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Wang Y, Jiang R. Androgens and erectile dysfunction: from androgen deficiency to treatment. Sex Med Rev 2024; 12:458-468. [PMID: 38719619 DOI: 10.1093/sxmrev/qeae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Androgens play important roles in regulating the growth and development of the male reproductive system and maintaining libido and erectile function. The specific mechanisms by which androgen deficiency leads to erectile dysfunction (ED) are not yet fully understood. OBJECTIVES To understand the mechanisms and treatment of androgen deficiency-related ED. METHODS A literature search in the past 10 years was conducted in PubMed and Google Scholar to determine the effects of androgen deficiency on erectile function and the treatment of androgen deficiency. RESULTS Androgen deficiency can be caused by hypothalamic-pituitary lesions and injuries, testicular-related diseases and injuries, endocrine and metabolic disorders, the side effects of medication, and age. Androgen deficiency can lead to ED by inhibiting the NOS/NO/cGMP pathway (nitric oxide synthase/nitric oxide/cyclic guanosine monophosphate) and altering the expression of ion channel proteins, as well as by inducing oxidative stress, death, and fibrosis in penile corpus cavernosum cells. Testosterone replacement therapy is effective at improving the serum testosterone levels and erectile function in patients with androgen deficiency. For patients who need to maintain a low androgenic state, erectile function can be improved by lifestyle changes, treatment with phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shock wave therapy, and stem cell therapy. CONCLUSIONS Androgen deficiency can affect the structure and function of the penile corpus cavernosum, leading to ED. Areas of further study include how androgen replacement therapy can improve erectile function and how to improve the maintenance of erectile function in patients with hypoandrogenic status.
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Affiliation(s)
- Yuan Wang
- Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Rui Jiang
- Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
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Narasimman M, Sandler M, Bernstein A, Loloi J, Saltzman RG, Bernie H, Ramasamy R. A primer on the restorative therapies for erectile dysfunction: a narrative review. Sex Med Rev 2024; 12:505-512. [PMID: 38494449 DOI: 10.1093/sxmrev/qeae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy. OBJECTIVE The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice. METHODS The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search. RESULTS Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment. CONCLUSION Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.
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Affiliation(s)
- Manish Narasimman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Max Sandler
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Ari Bernstein
- Department of Urology, New York University Langone Health, New York, NY10016, United States
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
| | - Russell G Saltzman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Helen Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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Hegazy M, Sheir KZ, Gaballah MA, Elshal AM. A randomized controlled trial evaluating low-intensity shockwave therapy for treatment of persistent storage symptoms following transurethral surgery for benign prostatic obstruction. Prostate Cancer Prostatic Dis 2024; 27:305-311. [PMID: 38553627 PMCID: PMC11096095 DOI: 10.1038/s41391-024-00820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Low-intensity shockwave therapy (Li-SWT) can improve bladder function through enhancement of angiogenesis and nerve regeneration and suppression of inflammation and overactivity. In this trial, we aimed to evaluate the efficacy of Li-SWT on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO). METHODS Between July 2020 and July 2022, 137 patients with persistent storage symptoms; urgency episodes/24 h ≥ 1 and daytime frequency ≥8, for at least three months after TUS for BPO were randomly allocated to Li-SWT versus sham versus solifenacin 10 mg/day in 3:1:1 ratio. The primary end point was the percent reduction from baseline in overactive bladder symptom score (OABSS) at 3-month follow-up. The changes in 3-day voiding diary parameters, quality of life (QoL) score, peak flow rate and residual urine at 3 and 6-month follow-up were compared. Treatment-related adverse effects were also evaluated. RESULTS Baseline data were comparable between groups. The percent reduction from baseline in OABSS at 3-month follow-up was significantly higher in Li-SWT compared to sham (-55% versus -11%), and it was comparable between Li-SWT and solifenacin-10 (-55% versus -60%). Li-SWT achieved significant improvement like solifenacin-10 in 3-day voiding diary parameters and QoL score at 3-month follow-up. This improvement remained comparable between Li-SWT and solifenacin-10 at 6-month follow-up. No adverse effects related to Li-SWT were noted apart from tolerable pain during the procedure. Solifenacin-10 was associated with bothersome adverse effects in 73% of the patients with 11.5% discontinuation rate. CONCLUSIONS Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with comparable efficacy and better tolerance compared to solifenacin.
