Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study

Abstract

Objective: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP). Materials and methods: Patients who had undergone robot-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment was evaluated 1 month (t1) and 1 year (t2) after the final treatment. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) scores. Results: Eighteen patients were included in the study. However, two patients breached the protocol and consequently 16 patients were included in the analysis at t1 and 15 patients were included in the analysis at t2. At baseline the median age was 62 years (range 51 to 70 years) and the median time since surgery was 24 months (range 12 to 54 months). The median preoperative IIEF-5 score was 25 (range 22 to 25) and the median baseline IIEF-5 score was 9.5 (range 5 to 20). The median change in IIEF-5 scores was +3.5 (range –1 to 8; p = 0.0049) and +1 (range –3 to 14; p = 0.046) at t1 and t2, respectively. No severe side-effects were reported. Conclusions: LI-ESWT may improve erectile function after bilateral nerve-sparing RP. Based on these results, further studies in patients with ED after nerve-sparing RP are justified.

Keywords:

• Erectile dysfunction
• extracorporeal shockwave therapy
• radical prostatectomy

Acknowledgements

The Duolith® SD1 T-Top was kindly put at our disposal by Storz Medical.

Declaration of interest

Jens Sønksen is a speaker for Eli Lilly, Coloplast and Astellas, a shareholder for Multicept, and acts as an advisory board member for Eli Lilly, Astellas and Menarini. Mikkel Fode is a speaker for Eli Lilly, Coloplast and Astellas, and acts as an advisory board member for Eli Lilly and Menarini.