Katz JE 1 1 Department of Urology, University of Miami, Miami, FL, USA , Clavijo RI 2 2 Department of Urology, University of California at Davis, Davis, CA, USA , Rizk P 1 1 Department of Urology, University of Miami, Miami, FL, USA , Ramasamy R 3 3 Department of Urology, University of Miami, Miami, FL, USA
COMMENT
Dr. Jonathan Elliott Katz and cols., taking into consideration that Li-ESWT is not U.S. Food and Drug Administration approved and is considered investigational in the United States and available to patients under clinical trial protocols, made a nice review on the physic aspects of shockwaves. And drive attention to the aspect that each device should use the protocol approved for it.
In 2010, Vardi et al. (11. AVardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010;58:243-8.) published their first paper, which introduced the use of low intensity extracorporeal shock wave therapy (LI-ESWT) for ED. Since them, many articles have been published communicating safety and efficacy of Li-ESWT in ED patients (22. Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2017;14:27-35.). The results of studies with a small number of patients and a short observation period were encouraging, but we live with the diversity of devices and the lack of clear protocols, mainly in special populations.
In a recent report, Dr. Fojecki and cols. (33. Fojecki GL, Tiessen S, Osther PJS. Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study. Sex Med. 2018;6:1-7.) presented 6- and 12-month data from a randomized, sham-controlled trial on LI-ESWT for ED and did not find any clinically significant effect between two different protocols.
According to another recent publication on Journal of Sexual Medicine (44. Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. J Sex Med. 2019;16:168-94.): “These studies provide preliminary insights, but no definitive answers, and many questions remain unanswered regarding the mechanism of action, as well as the ideal treatment protocol”.
However, there is a need to define which subgroup of ED population is best suited and the most appropriated LI-ESWT treatment protocol including template, modality of shockwaves energy, emission frequency, and total energy delivery.
So, we still do require better design studies with clear inclusion and exclusion criteria using validated tools to access erectile function improvement in long follow up periods. Ideally we should do it before treating our patients.
REFERENCES
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1AVardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010;58:243-8.
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2Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2017;14:27-35.
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3Fojecki GL, Tiessen S, Osther PJS. Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study. Sex Med. 2018;6:1-7.
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4Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. J Sex Med. 2019;16:168-94.
Publication Dates
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Publication in this collection
31 July 2020 -
Date of issue
Sep-Oct 2020
