Dr. Saut Phearum, Andrology Phnom Penh Clinic
A FIT 67 YEAR-OLD MALE PRESENTED COMPLAINING OF EIGHT YEARS OF PERSISTENT ED
Patient was unresponsive to or dissatisfied with various PDE5i drugs, including Cialis and Viagra. He reported deteriorating marital well-being and increasing frustration and anxiety.
Since the patient was a long-term sufferer of ED who had previously undergone treatment with PDE5i drugs, his urologist, Dr. Rokkas, elected to pursue Erectile Dysfunction Shock Wave Therapy (EDSWT) using the ED1000. This treatment utilizes low-intensity extracorporeal shock waves to encourage neovascularization in the penis shaft and crus in order to relieve vascular deficiency. “This course of therapy offers multiple advantages to patient and doctor alike,” noted Dr. Rokkas. “It’s an easy-to-use, non-invasive, and pain-free process that can produce permanent improvement. Plus there is no danger of drug interaction.” Dr. Rokkas carried out the treatments, without sedation, in his clinic.
The patient underwent a series of twelve treatments over a period of several weeks. After six treatments, Dr. Rokkas reported the patient experiencing morning erections. Further treatments resulting in continuing improvements: He cited that after the treatments with the ED1000, the patient was able to experience stronger erections, and in the Erection Hardness Questionnaire, he progressed from level 1 to level 3. “The patient reported no adverse effects,” noted Dr. Rokkas, “which is typically the case with EDSWT.” Viagra was prescribed in conjunction with EDSWT treatment. After ten treatments, the patient reported satisfying sexual relations: “My marital life is already better. I can perform sexually and I feel that I’m once again in control. The anxiety I faced for eight years is diminishing.”
80 YEAR-OLD MAN: I FEEL 20 YEARS YOUNGER…
Prof. Peter Lim, Gleneagles Hospital Senior Consultant and the Chairman of the Singapore Men’s Health Association, claims that in the recent years there is a growing number of older people suffering from erectile dysfunction, that are interested in improving their erection and reviving their sex life. These people turn to him, searching for the ultimate solution.
Recently, he was approached by an 80 year-old man, who didn’t want his age to affect his sex life. He and his wife were married for 30 years and were used to having sexual intercourse at least once a week. His age, in addition to prostate surgery, left him dissatisfied with his performance. He decided to approach Prof. Lim after hearing about the revolutionary shockwave therapy.
After the treatment he was very satisfied both with his performance and sexual intercourse frequency (increased to an average of 2-3 times a week). According to the patient: “I now feel more confident & more satisfied when I have intercourse with my wife after treatment and pleasantly surprised that I feel 20 years younger!”.
According to the National University Hospital survey, 54% of men aged 40 to 65 suffer from impotence.
Prof. Lim is also referring to the fact that there more and more men between the ages 25 to 40 also suffering from impotence mainly due to stress and anxiety. Gleneagles Hospital is the first hospital in Singapore to use this technology, but other hospitals are starting to show interest in this revolutionary treatment. Prof. Lim has treated 60 patients in less than 1 year.
A CURATIVE THERAPY FOR ED EDGES FORWARD
Dr. Burnett, a member of the Urology Times Editorial Council, is professor of urology at Johns Hopkins University School of Medicine, Baltimore. He serves as an investigator for Medispec.
The clinical practice of erectile dysfunction (ED) management has been advanced greatly in the past 2 decades, owing to major progress made in the scientific study of this condition that, in turn, led to new treatments. However, current treatments for ED remain less than ideal because they are effectively “on demand” and they uniformly do not provide a sustained erection recovery benefit.
The ongoing purpose of scientific research efforts in this discipline is to achieve pathophysiologically grounded and clinically restorative interventions—in essence, curative therapy. Much excitement has surrounded such ideas as gene therapy and stem cell therapy for this exact purpose, although their promise is as yet unfulfilled.
The concept that low-intensity shock wave therapy may subserve curative therapy for ED has driven a great deal of excitement toward this particular treatment. A novelty when initially investigated 5 years ago, it has now been subjected to multiple randomized, placebo-controlled, and additional open-label studies in clinics worldwide, demonstrating impressive efficacy and safety.
The attraction of this therapy is noted by being easily administered and noninvasive. Its role may be defined by treatment success in as much as 70% of phosphodiesterase type-5 (PDE-5) inhibitor non-responders or otherwise allowing many to recover PDE-5 inhibitor responsiveness after treatment. In this mode, shock wave therapy at least affords a reduced need for second-line, semi-invasive ED treatment options in process-of-care paradigms.
Amid this excitement, concerns regarding the application of this therapy persist. The mechanism of its effect remains elusive, although some scientific work has suggested it exerts angiogenesis and local neovascularization effects or stimulates stem cell recruitment with tissue repair. A patient acceptance barrier is also possible because the treatment does require extensive treatment sessions. Ongoing work will also be required to define an optimal treatment protocol and establish the preferred role of this treatment for target populations with ED.
