Clinical Info


Effect of penile rehabilitation with low intensity extracorporeal shock wave therapy on erectile function recovery following robot-assisted laparoscopic prostatectomy

Shogo Inoue, Tetsutaro Hayashi, Jun Teishima, Akio Matsubara

Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

TAU – Translational Andrology & Urology Jurnal, Vol 9 No. 4, August 2020

Backgrounds: Considering the natural course of cavernous nerve recovery after robot-assisted laparoscopic prostatectomy (RALP), early intervention of low intensity extracorporeal shock wave therapy (LIESWT) would be more effective for enhancing overall recovery of sexual function (SF). Our objective of this study is to analyze longitudinally the alterations of SF in patients after RALP, with a focus on the effect of early and delayed intervention with LIESWT.

Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients.

Spivak L, Shultz T, Appel B, Verze P, Yagudaev D, Vinarov A.

Sex Med Rev. 2019 Aug 1. pii: S2050-0521(19)30072-1.

Introduction: The cause of erectile dysfunction (ED) in diabetic patients is complex and involves both neurogenic and vasculogenic components and is often hard to treat.
Aim: To study the effect of low-intensity extracorporeal shock wave therapy (Li-ESWT) therapy on a subgroup of diabetic patients with ED who are responders (PDE5I-R) and non-responders PDE5I-NR) to phosphodiesterase 5 inhibitors (PDE5I).
Methods: Analysis of pooled data from 5 double-blind, sham-controlled trials was performed. In this sub-analysis, of 350 patients in the PDE5I-R group and with vasculogenic ED, we found 61 patients with diabetes mellitus who underwent LI-ESWT….

Determinants of Early Response to Low-Intensity Extracorporeal Shockwaves for the Treatment of Vasculogenic Erectile Dysfunction: An Open-Label, Prospective Study.

Vita R, Benvenga S, Giammusso B, La Vignera S.

J Clin Med. 2019 Jul 11;8(7).

The aim of this study was to expand existing literature on the effects of cardiovascular risk factors on the outcome of low-intensity extracorporeal shockwaves therapy (LIESWT), and to evaluate the role of hormone concentrations. Twenty patients with long-standing, PDE5i-resistant, vasculogenic erectile dysfunction (VED) were treated with six weekly sessions of LIESWT (9000 pulses). After a three-week break, four poor responders underwent another six weekly sessions. Rigidity score (RS) questionnaire was administered at baseline (T0), last session (T1), and three months after LIESWT (T2), while the Improvement component of the Clinical Global Impression of Change (CGIC-I) and the International Index of Erectile Function-5 (IIEF-5) questionnaires were administered at T1 and T2, and at T0 and T2, respectively….

Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile

Jeffrey D. Campbell , Bruce J. Trock, Adam R. Oppenheim, Ifeanyichukwu Anusionwu, Ronak A. Gor and Arthur L. Burnett

Therapeutic Advances in Urology, 2019, Vol. 11: 1–13

Background: The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LiESWT) for the treatment of erectile dysfunction (ED).
Materials and methods: A comprehensive search of PubMed, Medline, and Cochrane databases was performed from November 2005 to July 2018. RCTs evaluating efficacy of LiESWT in the treatment of ED were selected. The primary outcomes were the mean difference between treatment and sham patients in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score 1 month after treatment ….

Low Intensity Shock Wave Treatment for Erectile Dysfunction—How Long Does the Effect Last?

Noam D. Kitrey, Yoram Vardi, Boaz Appel, Arik Shechter, Omar Massarwi, Yasmin Abu-Ghanem, Ilan Gruenwald

The Journal of Urology, Volume 200, Issue 1, Pages 167–170, July 2018

Purpose: We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome.
Materials and Methods: Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire…

Low Intensity Shockwave Therapy (LiST) Promotes Angiogenesis and Modulates Sympathetic Activity of the Erectile Tissue in Naturally Aged Rats

Original Research

Journal of Sexual Medicine-03-2018-162

Background: Low-intensity shock wave therapy (LiST) improves erectile function in patients with erectile dysfunction (ED), probably by promoting angiogenesis as suggested by studies on animals with comorbidities as disease associated ED models. Aim: To investigate the effects of LiST on erectile tissue of healthy, naturally aged rats…

Low Intensity Shock Wave Treatment for Erectile Dysfunction-How Long Does the Effect Last?

