Shockwave treatment may benefit mild-to-moderate erectile dysfunction up to 2 years
Patients with mild-to-moderate erectile dysfunction (ED) treated with low intensity shockwave treatment (LIST) may retain its benefits for up to 2 years, according to a study.
The study followed 156 patients aged 27 to 81 years with a wide range of ED severity in different clinical studies which used the same LIST treatment protocol (12 treatment sessions in 9 weeks; 5 treatment points along the penis; 1,500 shockwaves applied at 0.09 mJ/mm2 and 120 shocks/min). Treatment efficacy was evaluated using the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire at baseline before treatment, then 1, 6, 12, 18 and 24 months after treatment.
Of the 156 patients, treatment was successful in 99 patients (63.5 percent) at 1 month after treatment. This declined gradually to 53 patients (34 percent) at the 2-year mark. Subsequent analysis also found that all patients with diabetes mellitus and severe ED at baseline lost any beneficial effects of LIST during their 2-year followup. However, 76 percent of patients with milder forms of ED and without diabetes retained LIST benefits at the same follow-up points. [J Urol 2018;200(1):167–170]
“On one hand, the long-term outcome reported in this study is relatively disappointing, mainly for patients with severe ED,” wrote the authors. “On the other hand, the lasting effect of LIST in a substantial group of patients revalidates the genuine restorative nature of this modality which cannot be attributed only to a placebo effect.”
LIST therapy is a relatively new treatment modality for ED, with several studies demonstrating some short-term efficacy of the technique using various types of energy (electrohydraulic, electromagnetic or piezoelectric), protocols and devices. LIST has also shown to be effective even in patients with severe ED who are no longer responding to PDE5 inhibitors. [Ther Adv Urol 2013;5(2):95–99; J Urol 2016; 195(5):1550–1555]
While the mechanism of action is not fully understood, animal studies have shown that the shear stress exerted by shockwave energy induces the release of angiogenic factors and subsequent revascularization, which may improve poor cavernous blood flow—one of ED’s underlying causes. [J Orthop Res 2003;21(6):984–989]
“The apparent advantages of LIST, which is a non-invasive, non-pharmacological, easy to apply, painless and relatively inexpensive procedure, made it appealing,” said the researchers. “[However] all of its advantages are relevant only if the effect is durable and preserved for a reasonable time. To date there is an increasing number of publications on LIST short-term efficacy but information on the long-term effect is lacking. To our knowledge this is the first study trying to answer this critical question.”
One possible factor accounting for the fading-out phenomenon could be the ongoing progress of underlying ED pathology in patients. As LIST does not treat the systemic disease itself, its atherosclerotic effects may continue to impair cavernous tissue and endothelial function during followup, thus accounting for the lost response in all patients with severe baseline ED and DM.
“Further research is needed to optimize current treatment characteristics,” wrote the authors. “In the meantime, the data provided in this study can help us improve patient selection and better inform patients about the expected outcome.”