低能量冲击波治疗外伤性勃起功能障碍的疗效分析

目的探讨低能量冲击波治疗(LI-ESWT)外伤性勃起功能障碍(ED)的疗效。方法收集2017年8月至2019年9月北京积水潭医院收治的62例外伤后尿道狭窄行尿道吻合术后诊断为外伤性ED患者的病例资料。患者平均年龄(36±11)岁。其中骨盆骨折尿道断裂46例,骑跨伤尿道断裂16例。患者均诉外伤后即出现ED,病史(12.2±4.7)个月。62例中30例采用LI-ESWT(冲击波组),年龄(33±11)岁,病史(12.7±5.1)个月,阴茎勃起硬度评分(EHS)(1.50±0.51)分,国际勃起功能指数(IIEF-5)评分(8.57±3.98)分,其中轻度(12~21分)6例、中度(8~11分)9例、重度(≤7分)15例。32例未接受任何治疗,仅与冲击波组同时间点进行定期随访(对照组),年龄(39±12)岁,病史(11.7±4.4)个月,EHS(1.47±0.51)分,IIEF-5评分(8.50±5.24)分,其中轻度(12~21分)8例、中度(8~11分)9例、重度(≤7分)15例。两组患者一般资料比较差异无统计学意义(P>0.05)。冲击波组对3个不同部位(阴茎干和左右侧阴茎脚),发射3000次冲击波,能量强度为0.09 mJ/mm2;每周2次,治疗全程共6周。两组分别于入组前和冲击波治疗后4、8、12周评价观察指标,包括IIEF-5、阴茎夜间勃起测试(NPT)和EHS、性生活日记(SEP2)。结果治疗后冲击波组和对照组的IIEF-5分别为(15.67±3.89)分和(9.41±4.66)分,IIEF-5增加值分别为(7.10±3.79)分和(1.03±0.97)分,EHS分别为(2.60±0.62)分和(1.53±0.51)分,差异均有统计学意义(P<0.01)。冲击波组和对照组治疗后SEP2问题2回答"是",即阴茎勃起后能成功插入阴道的比例分别为67%(20/30)和0,差异有统计学意义(P<0.01)。按照IIEF-5增加5分计算有效率,冲击波组和对照组有效率分别为70%(21/30)和0,差异有统计学意义(P<0.01)。按照EHS评分为≥3分计算有效率,冲击波组和对照组有效率分别为67%(20/30)和0,差异有统计学意义(P<0.01)。NPT监测冲击波组治疗后符合正常有效勃起16例(53%),对照组0例,差异有统计学性意义(P<0.01)。冲击波组和对照组随访至治疗后8周和12周,两组观察指标比较差异均有统计学意义(P<0.05)。冲击波组治疗过程和治疗后均未发现并发症。结论LI-ESWT能显著改善外伤性ED患者的勃起功能,是外伤性ED有效和安全的治疗方法。     

Questionable efficacy of extracorporeal shock wave therapy for Peyronie's disease: results of a prospective approach

PURPOSE: Extracorporeal shock wave therapy (ESWT) for Peyronie's disease is still a topic of debate. We evaluated the effects of ESWT in a large series of patients with Peyronie's disease via a prospective approach. MATERIALS AND METHODS: In a prospective study 114 patients with Peyronie's disease were treated with ESWT. Baseline and followup examinations included ultrasound, and measurement of plaque size and curvature. Symptomatology was evaluated based on a standardized interview. A Minilith SL1 (Storz Medical AG, Kreuzlingen, Switzerland) lithotriptor was used with 4,000 shock waves at a maximum energy level of 0.17 mJ/mm2 applied per session. RESULTS: A total of 96 patients were available for followup. Considering the total study group no significant changes in penile curvature, plaque size or sexual function were observed despite significant improvements in patients with a curvature of 31 to 60 degrees. Penile pain ceased in 76% of the affected patients. CONCLUSIONS: According to our data ESWT does not appear to be significantly effective for decreasing penile curvature and plaque size or improving sexual function in the total population of patients with Peyronie's disease despite improvements in individuals. Penile pain seems to resolve earlier than during the natural course. Regarding the results of this study and previous reports with exact documentation of the clinical findings it can be concluded that ESWT cannot be recommended as a standard procedure for Peyronie's disease. To evaluate the exact efficacy of ESWT a controlled, single-blind, multicenter study with exact documentation of symptoms is urgently required.     

Low-intensity extracorporeal shock wave therapy for Peyronie's disease:a single-center experience

The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy(LiESWT)protocol for the treatment of Peyronie's disease(P...     