Kitrey ND., Vardi Y., Appel B., Shechter A., Massarwi O., Abu-Ghanem Y., Gruenwald I.

J Urol. 2018 Mar 1. pii: S0022-5347(18)39376-5. doi: 10.1016/j.juro.2018.02.070.

Purpose: We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome.
Materials and Methods: Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function)…

Low-Intensity Shockwave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial

Kalyvianakis D., Hatzichristou D.

J Sex Med. 2017 Jul;14(7):891-897. doi: 10.1016/j.jsxm.2017.05.012

Background: Although several reports have documented the subjective improvement of erectile function after low-intensity extracorporeal shockwave therapy (LI-ESWT) in patients with vasculogenic erectile dysfunction (ED), objective assessment data of penile hemodynamics are lacking.
Aim: To assess penile hemodynamics before and 3 months after LI-ESWT…

Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis

Raul I. Clavijo, MD, Taylor P. Kohn, MD, Jaden R. Kohn, BS, and Ranjith Ramasamy, MD

Journal of Sexual Medicine 2017;14:27e35, jsxm.2016.11.001

Introduction: Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED).
Aim: To use systematic review and meta-analysis to assess the efficacy of Li-ESWT by comparing change in erectile function as assessed by the…

Low-Intensity Extracorporeal Shockwave Treatment Improves Erectile Function: A Systematic Review and Meta-Analysis

Zhihua vLu, vGuiting Lin, Amanda Reed-Maldonado, Chunxi Wang, Yung-Chin Lee, Tom F. Lue

Journal of European Urology 10.2016. 2016.05.050

Context: As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED…

Impact of Aging and Comorbidity on the Efficacy of Low-Intensity Shockwave Therapy for Erectile Dysfunction

Shin-ichi Hisasue, Toshiyuki China, Akira Horiuchi, Masaki Kimura, Keisuke Saito, Shuji Isotani, Hisamitsu Ide, Satoru Muto, Raizo Yamaguhi and Shigeo Horie

International Journal of Urology (2015). doi: 10.1111/iju.12955

Objectives: To evaluate the efficacy of low-intensity shock wave therapy and to identify the predictive factors of its efficacy in Japanese patients with erectile dysfunction.
Methods: The present study included 57 patients with erectile dysfunction who satisfied all the following conditions: more than 6-months history…

Penile Low-Intensity Shockwave Treatment is Able to Shift PDE5i Non-Responders to Responders: A Double-Blind Sham-Controlled Study

Kitrey, N.D., et al.

Journal of Urology (2015)

Purpose: Sham-controlled evaluation of penil low-intensity shockwave (LIST) effect on patients unable to have sexual intercourse with phosphodiesterase 5 inhibitors.
Materials and Methods: A prospective randomized double-blind sham-controlled study on vasculogenic ED patients who stopped using PDE5i due to no efficacy. all patients had an erectile hardness score (EHS) ≤2 with PDE5i…

Low-Intensity Extracorporeal Shockwave Treatment of Erectile Function: A Study in an Indian Population

Vasan Satya Srini, MD; Rahul Kumar Reddy, MD; Tamar Shultz, PhD; Bela Denes, MD.

The Canadian Journal Of Urology; 22(1), p:7614-7622; February 2015

Introduction: Erectile Dysfunction (ED) has been shown to be associated with a number of physical conditions ans affects not only physical but also psychosocial health. Currently oral, on-demand phosphodiesterase type 5 inhibitors (PDE5i) are preferred first line treatment. Though effective, these drugs have limitations and are associated with significant non-compliance, side effects and do not reverse…

Penile Low-Intensity Shockwave Therapy: A Promising Novel Modality for Erectile Dysfunction

Yasmin Abu-Ghanem, Noam D. Kitrey, Ilan Gruenwald, Boaz Appel, Yoram Vardi

Korean J Urol 2014;55:295-299

Great advances in the understanding and treatment of erectile dysfunction (ED) have been made in the past two decades. Most patients suffering from ED respond to the available options for treatment, including oral phosphodiesterase type 5 inhibitors (PDE5i) and intracavernosal injections of vasodilating agents. However, these medications are unable to alter the underlying pathophysiology of the…

Low-Intensity Extracorporeal Shockwave Therapy in Vascular Disease and Erectile Dysfunction: Theory and Outcomes

Ilan Gruenwald, MD; Noam D. Kitrey, MD; Boaz Appel, MD; Yoram Vardi, MD.

