The Efficacy of Low-Intensity Shock Wave Therapy based on the Stratification of Erectile Dysfunction Patients: A Long-term Follow-up

Abstract

Abstract Objectives Low intensity extracorporeal shockwave therapy (LIESWT) significantly improves erectile function in patients with vasculogenic erectile dysfunction (ED). We aimed to evaluate the effect of LI-ESWT on different subtypes of ED and to assess through a long-term follow up how long the improvement in erectile function lasts.Methods This was a retrospective review of a prospectively maintained database at the department of urology at Cairo university hospitals. Patients with vasculogenic ED underwent 6–12 sessions of focal LI-ESWT 5000 impulses 0.01 j/mm2 using the electromagnetic Dornier Aries® 1 machine. All patients received at least 6 sessions of LI-ESWT. Then, patients were assessed clinically by using the erection hardness scores (EHS), and erectile function using the international index of erectile function (IIEF-EF) domain score at three months post LI-ESWT and every six months. Also, penile hemodynamics at three months post LI-ESWT and at the last follow up visit.Results 42 patients were identified with mean age 50 ± 12 years, mean ED duration 31 ± 35 months and mean follow up 10 ± 6 months. Overall IIEF-EF was 16 ± 6 and improved to 22 ± 6 at three months and to 21 ± 6 at last follow up (p < 0.01). Minimally important clinical difference was achieved in 69% at three months and in 60% of the whole cohort at last follow up. Risk factors associated with higher MICD at three months were age (p = 0.01), uncontrolled diabetes mellitus ratio (p = 0.04), hypertension (p = 0.24), cardiovascular (p = 0.8), smoker (p = 0.63), and ex-smoker (p = 0.3).Conclusion Li-ESWT have a potential long-term efficacy on different degrees of ED evidenced by the improvement in the penile hemodynamics at the final follow-up particularly in those with controlled diabetes mellitus and advancing age.