Effect of low-intensity extracorporeal shock wave therapy on diabetic erectile dysfunction: Randomised control trial

This study aimed to assess the effectiveness of low-intensity extracorporeal shockwave therapy (Li-ESWT) in the management of erectile dysfunction in diabetic patients with mixed vasculogenic and neurogenic causes as confirmed by nerve conduction and Doppler studies. This randomised controlled trial included 42 patients 41–55 years of age with a confirmed diagnosis of erectile dysfunction and diabetic polyneuropathy. They were randomly allocated to one of two groups: shock wave group (n = 21) treated with Li-ESWT plus pelvic floor muscle training and control Group (n = 21) treated with pelvic floor muscle exercise and sham therapy by a shock wave. The erectile function was scored according to the five-item version of the International Index of Erectile Function (IIEF-5). Colour-coded duplex sonography was used for the evaluation of penile perfusion of the two cavernous arteries. The assessment was done before and three months after treatment. IIEF-EF increased significantly in the study group (p < .001), but not in the control group (p = .194). Peak systolic velocity increased significantly in the two groups; however, the post-treatment peak systolic velocity was significantly higher in the study group compared to the control group (p < .001, for both arteries).     

Evaluation of erectile dysfunction in patients with Peyronie's disease

Of 62 hospitalized patients with Peyronie's disease 18 (29 per cent) had abnormal nocturnal penile tumescence studies that were characterized as indicating organic impotence. However, the majority of these patients had some underlying disease or factor other than the plaque itself to explain the altered nocturnal penile tumescence. In only 5 per cent of these patients could the abnormal nocturnal penile tumescence be attributable to the plaque itself. Primary excision of the plaque and dermal grafting improved erectile function in all except a minority of patients who required insertion of a penile prosthesis to alleviate continued erectile impotence. For this reason we do not recommend insertion of a penile prosthesis during plaque excision. The plaque of Peyronie's disease does not appear to impede vascular flow distal to the plaque. However, previous excision may result in altered hemodynamics that can result in erectile impotence.     

Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience

OBJECTIVE: To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease. PATIENTS AND METHODS: After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0-5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11-0.17 mJ/mm2) at 3-week intervals. The results were analysed using the Wilcoxon signed-rank test. RESULTS: Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4-60) months and the mean follow-up 7.5 (5-11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3 degrees (10 degrees -60 degrees ) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1-4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side-effects were reported. CONCLUSION: ESWT is an effective and safe treatment for Peyronie's disease; the long-term follow-up and results are awaited.     

Prevalence of Peyronie's disease among patients with erectile dysfunction

PURPOSE: To assess the prevalence of Peyronie's disease (PD) among patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 1,440 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function (IIEF). All patients were also screened for socio-demographic data and risk factors for ED that included age, smoking, diabetes, hypertension, dyslipidemia, Ischemic Heart Disease (IHD), and psychological disorders. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Patients underwent routine laboratory investigation in addition to testosterone and prolactin assessment. RESULTS: Mean ages +/-SD were 54.1 +/- 6.9 (range 42-71) and 52.5 +/- 11.9 (range 20-84) years for patients with and without PD respectively. Of the patients, 11.8% had mild, 38.3% had moderate and 49.9% had severe ED. 7.9% of the patients had PD. Significant associations between PD and both the longer duration and the increased severity of ED were detected. There were also significant associations between PD and the following socio-demographic risk factors of ED: age, obesity, smoking, duration and number of cigarettes smoked per day. Concomitant diseases and medical comorbidities such as diabetes, dyslipidemia, psychological disorders and the presence of at least one risk factor were significantly associated with PD in patients with ED. CONCLUSIONS: Peyronie's disease was not rare among the study population. There were significant associations between ED risk factors and PD. Further studies are needed to investigate how much ED and PD influence each other.     

Tadalafil dosed once a day in men with erectile dysfunction: a randomized, double-blind, placebo-controlled study in the US

The efficacy and safety of tadalafil, dosed once a day for the treatment of erectile dysfunction, was assessed in a randomized, double-blind, placebo-controlled, parallel-design study at 15 US centers. Following a 4-week treatment-free run-in period, patients (>or=18 years of age) were randomly assigned to 24 weeks treatment with tadalafil 2.5 mg, tadalafil 5 mg or placebo. Primary efficacy endpoints were change at 24 weeks in International Index of Erectile Function Erectile Function (EF) Domain score and mean per-patient percentage 'yes' responses to Sexual Encounter Profile diary questions 2 and 3. Tadalafil significantly improved erectile function compared with placebo for all three co-primary efficacy endpoints. Few patients discontinued because of adverse events (2.1%, placebo; 6.3%, tadalafil 2.5 mg; 4.1%, tadalafil 5 mg). Common treatment-emergent adverse events (>or=5%) were nasopharyngitis, influenza, viral gastroenteritis and back pain. Tadalafil 2.5 mg and 5 mg, dosed once a day for 24 weeks, was well tolerated and significantly improved erectile function.     