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Affiliation(s)
- Mohammed Hegazy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Khaled Z Sheir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Ahmed M Elshal
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Hinojosa-Gonzalez DE, Talamas Mendoza A, Torres-Martinez M, Diaz-Garza K, Hernandez BS, Muñoz Hibert MI, Ramirez-Mulhern I, Morales Palomino KL, Gonzalez-Oyervides R. Indirect assessment of low-intensity shockwave therapy's energy density and pulse frequency for erectile dysfunction: a systematic review, bayesian network meta-analysis and meta-regression. Int J Impot Res 2024:10.1038/s41443-024-00910-w. [PMID: 38778153 DOI: 10.1038/s41443-024-00910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Shockwaves are thought to activate regenerative and angiogenic pathways, providing a possible therapeutic benefit for patients with erectile dysfunction. This study aimed to analyze the effectiveness of low-intensity extracorporeal shockwave therapy energy density and pulse frequency. In May 2022, a systematic search of online databases was performed to identify randomized clinical trials related to low-intensity extracorporeal shockwave therapy in erectile dysfunction. Eligible articles compared low-intensity extracorporeal shockwave therapy to controls or sham procedures. A Bayesian framework with 200,000 Markov chains was performed. We included a total of 1272 patients from 18 studies. The energy flux density measured in joules included 0.09 mJ/mm2 (mean difference 3.2 IIEF [95% CrI 2.8, 3.6]), 0.15 mJ/mm2 (mean difference 4.9 IIEF [95% CrI 2.8, 7.2]) and 0.20 mJ/mm2 (mean difference 1.2 IIEF [95% CrI 0.11, 2.3]). Of these, 0.15 mJ/mm2 had the greatest ranking (SUCRA = 0.983) compared with placebo. When analyzed by pulse frequency, significant increases were found in 500 pulses/session (mean difference 2.5 IIEF [CrI 1.9, 3.2]), 1500 pulses/session (mean difference 4.6 IIEF [95% CrI 3.9, 5.4]) and > 3000 pulses/session (mean difference 3.1 IIEF [95% CrI 2.1, 4.2]). Of these, 1500 pulses/session had the highest SUCRA, at 0.996. Our network meta-analysis suggests that low-intensity extracorporeal shockwave therapy is an effective intervention for erectile dysfunction, as measured by increases in the IIEF-EF. Sessions featuring 1500 pulses and an energy flux density of 0.15 mJ/mm2 appear to be the most effective.
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Affiliation(s)
- David E Hinojosa-Gonzalez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico.
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Alejandro Talamas Mendoza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | - Mauricio Torres-Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | - Karla Diaz-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | - Beatriz S Hernandez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | - Monica Isabel Muñoz Hibert
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | - Isabela Ramirez-Mulhern
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
| | | | - Roberto Gonzalez-Oyervides
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave Morones Prieto 3000, Monterrey, NL, 64000, Mexico
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Hayon S, Panken EJ, Bennett NE. Variations in Low Intensity Shockwave Treatment Protocols for Erectile Dysfunction: A Review of the Literature and Guide to Offering Treatment. World J Mens Health 2024; 42:283-289. [PMID: 37853533 PMCID: PMC10949028 DOI: 10.5534/wjmh.230105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/12/2023] [Accepted: 06/07/2023] [Indexed: 10/20/2023] Open
Abstract
Low-intensity shockwave therapy (LiSWT) for erectile dysfunction (ED) continues to gain popularity in both clinical practice and the academic literature. The majority of trials and meta-analysis studies have shown LiSWT to be low risk with a trend toward positive improvements in International Index of Erectile Function (IIEF) scores. However, there is still debate over the clinical utility of LiSWT and there is no agreed upon optimal treatment protocol. In this review article we summarize published meta-analysis studies of LiSWT for ED, and review the treatment protocols from randomized sham-control trials published in the last 10 years. We found the most common device settings were an energy of 0.09 mJ/mm² and a frequency of 5 Hz. Shock number and location varied, but the most common protocol was 1,500 shocks per session, with 900 shocks to the penis (shaft, base, or hilum) and 600 shocks to the proximal corpora/crura. Protocols ranged from 4 to 12 treatment sessions. We also describe our institutional experience with LiSWT, including patient counseling and treatment protocol.
