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。

Low-intensity extracorporeal shock wave therapy for traumatic erectile dysfunction:results of a controlled trial

Objective To evaluate the efficacy of low-intensity extracorporeal shock wave therapy(LI-ESWT)in patients with traumatic erectile dysfunction.Methods The present study included 62 patients with traumatic erectile dysfunction,including 30 patients treated with low intensity shock waves and 32 controlled patients.The treatment groups were performed six times(twice per week),each by 3000 impulses.The follow-up was performed 4,8 and 12 weeks after LI-ESWT.The International Index of Erectile Function-5(IIEF-5),nocturnal penile tumescence(NPT)and the Erection Hardness Score(EHS)were used to evaluate the therapeutic efficacy of LI-ESWT.Results LI-ESWT could significantly improve IIEF-5(15.67±3.89 vs.9.41±4.66,P<0.01).67%of patients in the LI-ESWT group and none of the control group answering'yes’to the SEP-Q2 elevated.In the low intensity shock wave treatment group and the control group 67%and 0 of patients,respectively,achieved erection hard enough for vaginal penetration,that is an EHS(Erection Hardness Score)of 3(P<0.01).According to changes in the IIEF-5 score treatment was effective in 70%of men who received low intensity shock wave treatment but in none in the control group(P<0.01).Therapeutic efficacy could last 12 weeks(P<0.05).No adverse events were reported during and following treatment.Conclusions These studies suggest that LI-ESWT could improve the IIEF and EHS of traumatic ED patients.