Long-term Restoration of the Penile Microcirculation in Patients with Vasculogenic Erectile Dysfunction with Low-Intensity Shock Wave Treatment

Abstract

Background: Vasculogenic erectile dysfunction is a prevalent disease that can be treated using low-intensity shock waves (LI-SWT).

Aim: The aim of this study was to determine the most effective treatment plan and combination of factors leading to the  desired result.

Methods: 261 patients were randomly selected, including 19 who underwent sham treatment and gave written consent to undergo LI-SWT. The ages of the patients ranged from 23 to 75 years old and they were divided into three groups. One group received treatment every day (24), another group received treatment twice a week for three weeks (167), and the third group received treatment twice a week with a one-week break (70). All patients filled out questionnaires and underwent penile triplex ultrasonography with ultrasound detection of penile arteries and penile blood flow velocity (PBFV) at baseline, immediately after treatment termination, and six months later. Additionally, 144 out of 261 patients were followed up after 12 and 24 months. The study used IBM SPSS Statistics, ver. 23.0 to compare treatment type effects with other criteria such as the duration of erectile dysfunction, patient age, intensity/frequency of treatment procedures, Erectile Hardness Score (EHS), International Index of Erectile Function domain (IIEF-ED) score, concomitant diseases, metabolic disorders, environmental factors, habits, sexual activity, and different treatment options in the past.

Results: Investigations showed that the improvement in IIEF5 and EHS scores was mostly subjective, while the velocity changes after treatment with simultaneous improvement of artery detection were more objective. These changes interacted with the disease duration, the number and frequency of the procedures, different comorbidities, etc. Artery visualization and velocity increase over time, from screening level to improved measures after treatment termination, 6, 12,24 months with improvement tendency. The study also found that the frequency of treatment provided affected the artery visualization dynamics data and that there were statistically significant interactions between the frequency of the provided treatment, different comorbidities, and disease duration in velocity measures.

Conclusions: Overall, improvement was detected in all three groups, and such improvement was not related to different treatment strategies. Additionally, the study found that LI-SWT was a safe and feasible treatment option resulting in clinical improvement rates during long-lasting follow-up.