Transient improvement in erectile function is seen with low-intensity shock wave therapy

Transient subjective improvement in erectile function may be seen with a low-intensity extracorporeal shock wave therapy (Li-ESWT) protocol consisting of 1500 shocks per treatment with energy of 0.2 mJ/mm² twice per week for 6 weeks, according to research presented at the 24th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in San Diego, California.¹

The mean pre-treatment IIEF-EF score was 14.24 ± 1.21. The mean IIEF-EF saw an increase to 15.80 ± 1.46 at Time 2, 16.12 ± 1.46 at Time 3, 18.12 ± 1.57 at Time 4 (P = .016), and 16.36 ± 1.86 at Time 5.

“Numerous studies suggest that Li-ESWT results in subjective improvement in erectile function…However, the optimal treatment protocol and duration of response is not well described,” wrote the study authors, led by Skye Coffey of the University of Virginia Health System in Charlottesville.

To this end, the investigators evaluated changes in International Index of Erectile Function-Erectile Function (IIEF-EF) domain score after treatment with Li-ESWT delivered in 1500 shocks per treatment with energy of 0.2 mJ/mm² twice per week for 6 weeks. The Storz Duolith T-Top Ultra shock wave device was used to deliver treatment.

Study participants were required to hold phosphodiesterase 5 use for 1 month prior to all study visits, according to the authors. Patients had to be between 40 and 80 years of age, have known/suspected vasculogenic erectile dysfunction for at least 6 months and be in an active sexual relationship with at least 2 sexual attempts per month. IIEF-EF had to range between 8 and 25 and patients had to have an Erection Hardness Score of at least 1. Patients were required to have total testosterone ranging between 300 ng/dL and 1000 ng/dL, hemoglobin A1c of 8% or lower, no pelvic external radiation therapy or surgery within 12 months, and no anatomic malformations.

Shocks were delivered over the right and left penile shaft (500 shocks/site) and bilateral crura (250 shocks/site).

“Patients completed IIEF-EF, Sexual Encounter Profile (SEP) questions two and three, Global Assessment Questions (GAQ), and Erection Hardness Score (EHS) questionnaires prior to initiation of treatments and following completion of treatments at 1-2 weeks, 4-6 weeks, 3 months and 6 months post-treatment,” wrote the authors. In addition, penile doppler in flaccid and rigid state was used to measure peak systolic velocity, end diastolic velocity, and resistive index.

The questionnaires and study procedures employed during the study were “performed prior to Li-ESWT treatment (Time 1), immediately following completion of treatment (Time 2), 4-6 weeks following treatment (Time 3), 3 months following treatment (Time 4), and 6 months following treatment (Time 5),” wrote the authors.

The investigators reported that a total of 25 patients completed all 5 study visits, and the mean pre-treatment IIEF-EF score was 14.24 ± 1.21. The mean IIEF-EF saw an increase to 15.80 ± 1.46 at Time 2, 16.12 ± 1.46 at Time 3, 18.12 ± 1.57 at Time 4 (P = .016), and 16.36 ± 1.86 at Time 5.

At baseline, 16 patients had an IIEF-EF score of 11-21. These patients reported significant improvement in IIEF-EF score at Times 2 and 4, according to the authors.

Regarding EHS score, the mean pre-treatment score was 2.1 ± 0.14. The investigators reported that EHS scores after Li-ESWT “trended towards improvement.”

For the SEP questions, the investigators reported that there was no significant increase in positive response rate for questions 2 or 3 after Li-ESWT, and for the GAQ questions, no increase in the positive response rate was seen after Li-ESWT.

The investigators noted in their conclusion that the improvements observed in the study “may not be sustained 6 months following treatment.”

Reference

1. Coffey S, Matthew AN, Klausner AP, Smith RP, Krzastek SC. Li-ESWT may result in transient subjective improvements in erectile function. Presented at: 24th Annual Fall Scientific Meeting SMSNA; November 16-18, 2023; San Diego, CA. Abstract 231