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Affiliation(s)
- Solomon Hayon
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Evan J Panken
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Remondini T, Millman A, Jarvi K, Grober E, Krakowsky Y. Survey of the quality and origins of websites on penile low-intensity shockwave therapy in Canada. Can Urol Assoc J 2023; 17:E358-E363. [PMID: 37549347 PMCID: PMC10657231 DOI: 10.5489/cuaj.8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The aim of this study was to establish the quality of patient-facing websites advertising low-intensity shockwave therapy (LISWT) for erectile dysfunction (ED) and Peyronie's disease (PD) patients in Canada. METHODS Canadian websites offering LIWST for ED or PD were identified using online web searches. The characteristics of these websites were reviewed, along with examining the presence of HONCode certification, assigning a brief DISCERN score (a tool designed to evaluate health information online) and readability scores. We also examined the LIWST technology advertised, as well as benefits of LIWST cited by the websites. RESULTS Twenty-five unique websites linked to 46 clinics were identified and reviewed. Twenty-four percent of websites were run by a urologist. Other specialties offering LISWT included general practitioners, anesthesiologists, naturopaths, nurse practitioners, physiotherapists, and registered massage therapists. Twenty-four percent of the websites advertised the use of a focused shockwave generator. Forty percent of the websites had peer-reviewed references. The average brief DISCERN score was 14 (standard deviation 3.4). There was no association between the physician-or non-physician-led websites and the use of peer-reviewed references, readability scores, the number of clinic locations, or higher brief discern scores. CONCLUSIONS LISWT is readily advertised online for ED and PD patients in Canada; however, only a minority use a focused shockwave generator. There is a wide diversity of practitioners offering LISWT. Websites offering LISWT are generally of poor quality and do not provide adequate information for patients to make educated treatment decisions.
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Affiliation(s)
- Taylor Remondini
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexandra Millman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ethan Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yonah Krakowsky
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Bocchino AC, Pezzoli M, Martínez-Salamanca JI, Russo GI, Lo Giudice A, Cocci A. Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities. Investig Clin Urol 2023; 64:118-125. [PMID: 36882170 PMCID: PMC9995960 DOI: 10.4111/icu.20220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
To review the evidence of clinical efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) for the treatment of erectile dysfunction (ED). A search on PubMed using Medical Subject Headings terms [((low intensity extracorporeal shockwave therapy) OR (Li-ESWT)) AND (erectile dysfunction)] was conducted in August 2022, to obtain studies on the use of Li-ESWT for the treatment of ED. Its success rate in terms of International Index of Erectile Function-5 (IIEF-5) score and Erection Hardness Score (EHS) improvement was recorded and analysed. A total of 139 articles were reviewed. Overall, 52 studies were included in the final review. 17 studies were on vasculogenic ED, 5 on post pelvic surgery ED, 4 specifically on ED in diabetic patients, 24 on non-specified origin ED and 2 on mixed pathophysiological origin ED. The mean age of patients was 55.87±7.91 (standard deviation) years and the duration of ED was 4.36±2.08 years. The mean IIEF-5 score went from 12.04±2.67 at baseline to 16.12±5.72, 16.30±3.26 and 16.85±1.63 respectively at 3, 6 and 12 months. The mean EHS went from 2.00±0.46 at baseline to 2.58±0.60, 2.75±0.46 and 2.87±0.16 respectively at 3, 6 and 12 months. Li-ESWT may be a safe and efficacy option for the treatment and cure of ED. Further studies are needed to assess which patients are more suitable for this procedure and which Li-ESWT protocol can lead to the best outcomes.