MY EXPERIENCE WITH ESWT FOR CHRONIC PELVIC PAIN
62 YEAR-OLD MALE EFFECTIVELY TREATED FOR RECURRENT ANGINA WITH ESMR
Patient is an active 62-year-old male who has elevated cholesterol and suffers from diabetes. Patient experienced sudden onset of recurrent angina at low work thresholds, along with breathlessness and dizziness. Previously he underwent several coronary bypass surgeries, which resulted in only partial revascularization. Currently, ischemic territories are unapproachable by angioplasty.
Since angioplasty was not a viable option, the patient underwent a non-invasive Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy at the University of Malaya Medical Center (UMMC), under care of Prof. Wan Azman Wan Ahmad , head of the cardiology division at UMMC. Prof. Wan Azman: “This patient has been through several coronary bypass procedures and multiple percutaneous coronary interventions. His surgical and interventional options have been exhausted, so classic therapy remains limited to the use of multiple anti-anginal medications, reduced activity, exertion, and stress level, and significant alteration and limitation of lifestyle, all of which are unacceptable to the patient. At this point in time, the only effective remaining procedure is ESMR.”
ESMR therapeutically induces the growth and development of new vasculature in zones of severe ischemia in the myocardium. The patient underwent nine ESMR sessions, during each of which he received 500 shockwave impulses precisely targeted to the ischemic area. “As a result of the therapy,” notes Prof. Wan Azman, “new capillaries and arterioles generated will connect to remnant existing vasculature, precluding the need of further intervention.”
Although results are typically evident after one month of the treatment, this patient noted an improvement in stamina after the first session. Upon receiving six treatments, there was a notable improvement in his appetite, comfort, and sense of well-being. “Before the treatment, I had given up the thought of lifting my grandchildren into my arms or getting back to my beloved gardening. Now I feel like I’ve been blessed with a new life.”
CAREER OF CHAMPION RUNNER WITH MULTIPLE INJURIES IS SAVED WITH ESWT
30-year-old Andrea Miller, world-ranked hurdler from New Zealand, diagnosed with necrosis/bone degeneration of the medial tibial plateau, subsequent to anserinus bursitis.
Initially the injury was treated with cortisone injections, which yielded only short-term relief. Patient turned to Kompass Health Associates, where Kenneth Craig suggested Extracorporeal Shockwave Treatment with Orthospec by Medispec Ltd. After the first treatment session, there was immediate reduction in resting symptoms and swelling, and improvement in appearance. Following three more sessions, there was evident regrowth of the tissue damaged by cortisone. Patient, now pain-free, returned to competitive training and within one year broke her own record in the European circuit.
Two years later, the patient suffered a 12 mm medial bundle planter fascia tear. Initial conventional therapy included taping, moon boot, and autologous blood injections. As patient was unable to train at a competitive level, she returned to Kompass Health Associates for ESWT. There was an immediate resolution of morning pain, and within three weeks there was a 90% improvement in muscle function.
Patient immediately began to train for the 2010 Commonwealth games and won a bronze medal. “I am thankful to have the opportunity to compete in the 2010 games,” says Ms. Miller. “I truly thought my Commonwealth dreams were over even before they had begun.” In addition to being a champion hurdler, Ms. Miller is a licensed physiotherapist. “I am familiar with shockwave therapy, but the device that Ken uses is different—with far better outcomes.”
Currently Ms. Miller is training for the 2012 London Olympics.
SIMPLE TOOL FOR COSMETOLOGISTS FOR FACIAL AESTHETICS
55 year-old healthy female smoker who was dissatisfied with facial discolorations and hanging skin on the neck.
Patient was unwilling to undergo surgical procedures. Her cosmetologist, introduced her to Slimspec, a product originally designed to use acoustic radial waves for cellulite reduction and body firming. Acoustic Radial Wave Therapy (ARWT) has been shown to improve blood circulation and metabolism of fat cells within the skin’s connective tissue. This improves lymphatic drainage of skin toxins and stimulates collagen formation, thus making the skin more elastic and firm.
Recently, ARWT has been applied to clearing facial blemishes and tightening sagging skin. ARWT increases metabolism in the treated area, so toxins and fluids retained within fat cells can be released by the lymphatic system. The cosmetologist applied unfocused acoustic radial waves to the patient’s neck and chin, and beneath her eyes.
Patient underwent a series of 5 treatments at the cosmetologist’s studio. After the first treatment, there was a noticeable reduction in red facial discoloration. Upon the third treatment, skin was significantly firmer and more flexible. Skin on the neck and under the eyes showed reduced swelling and was more taut.
The treatment suggested by this practitioner serves as only one among several treatment options. Practitioners are advised to tailor treatment to the individual symptoms and needs of each client.