PMID- 34829899 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211130 IS - 2227-9059 (Print) IS - 2227-9059 (Electronic) IS - 2227-9059 (Linking) VI - 9 IP - 11 DP - 2021 Nov 12 TI - Efficacy of Penile Low-Intensity Shockwave Therapy and Determinants of Treatment Response in Taiwanese Patients with Erectile Dysfunction. LID - 10.3390/biomedicines9111670 [doi] LID - 1670 AB - BACKGROUND: Erectile dysfunction (ED) remains an emotional wrench to patients and a therapeutic challenge to urologists in andrology clinics worldwide. This is, in part, related to refraction to, or transient effect of phosphodiesterase 5 inhibitors (PDE5i), coupled with patients' dissatisfaction with this treatment modality. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an evolving treatment option, with promising curative potential. Current international guidelines are inconclusive, bear weak recommendation strength, and lack ethnogeographic consensus. OBJECTIVES: This study evaluated the safety, efficacy, and effect duration of Li-ESWT, as well as exploring disease-associated determinants of treatment success in Taiwanese males with ED. METHODS: A cohort of 69 eligible cases treated with 12 sessions of Li-ESWT and followed up for at least 12 months after treatment, between January 2018 and December 2019 at our medical facility, was used. The present single-center, retrospective, non-randomized, single-arm study employed standardized erectile function evaluation indices, namely, the five-item International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Clinicopathological analyses of selected variables and comparative analyses of time-phased changes in the EF indices relative to baseline values were performed. Evaluation of treatment success was based on minimal clinically important difference (MCID), using a binomial logistic regression model. RESULTS: The median age and duration of ED for our Taiwanese cohort were 55 years and 12 months, respectively, and an average of 31.3% presented with co-morbidities. The mean improvement in IIEF-5, EHS, and quality of life (QoL) domain scores relative to the baseline values was statistically very significant (p < 0.001) at all indicated follow-up time-points. When stratified, Taiwanese patients with severe and moderate ED benefited more from Li-ESWT, compared with those in the mild or mild-to-moderate group. Patients' pre-Li-ESWT PDE5i response status was not found to significantly influence Li-ESWT response. Univariate analysis showed that age > 45 years (p = 0.04), uncontrolled diabetes mellitus (p = 0.04), and uncontrolled hyperlipidemia (p = 0.01) were strongly associated with Li-ESWT efficacy; however, only age > 45 years (p = 0.04) and uncontrolled hyperlipidemia (p = 0.03) were found to be independent negative predictors of Li-ESWT success by the multivariate logistic model. Follow-up was uneventful, with no treatment-related adverse events or side effects reported. Of the treated patients, 86.1% indicated satisfaction with the treatment regimen, and over 90% indicated they would recommend the same therapy to others. CONCLUSIONS: Li-ESWT is a safe and efficacious therapeutic modality for Taiwanese patients with ED. Uncontrolled hyperlipidemia and age > 45 years are independent negative predictors of treatment success for this cohort. FAU - Tzou, Kai-Yi AU - Tzou KY AUID- ORCID: 0000-0001-9153-307X AD - Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan. AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan. FAU - Hu, Su-Wei AU - Hu SW AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan. AD - Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan. FAU - Bamodu, Oluwaseun Adebayo AU - Bamodu OA AUID- ORCID: 0000-0001-8229-0408 AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - Division of Hematology and Oncology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. FAU - Wang, Yuan-Hung AU - Wang YH AD - Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan. AD - Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. FAU - Wu, Wen-Ling AU - Wu WL AUID- ORCID: 0000-0001-5240-2421 AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan. FAU - Wu, Chia-Chang AU - Wu CC AD - Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan. AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan. AD - TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan. LA - eng PT - Journal Article DEP - 20211112 PL - Switzerland TA - Biomedicines JT - Biomedicines JID - 101691304 PMC - PMC8615607 OTO - NOTNLM OT - EHS OT - IIEF-5 OT - Li-ESWT OT - MCID OT - erectile dysfunction OT - ethnogeography OT - extracorporeal shockwave therapy OT - independent predictors OT - minimal clinically important difference OT - treatment success COIS- The authors declare no conflict of interest. EDAT- 2021/11/28 06:00 MHDA- 2021/11/28 06:01 PMCR- 2021/11/12 CRDT- 2021/11/27 01:10 PHST- 2021/09/15 00:00 [received] PHST- 2021/11/08 00:00 [revised] PHST- 2021/11/09 00:00 [accepted] PHST- 2021/11/27 01:10 [entrez] PHST- 2021/11/28 06:00 [pubmed] PHST- 2021/11/28 06:01 [medline] PHST- 2021/11/12 00:00 [pmc-release] AID - biomedicines9111670 [pii] AID - biomedicines-09-01670 [pii] AID - 10.3390/biomedicines9111670 [doi] PST - epublish SO - Biomedicines. 2021 Nov 12;9(11):1670. doi: 10.3390/biomedicines9111670.