Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction.

Abstract Introduction & Objectives Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a recent introduction for the treatment of Erectile Dysfunction (ED) with arterial hypo-inflow. The rationale of this non-invasive technique relies on vascular endothelial growth factor (VEGF) stimulation, stem cells recruitment, Schwann cell activation and the result is neoangiogenesis and nerve regeneration, with consequent more vigorous erection. Aim of this study was to evaluate the impact of Li-ESWT in improving penile dynamic-doppler parameters and sexual function in patients treated for ED. Materials & Methods This was a prospective study with a cohort of patients evaluated for ED at our Department between 2019 and 2021. All patients underwent a standardized baseline visit with physical examination, medical history, International Index of Erectile Dysfunction (IIEF-5) administration and Penile dynamic-Doppler echography. Penile dynamic-Doppler was performed to evaluate vascular parameters and the latter two were repeated one month after treatment. Patients with a PSV<30 cm/s were considered eligible for Li-ESWT. Our protocol consisted of eight weekly-sessions with 1500 strokes distributed in 5 different locations along the penis. ANOVA and chi-square tests, Wilcoxon sign-rank test and Loess curve were used to examine differences in continuous and categorical variables, to compare peak systolic velocity difference (PSV-d) before and after treatment and to depict the relationship between PSV kinetics and IIEF score improvement after treatment, respectively. Results Li-ESWT was performed in 113/1145 (9,8%) patients with ED associated with PSV<30 cm/s. Preoperative median PSV was 25,5±4,6 cm/sec while IIEF score was 12 (IQR 4-14). After treatment, a significant median PSV-d increase of 5±3.4 cm/sec was recorded (p-value30 cm/sec at post-therapeutic penile dynamic Doppler. A significant IIEF score improvement was assessed in patients with a >5 cm/s PSV increase. Conclusions Shock wave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.