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Affiliation(s)
| | - Marta Pezzoli
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | | | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Bryk DJ, Murthy PB, Ericson KJ, Shoskes DA. Radial wave therapy does not improve early recovery of erectile function after nerve-sparing radical prostatectomy: a prospective trial. Transl Androl Urol 2023; 12:209-216. [PMID: 36915873 PMCID: PMC10006002 DOI: 10.21037/tau-22-310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/20/2022] [Indexed: 02/09/2023] Open
Abstract
Background Low intensity shockwave therapy is an emerging treatment option for men with vasculogenic erectile dysfunction. Radial wave therapy (rWT), which differs from focused shockwave (fSWT) as it produces lower pressure waves with lower peak energy, is used to treat soft tissue and skin conditions and has some data to support its use in vasculogenic erectile dysfunction. There is limited data for the use of rWT for the treatment of erectile dysfunction after nerve-sparing (NS) radical prostatectomy. We report the first trial of rWT for penile rehabilitation after NS radical prostatectomy. Methods We performed a prospective, non-randomized, open-label trial. Men with good pre-operative erectile function who underwent a NS radical prostatectomy at our institution from 2018-2020 were considered for inclusion. We compared post-operative erectile function outcomes between the rWT (6 weekly treatments initiated approximately 2 weeks post-operatively) plus standard of care (phosphodiesterase type 5 inhibitor) arm and the non-sham controlled standard of care arm. The primary end point for our study was the proportion of men who returned to "near normal" erectile function, defined as IIEF-5 score ≥17 and erectile hardness score (EHS) ≥3, by 3 months post-operatively between the intervention and control arm. We also compared mean IIEF-5 scores and median EHSs between the arms. Results One hundred and six patients were enrolled, of whom 73 patients had at least one reported survey response between 6 and 12 weeks post-operatively. Five (17%) and 11 (26%) patients recovered erectile function in the control and intervention arms, respectively, which was not a statistically significant difference (P=0.37). However, the intervention arm did have a significantly higher median EHS compared to the control arm (1 vs. 2, P=0.03). There were 4 adverse events related to pain during treatment and required only treatment intensity de-escalation. Conclusions rWT is safe but did not substantially improve the recovery of early erectile function after NS radical prostatectomy.
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Affiliation(s)
- Darren J Bryk
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Prithvi B Murthy
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Kyle J Ericson
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Department of Urology, Cleveland, OH, USA
| | - Daniel A Shoskes
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Senior Medical Director, Pacific Edge, Hummelstown, PA, USA
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Dietrich PN, Doolittle J, Brink S, Hanna D, Fitzgerald J, Dadhich P, Sandlow JI, Kansal J, Bajic P. An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where. Urology 2023; 174:135-140. [PMID: 36736913 DOI: 10.1016/j.urology.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize direct-to-consumer (DTC) men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction (ED) and hypogonadism from DTC "men's health" clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications. METHODS We identified DTC Men's Health Clinics in the United States by internet search by state using the terms, "Men's Health Clinic," and "Low T Center." All stand-alone clinics were reviewed. RESULTS Two hundred and twenty-three clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement, and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised shockwave therapy and 84 (57.1%) PRP therapy. There were 56 (38%) who offered shockwave therapy and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p <.001). Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A nonphysician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics. CONCLUSION There is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of "men's health" clinics will help provide informed patient care and counseling.
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Affiliation(s)
- Peter N Dietrich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Sarah Brink
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Hanna
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - John Fitzgerald
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Pranav Dadhich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jagan Kansal
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Petar Bajic
- Center for Men's Health, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Mazzilli F. Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update. J Clin Med 2022; 11:6429. [PMID: 36362656 PMCID: PMC9657711 DOI: 10.3390/jcm11216429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 08/13/2023] Open
Abstract
Erectile Dysfunction (ED) is defined as "recurrent and persistent inability, partial or complete, to achieve or maintain an erection firm enough for satisfactory sexual intercourse in the presence of proper erotic stimuli"; the concept of ED replaced the previous definition of "impotence" [...].
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Affiliation(s)
- Fernando Mazzilli
- Andrology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1038, 00189 Rome, Italy; or
- AIED Center for Reproductive Medicine, Via Toscana 30, 00187 Rome, Italy
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11
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Reddy RV, Golan R, Loloi J, Diaz P, Saltzman RG, Watane A, Ramasamy R. Assessing the quality and readability of online content on shock wave therapy for erectile dysfunction. Andrologia 2022; 54:e14607. [PMID: 36240784 DOI: 10.1111/and.14607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022] Open
Abstract
Patients are becoming increasingly reliant on online platforms for obtaining health information. Previous research has shown that the quality of information available on the internet regarding novel medical therapies is generally poor and frequently misleading. Shock wave therapy represents a novel restorative therapy for erectile dysfunction (ED) that has recently gained attention. We hypothesised that online sources regarding shock wave therapy for ED would be fraught with misleading claims and unreliable health information. Our objective was to evaluate the quality and readability of online medical information on shock wave therapy as a treatment for ED. Websites were generated using a Google search of 'shock wave therapy for erectile dysfunction' with location filters disabled. Readability was analysed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. Articles were subdivided into those from private clinic websites and those from universities or news media websites. Statistical analysis was conducted using the Student's t test. Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch Reading Ease score was 46.4. The articles had a mean DISCERN score of 3.1, suggesting 'moderate quality' content. Articles from universities (n = 2) or news sources (n = 3) had significantly higher DISCERN scores than articles from private medical practices (n = 4). There was no difference in readability scores between the groups. Articles from private clinics are just as readable as those from universities or news media, but they are significantly more biased and misleading. The current online material relating to shock wave therapy for ED may not adequately inform patients in their medical decisions making, thereby necessitating closer collaboration between the sources disseminating information and urologists.
