Early Clinical Efficacy And Safety Of Linear Low-intensity Extracorporeal Shock Wave Therapy In The Treatment Of Erectile Dysfunction

Objective:To analyze the early clinical effect and safety of linear low-intensity extracorporeal shock wave(Li-ESWT)in the treatment of erectile dysfunction.Methods:The clinical data of 16 patients with vascular ED treated with Li-ESWT in our hospital fromJune 2019 to December 2020 were retrospectively analyzed.All patients received a course of 4-week Li-ESWT treatment,including900 pulses for the left and right corpus cavernosum and 1600 pulses for the bilateral penile peduncle,with energy density of 0.09mj/mm~2and frequency of150 pulses/min,once a week,for 4 consecutive weeks with a total of 20000 shock wave pulses.The general information,international index of erectile function-erectile function domain(IIEF-EF),self-estimation index of erectile function-no sexual intercourse(SIEF-NS),erection hardness score(EHS)and incidence of adverse reactions before treatment,4 weeks after treatment and 12weeks after treatment were analyzed.The relevant data analysis was carried out by SPSS 26.0 statistical software.Results:Among the 16 patients,13 patients had regular sexual life before and after treatment.The average IIEF-EF score was 12.92±5.78,18.62±9.58(P<0.05)and 18.69±8.88(P<0.05)before Li-ESWT,4 weeks after Li-ESWT,and 12weeks after Li-ESWT,respectively.The average EHS was 2.00±0.82,2.54±1.13(P<0.05)and 2.46±1.05(P<0.05)before Li-ESWT,4 weeks after Li-ESWT and 12 weeks after Li-ESWT.The average EHS at 4 weeks after Li-ESWT was no different from that at 12 weeks after Li-ESWT(P>0.05).The effective rates of the 13 sexually active ED patients at 4 and 12 weeks after treatment were the same,both were 61.5%.The effective rates of mild,moderate and severe ED patients at 4 weeks after Li-ESWT were 100%,66.7%and 20%respectively(P<0.05).The effective rates of different degrees of ED at 12 weeks after treatment were the same with those at 4 weeks after treatment.In 3 patients who had no sex before and after treatment.2 patients improved their SIEF-NS and EHS after 4weeks of treatment,and 1 patient improved his SIEF-NS and EHS at 12 weeks after treatment.The average EHS of all 16 patients was 2.00±0.73;4,2.50±1.03(P<0.05),and 2.44±0.96(P<0.05)before Li-ESWT,4 weeks after Li-ESWT and 12 weeks after Li-ESWT.The average EHS at 4 weeks after Li-ESWT was no different from that at 12 weeks after Li-ESWT(P>0.05)(P>0.05).Combined with the follow-up results of sexual life group and asexual life group,the total effective rate of 16 patients was 62.5%at 4 weeks after Li-ESWT,and 56.3%at12 weeks after Li-ESWT.Among the 16 patients,10 patients had a history of taking PDE5i,including 5 PDE5i non-responders and 5 PDE5i responders.After Li-ESWT treatment,1 PDE5i non-responder turned into PDE5i responder,and 3responders to PDE5i improved their response to PDE5i.There were no obvious adverse reactions or complications related to shockwave therapy during the treatment and follow-up.Conclusion:Li-ESWT has a high early effective rate in the treatment of vascular ED,and the effective rate of mild to moderate ED patients was significantly higher than that of severe ED patients.The efficacy can last for 12 weeks and can improve patients’response to PDE5I with high safety.Moreover,Li-ESWT has certain curative effect on asexual ED,but more studies are needed to support it.