeonov P, Vasilev V, Georgiev M, Yanev K. Prostate carcinoma - staging and possibilities for operative treatment. Medical science. 2008;2:51-5.

3. Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000;163(6):1802-7.

4. Hatzichristou D, d’Anzeo G, Porst H, Buvat J, Henneges C, Rossi A, et al. Tadalafil 5 mg once daily for the treatment of erectile dysfunction during a 6-month observational study (EDATE): impact of patient characteristics and comorbidities. BMC Urol. 2015;15:111.

5. Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, et al. Shock wave technology and application: an update. Eur Urol. 2011;59(5):784-96.

6. Frairia R, Berta L. Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles Ligaments Tendons J. 2011;1(4):138-47.

7. Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37.

8. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;13(2):1265-8.

9. Hazan-Molina H, Reznick AZ, Kaufman H, Aizenbud D. Periodontal cytokines profile under orthodontic force and extracorporeal shock wave stimuli in a rat model. J Periodontal Res. 2015;50(3):389-96.

10. Becker M, Goetzenich A, Roehl AB, Huebel C, de la Fuente M, Dietz-Laursonn K, et al. Myocardial effects of local shock wave therapy in a Langendorff model. Ultrasonics. 2014;54(1):131-6.

11. Yang P, Guo T, Wang W, Peng YZ, Wang Y, Zhou P, et al. Randomized and double-blind controlled clinical trial of extracorporeal cardiac shock wave therapy for coronary heart disease. Heart Vessels. 2013; 28(3):284-91.

12. Hayashi D, Kawakami K, Ito K, Ishii K, Tanno H, Imai Y, et al. Low-energy extracorporeal shock wave therapy enhances skin wound healing in diabetic mice: a critical role of endothelial nitric oxide synthase. Wound Repair Regen. 2012;20(6):887-95.

13. Hanna M, Pedersen D, Lund M, Marcussen N, Lund L. Low energy ESWT, a novel treatment for diabetic nephropathy (animal study). J Endourol. 2012;26:16-22.

14. Chitale S, Morsey M, Swift L, Sethia K. Limited shock wave therapy vs sham treatment in men with Peyronie’s disease: results of a prospective randomized controlled double-blind trial. BJU Int. 2010;106(9):1352-6.

15. Abu-Ghanem Y, Kitrey ND, Gruenwald I, Appel B, Vardi Y. Penile low-intensity shock wave therapy: a promising novel modality for erectile dysfunction. Korean J Urol. 2014;55(5):295-9.

16. Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010; 58(2):243-8.

17. Chung E, Cartmill R. Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial. BJU Int. 2015;115(Suppl 5):46-9.

18. Olsen AB, Persiani M, Boie S, Hanna M, Lund L. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol. 2015;49(4):329-33.

19. Frey A, Sonksen J, Fode M. Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study. Scand J Urol. 2016;50:123-7.

20. Bechara A, Casabe A, De Bonis W, Nazar J. Effectiveness of lowintensity extracorporeal shock wave therapy on patients with erectile dysfunction (ED) who have failed to respond to PDE5i therapy. A pilot study. Arch Esp Urol. 2015;68(2):152-60.

21. Pelayo-Nieto M, Linden-Castro E, Alias-Melgar A, Espinosa-Pérez Grovas D, Carreño-de la Rosa F, Bertrand-Noriega F, et al. Linear shock wave therapy in the treatment of erectile dysfunction. Actas Urol Esp. 2015;39(7):456-9.

22. Srini VS, Reddy RK, Shultz T, Denes B. Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population. Can J Urol. 2015;22(1):7614-22.

23. Yee CH, Chan ES, Hou SS, Ng CF. Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study. Int J Urol. 2014;21(10):1041-5.

24. Palmieri A, Imbimbo C, Creta M, Verze P, Fusco F, Mirone V. Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie’s disease and erectile dysfunction: results from a prospective randomized trial. Int J Androl. 2012;35(2):190-5.

25. Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012;187(5):1769-75.

26. Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol. 2009;56(3):418-24.

27. Poulakis V, Skriapas K, de Vries R, Dillenburg W, Ferakis N, Witzsch U, et al. Extracorporeal shockwave therapy for Peyronie’s disease: an alternative treatment? Asian J Androl. 2006;8(3):361-6.

28. Skolarikos A, Alargof E, Rigas A, Deliveliotis C, Konstantinidis E. Shockwave therapy as first-line treatment for Peyronie’s disease: a prospective study. J Endourol. 2005;19(1):11-4.

29. Kolev N, Atanasov J, Dunev V, Stoykov B, Kotsev R, Vanov A, et al. Open Retropubic and Robot-Assisted Radical Prostatectomy in Prostate Carcinoma: Advantages of Methods. Journal of Biomedical and Clinical Research. 2016;9(2):145-9.

30. Hinev A, Hadjiev V, Kolev N. Validation of preoperative nomograms predicting lymph node involvement in prostate cancer: a Bi-institutional study. Eur Urol. 2011;60(6):1310-1.

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