国产低能冲击波设备治疗勃起功能障碍的多中心随机对照研究

目的评估国产线性低能冲击波设备(E100)治疗勃起功能障(ED)的安全性和有效性。方法本研究为一多中心、随机双盲对照研究。病史、国际勃起功能评分(IIEF-6)及夜间阴茎勃起监测确诊的ED患者,按照2︰1的顺序随机分为治疗组及对照组,接受低能冲击波治疗每周1次,共4周,能量0.09mJ/mm2;分4个部位,每部位冲击900次,共3600次,对照组在探头内置铁片阻挡冲击波输出,其余与治疗组完全相同。治疗结束后12周随访,内容包括IIEF-6及夜间阴茎勃起监测。结果治疗组40例中的35例,对照组20例中的16例完成治疗及随访。治疗组与对照组在基线年龄、身高、IIEF-6等均无显著差异;治疗组IIEF-6随访结果显著优于对照组(17.60±6.18 vs.14.00±6.13);治疗组有效率显著高于对照组(68.6%vs.12.5%)。两组均无副作用报告。结论国产低能冲击波设备(E100)治疗勃起功能障碍安全、有效。     

The prevalence of Peyronie's disease in diabetic patients with erectile dysfunction

We attempted in this study to investigate the prevalence of Peyronie's disease (PD) among diabetic patients with erectile dysfunction (ED). Two-hundred and six diabetic patients were further evaluated in this study. Forty-two (20.3%) patients had PD. There were significant associations between PD and risk factors of age, obesity and smoking. All patients with PD had also ED. Penile curvature was present in 82.1% of all patients with PD. Of the patients with PD, 25.4% had pain with or without erection. Significant associations between PD and ED and ED duration were detected. This study confirmed the high prevalence of PD among diabetic patients with ED. Further work is needed probing the mechanisms through which diabetes affects the pathogenesis of ED and PD.     

Tadalafil versus solifenacin for persistent storage symptoms after prostate surgery in patients with erectile dysfunction: A prospective randomized study

Objectives: The occurrence of residual storage symptoms after surgical relief of bladder outlet obstruction as a result of benign prostatic enlargement (BPE) underlines the intricate mechanism involved in lower urinary tract symptoms (LUTS). The aim of the present study was to compare tadalafil with solifenacin in modifying symptoms and uroflowmetric parameters in patients with erectile dysfunction (ED) and residual storage symptoms after prostate surgery. Methods: From May 2007 to April 2009, we evaluated 68 patients who had undergone prostate surgery at least 6 months earlier, and presented with ED and persistence of storage symptoms. A total of 56 patients were randomized to receive tadalafil 5 mg (group 1) or solifenacin 5 mg (group 2), both given daily for 12 weeks. International Prostate Symptoms Score (IPSS), IPSS Quality of Life, International Index of Erectile Function‐5 (IIEF‐5) and uroflowmetry parameters were collected at baseline and after 12 weeks of treatment. Results: A total of 26 patients in group 1 and 25 patients in group 2 completed the study. Each group showed a significant and comparable improvement of urinary symptoms with a decrease of IPSS value. Only in group 1 did the treatment with tadalafil result in a significant increase of IIEF‐5. No statistically significant variations were noted in uroflowmetric parameters in both groups. Conclusions: In patients suffering from ED and storage symptoms after surgical treatment for LUTS‐BPE, tadalafil 5 mg given once daily for 12 weeks provided a comparable improvement in IPSS to solifenacin 5 mg given for the same period of time.     

低强度体外冲击波在勃起功能障碍中的应用进展

勃起功能障碍(ED)的发病率和就诊率日益增高,尤其在40岁以上人群,且其发病率与年龄呈正相关,预计2025年全球ED患者可达3亿人左右。目前,对ED病理生理学机制的研究逐渐深入,对其治疗也有了诸多突破性的进展,但鲜有在分子水平上针对ED病理学变化进行治疗及康复的措施。而低强度体外冲击波(Li SWT)作为一种新兴无创的微能量临床疾病治疗模式,不仅有望从根本上修复ED患者阴茎海绵体的病理学损伤,更是在目前诸多西医治疗具有一定局限性的情况下(如对口服磷酸二酯酶抑制剂-5无反应),为ED的治疗开辟了一条新的思路。本文旨在介绍ED诊疗的现状、Li SWT目前在国内外动物研究及临床实验中治疗ED的机制及进展,为罹患有ED的患者带来新的曙光。     

