What happens if it fails?

This study confirmed (with co-morbidities), that a repeated course for earlier `failures’ produced a significant improvement in erectile function in patients with poor response to a standard shockwave protocol.

Vardi Y., Appel B., Kitrey N.D., Massarwa O., Gruenwald I. European Urology, Supplements. Conference: 29th Annual Congress of the European Association of Urology, EAU. Stockholm, Sweden. Conference Start: 20140411. Conference End: 20140415. Conference Publication: (var.pagings). 13 (1) (pp e604), 2014.

Date of Publication: April 2014. AN: 71485604

INTRODUCTION & OBJECTIVES:

The effect of low intensity shockwave as a treatment option for erectile dysfunction has been previously described. The current protocol consists of 12 treatment sessions. The aim of this study was to assess the efficacy of a second treatment course of shockwave therapy identical to the first, in patients who had not satisfactorily responded to the first round.

MATERIAL & METHODS:

All the men that were treated by shockwave therapy, and did not meet our criteria for success and showed partial or no response during the six months after completion of the protocol, were offered a repeat  identical treatment protocol for the second time. The initial failure and the response to the second treatment protocol were evaluated one month after the end of treatment and were defined according to the change in the IIEF domain questionnaire (Rosen minimal change clinical improvement) and/or by CGIC (Clinical Global Impression of Change).

RESULTS:

Thirty patients were included in this study. Their median age was 58 (28 – 76), 13 (43.3%) had diabetes mellitus, and 25 (83.3%) had cardiovascular disease or cardiovascular risk factors. 22 patients (73.3%) had severe ED.

Their median baseline IIEF score before treatment was 8 (range 6 – 19), and after the first treatment protocol it improved to a median of 10 points.

Twelve patients (40%) responded successfully to the additional treatment protocol according to the Rosen criteria, and 17 (56.6%) by the CGIC. The median IIEF score on follow up after the second course increased from 8 to 13.5 points.

CONCLUSIONS:

Recently there have been reports from other sources on evaluating shorter protocols by lowering the number of sessions to six.

Our study showed the opposite, and demonstrates that there are patients who need additional exposure to this energy in order to respond.

A “Second round” protocol was effective in approximately half the patients who responded poorly to the standard one.

Further research is needed to develop optional treatment protocols that could maximize the positive effect of shockwave treatment.