Korean J Urol 2014;55:295-299

Introduction: Low-intensity extracorporeal shock wave therapy (LI-ESWT) to the penis has reccently emerged as a new and promising modality in the treatment of erectile dysfunction (ED).
Aim: To review the published literature on the mechanism of action of LI-ESWT; and to report our clinical data on its efficacy in man with vasculogenic ED…

Shockwave Treatment of Erectile Function

Ilan Gruenwald, MD; Boaz Appel, MD; Noam D. Kitrey, MD; Yoram Vardi, MD.

Ther Adv Urol 2013;0(0):1–5. DOI: 10.1177/1756287212470696

Abstract: Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections…

Evolution of the Effect of Different Doses of Low-Energy Shockwave Therapy on the Erectile Function of Streptozotocin (STZ) – Induced Diabetic Rats

Jing Liu, Feng Zhon, Guang-Yong Li, Lin Wang, Hui-Xi Li, Guang-Yi Bai, Rui-Li Guan, Yong-De Xu, Ze-Zhu Gao, Wen-Jie Tian and Zhong-Cheng Xin

Int J Mol Sci. 2013 May 21;14(5):10661-10673. doi: 10.3390/ijms140510661

Abstract: To investigate the therapeutic effect of different doses of low energy shock wave therapy (LESWT on the erectile dysfunction (ED) in streptozotocin (STZ) induced diabetic rats. SD rats (n=75) were randomly divided into 5 groups (normal control, diabetic control, 3 different dose LESWT treated diabetic groups). diabetic rats were induced by intra-peritoneal injection of STZ (60 mg/kg)…

Effects of Low-Energy Shockwave Therapy on the Erectile Function and Tissue of a Diabetic Rat Model

Dr. Xuefeng Qiu, Prof. Guiting Lin, Prof. Zhongcheng Xin, Dr. Ludovic Ferretti, Dr. Haiyang Zhang, Dr. Tom F. Lue and Prof. Ching-Shwun Lin

J Sex Med. 2013 Mar;10(3):738-746. doi: 10.1111/jsm.12024.

Introduction: Low-energy shockwave therapy (LESWT) has been shown to improve erectile function in patients suffering from diabetes mellitus (DM)-associeted erectile dysfunction (ED). However, the underlring mechanism remains unknown.
Aim: The aim of this study is to investigate whether LESWT can ameliorate …

Does Low Intensity Extracorporeal Shockwave Therapy Have a Physiological Effect on Erectile Function? Short-Term Results of Randomized, Doubleblind, Sham Controlled Study

Yoram Vardi, Boaz Appel, Amichai Kilchevsky and Ilan Gruenwald

J Urol. 2012 May;187(5):1769-1775. doi: 10.1016/j.juro.2011.12.117.

Purpose: We investigated the clinical and physiological effect of low intensity extracorporeal shock wave therapy on man with organic erectile dysfunction who are phosphodiesterase type 5 inhibitors responders.
Materials and Methods: After a 1-month of phosphodiesterase type 5 inhibitors woshout period, 67 man were randomized in a 2:1 ratio to receive 12 sessions…

Low-Intensity Extracorporeal Shockwave Therapy – A Novel Effective Treatment for Erectile Dysfunction in Severe ED Patients Who Respond Poorly to PDE5 Inhibitor Therapy

Ilan Gruenwald, MD, Boaz Appel, MD, and Yoram Vardi, MD

J Sex Med. 2012 Jan;9(1):259-264. doi: 10.1111/j.1743-6109.2011.02498.x.

Introduction: Low-intensity shock wave therapy (LI-ESWT) has been reported as an effective treatment in man with mild and moderate erectile dysfunction (ED).
Aim: The aim of this study is to determine the efficacy of LI-ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy…

Can Low-Intensity Extracorporeal Shockwave Therapy Improve Erectile Function? A 6-month Follow-up Pilot Study in Patients with Organic Erectile Dysfunction

Prof Y. Vardi, Dr. B. Appel, Dr. G. Jacob, Dr. O. Massarwi, Dr. I Gruen

Eur Urol. 2010 Aug;58(2):243-248. doi: 10.1016/j.eururo.2010.04.004.

Background: Low-intensity extracorporeal shockwave therapy (LI-ESWT) is currently under investigation regarding its ability to promote neovascularization in different organs.
Objective: To evaluate the effect of LI-ESWT on man with erectile dysfunction (ED) who have previously responded to oral phosphodiesterase type 5 inhibitors…

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