The Effects Of LIPUS On Cavernous Nerve Regeneration And The Preliminary Clinical Application Of Micro Energy In The Treatment Of Traumatic ED

Objective:Low-intensity pulsed ultrasound（LIPUS）and low-intensity extracorporeal shock wave therapy（Li-ESWT）belong to the category of micro energy medicine.The purpose of this study was to investigate the effect of LIPUS on the regeneration of the cavernous nerves（CN）in vitro,and observe the effect and safety of Li-ESWT in the treatment of traumatic erectile dysfunction（ED）.Methods:A 3D culture system was established by using the upstream ganglia of CN,the major pelvic ganglia（MPG）,as the research model,with the length of axon growth and regeneration density as the main evaluation indexes.The optimal parameters of LIPUS for CN regeneration were obtained by orthogonal experiment,and the nerve regeneration in LIPUS treatment group and control group were compared.Adipose derived stem cells（ADSCs）treated with and without LIPUS were used to extract exosomes,and the effects of exosomes on CN regeneration were observed.Li-ESWT was used for the treatment of traumatic ED,and the erectile function before and after treatment was compared.Results:After injury,the CN had the ability for regeneration.Using LIPUS with2.0w/cm² intensity,directly acting on MPG,or adding ADSCs derived exosomes with the concentration of 10¹²/m L in the culture system can significantly promote the growth of CN axons.After LIPUS pretreatment,the expression of BDNF and SDF-αin the exosomes was up-regulated,although not significant.The effect of pretreated ADSCs derived exosomes on the regeneration of CN axons was more significant.After Li-ESWT,the IIEF-5 score of 9 patients with ED after pfui was increased by2.56±2.13 points,among which 6 patients had increased erectile events during NPTR and 4 patients had increased glans sensitivity.Conclusion:LIPUS can not only directly stimulate the regeneration of CN axon,but also promote the regeneration of nerve through ADSCs derived exosomes.As another form of micro energy,Li-ESWT is expected to be a new choise to improve erectile function in patients with traumatic ED.