Extracorporal shock wave therapy in the treatment of Peyronie's disease. First results of a case-controlled approach

OBJECTIVE: To test whether extracorporal shock wave therapy (ESWT) has an effect in the treatment of Peyronie's disease. METHODS: 22 patients with Peyronie's disease and previous unsuccessful oral drug therapy were treated with ESWT in a prospective design with a follow-up of at least 3 months; 23 age-matched patients without previous therapy received oral placebo drug for 6 months daily as control. The standard follow-up included palpation, ultrasound, autophotography and evaluation of symptomatology based on a symptom score. The shock waves were applied under ultrasound guidance using the 'Storz Minilith SL1' lithotripter. RESULTS: The results show a significant decrease in penile curvature in the patients treated with ESWT. Concerning the decrease in pain, subjective improvement and improvement in the quality of sexual intercourse, there was no significant difference to the case-control group. The inhomogeneity of the 2 groups may influence these results due to the questionable varying natural history. CONCLUSIONS: A prospective, controlled multicenter study with standardized parameters (concerning technique and patients) is urgently required to test the effect of ESWT.     

Comparison of the efficacy and safety of low-intensity extracorporeal shock wave therapy versus on-demand sildenafil for erectile dysfunction

BackgroundLow-intensity extracorporeal shock wave therapy (Li-ESWT) is an effective therapy for erectile dysfunction (ED) but is not widely recognized and applied. This prospective nonrandomized study aimed to investigate the efficacy and safety of Li-ESWT.MethodsAfter a 4-week washout period of past ED treatment, patients entered one of 2 active treatment groups, either 9-week Li-ESWT or 100 mg on-demand sildenafil. Patients were evaluated in the first- and third-month following initiation of treatment. The Li-ESWT protocol comprised 2 sessions per week for 3 weeks, which were repeated after a 3-week interval. Patients in the drug group took self-administered sildenafil at a dose of 100 mg before intercourse. The primary outcome was the effectiveness of Li-ESWT measured by the International Index of Erectile Function-5 (IIEF-5) scores. Other measurements included erection hardness score (EHS) and Self-Esteem And Relationship (SEAR).ResultsA total of 78 participants completed the study (46 in the Li-ESWT group and 32 in the sildenafil group). Overall, 26.9% of the participants (21/78) included were psychogenic. In the third month, the outcome measured by IIEF-5 was 21.52 in the Li-ESWT group and 21.26 in the sildenafil group (P>0.05). Proportion of improvement defined by minimal clinically important difference (MCID) criteria was 52.2% in the Li-ESWT group and 59.4% in the sildenafil group (P>0.05). The EHS and SEAR improvement was similar in the 2 groups (P>0.05 at baseline and third month). Transient and mild adverse events were observed in both groups.ConclusionsIn our study, a similar treatment efficacy and safety was shown by the application of Li-ESWT as on demand sildenafil.     

他达拉非:ED患者及其配偶的选择偏爱?

勃起功能障碍(erectile dysfunction,ED)是男性常见疾病,直接影响患者及其配偶的生活质量。PDE5抑制剂是治疗ED的首选药物。尽管临床主要有3种PDE5抑制剂(西地那非、伐地那非和他达拉非)可供选择,但是患者及其配偶在选择PDE5抑制剂上是否有偏好,以及影响其选择的因素又有哪些本文简要地综述了最近的研究进展。     

Diagnosis of hypogonadism in patients treated with low energy shock wave therapy for erectile dysfunction: a narrative review

Several methods of treatment of erectile dysfunction (ED) are offered with low energy shock-wave therapy (LESWT) gaining increasing attention. Reports have documented that LESWT stimulates tissue neovascularization, proliferation and differentiation of endothelial cells, and production of nitric oxide - all can improve the condition of erectile tissue. However, the overall and sexual condition of men deteriorates with age which is linked with a constant decrease in testosterone concentration. A higher risk of sexual health disorders and reduced physical fitness correlates with a testosterone concentration of <12 nmol/L. Such patients may require testosterone replacement therapy. We conducted a target literature review to investigate whether testosterone concentration is taken into account in studies on the use of LESWT in the treatment of ED. We found that most studies did not provide any information on testosterone status. Only 8 of 25 studies examined showed values of testosterone concentrations. Only one of these analyses checked the relationship between the efficacy of LESWT and testosterone concentration. As a result, meta-analyses published to date may not show the full value of LESWT in the treatment of ED. We conclude that in the light of the significant role testosterone plays in the process of an erection and the mechanism of LESWT action, it can be recommended to examine testosterone concentration and to diagnose hypogonadism during the qualification of patients to studies on LESWT efficacy. Moreover, the effectiveness of LESWT in relation to the current testosterone concentration should also be further investigated.