Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction wi...

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Autores principales:	Kai-Yi Tzou, Su-Wei Hu, Oluwaseun Adebayo Bamodu, Yuan-Hung Wang, Wen-Ling Wu, Chia-Chang Wu
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	erectile dysfunction extracorporeal shockwave therapy Li-ESWT IIEF-5 EHS minimal clinically important difference Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/7e4ef0a3e2d84d00a0ddab979d897487
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spelling	oai:doaj.org-article:7e4ef0a3e2d84d00a0ddab979d8974872021-11-25T16:50:35ZEfficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction10.3390/biomedicines91116702227-9059https://doaj.org/article/7e4ef0a3e2d84d00a0ddab979d8974872021-11-01T00:00:00Zhttps://www.mdpi.com/2227-9059/9/11/1670https://doaj.org/toc/2227-9059Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (<i>p</i> < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients’ pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (<i>p</i> = 0.04), uncontrolled diabetes mellitus (<i>p</i> = 0.04), and uncontrolled hyperlipidemia (<i>p</i> = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (<i>p</i> = 0.04) and uncontrolled hyperlipidemia (<i>p</i> = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.Kai-Yi TzouSu-Wei HuOluwaseun Adebayo BamoduYuan-Hung WangWen-Ling WuChia-Chang WuMDPI AGarticleerectile dysfunctionextracorporeal shockwave therapyLi-ESWTIIEF-5EHSminimal clinically important differenceBiology (General)QH301-705.5ENBiomedicines, Vol 9, Iss 1670, p 1670 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	erectile dysfunction extracorporeal shockwave therapy Li-ESWT IIEF-5 EHS minimal clinically important difference Biology (General) QH301-705.5
spellingShingle	erectile dysfunction extracorporeal shockwave therapy Li-ESWT IIEF-5 EHS minimal clinically important difference Biology (General) QH301-705.5 Kai-Yi Tzou Su-Wei Hu Oluwaseun Adebayo Bamodu Yuan-Hung Wang Wen-Ling Wu Chia-Chang Wu Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
description	Background: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients’ dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. Objectives: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. Methods: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. Results: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (<i>p</i> < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients’ pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (<i>p</i> = 0.04), uncontrolled diabetes mellitus (<i>p</i> = 0.04), and uncontrolled hyperlipidemia (<i>p</i> = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (<i>p</i> = 0.04) and uncontrolled hyperlipidemia (<i>p</i> = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. Conclusions: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort.
format	article
author	Kai-Yi Tzou Su-Wei Hu Oluwaseun Adebayo Bamodu Yuan-Hung Wang Wen-Ling Wu Chia-Chang Wu
author_facet	Kai-Yi Tzou Su-Wei Hu Oluwaseun Adebayo Bamodu Yuan-Hung Wang Wen-Ling Wu Chia-Chang Wu
author_sort	Kai-Yi Tzou
title	Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
title_short	Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
title_full	Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
title_fullStr	Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
title_full_unstemmed	Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction
title_sort	efficacy of penile low-intensity shockwave therapy and determinants of treatment response in taiwanese patients with erectile dysfunction
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/7e4ef0a3e2d84d00a0ddab979d897487
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Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction

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