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Affiliation(s)
- Raghuram V Reddy
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roei Golan
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Parris Diaz
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Russell G Saltzman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Arjun Watane
- Department of Ophthalmology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Subasinghe SAAS, Pautler RG, Samee MAH, Yustein JT, Allen MJ. Dual-Mode Tumor Imaging Using Probes That Are Responsive to Hypoxia-Induced Pathological Conditions. BIOSENSORS 2022; 12:bios12070478. [PMID: 35884281 PMCID: PMC9313010 DOI: 10.3390/bios12070478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 05/02/2023]
Abstract
Hypoxia in solid tumors is associated with poor prognosis, increased aggressiveness, and strong resistance to therapeutics, making accurate monitoring of hypoxia important. Several imaging modalities have been used to study hypoxia, but each modality has inherent limitations. The use of a second modality can compensate for the limitations and validate the results of any single imaging modality. In this review, we describe dual-mode imaging systems for the detection of hypoxia that have been reported since the start of the 21st century. First, we provide a brief overview of the hallmarks of hypoxia used for imaging and the imaging modalities used to detect hypoxia, including optical imaging, ultrasound imaging, photoacoustic imaging, single-photon emission tomography, X-ray computed tomography, positron emission tomography, Cerenkov radiation energy transfer imaging, magnetic resonance imaging, electron paramagnetic resonance imaging, magnetic particle imaging, and surface-enhanced Raman spectroscopy, and mass spectrometric imaging. These overviews are followed by examples of hypoxia-relevant imaging using a mixture of probes for complementary single-mode imaging techniques. Then, we describe dual-mode molecular switches that are responsive in multiple imaging modalities to at least one hypoxia-induced pathological change. Finally, we offer future perspectives toward dual-mode imaging of hypoxia and hypoxia-induced pathophysiological changes in tumor microenvironments.
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Affiliation(s)
| | - Robia G. Pautler
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.G.P.); (M.A.H.S.)
| | - Md. Abul Hassan Samee
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.G.P.); (M.A.H.S.)
| | - Jason T. Yustein
- Integrative Molecular and Biomedical Sciences and the Department of Pediatrics in the Texas Children’s Cancer and Hematology Centers and The Faris D. Virani Ewing Sarcoma Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Matthew J. Allen
- Department of Chemistry, Wayne State University, 5101 Cass Avenue, Detroit, MI 48202, USA;
- Correspondence:
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Sandoval-Salinas C, Saffon JP, Martínez JM, Corredor HA, Gallego A. Are Radial Pressure Waves Effective for the Treatment of Moderate or Mild to Moderate Erectile Dysfunction? A Randomized Sham Therapy Controlled Clinical Trial. J Sex Med 2022; 19:738-744. [PMID: 35341724 DOI: 10.1016/j.jsxm.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radial wave therapy is commercialized as an option for the management of erectile dysfunction. However, the mechanism of action of the radial waves differs substantially from shock waves, so the evidence gathered for shock wave therapy cannot be extrapolated, and there are very few clinical trials with the radial wave. AIM To assess the efficacy and safety of radial wave therapy compared with sham therapy for the treatment of moderate and mild to moderate erectile dysfunction. METHODS A randomized, double-blind, sham-controlled clinical trial was realized. Eighty patients with moderate erectile dysfunction, without sickle cell anemia, anticoagulation treatment, comorbidities, or conditions associated with secondary erectile dysfunction were included. The efficacy and safety were assessed at 6 and 10 weeks after randomization. Patients were randomized 1:1 to 1 of 2 arms: (i) 6 weekly sessions of radial wave therapy (RW group) or (ii) 6 weekly sessions of sham therapy (control group). All patients received sildenafil 25 mg. OUTCOME The primary outcome was the mean change in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score at 6 weeks after randomization. RESULTS Eighty men were randomized. The average baseline IIEF-EF score was 16.3 (Standard Deviation - SD 3.2), and the median baseline Erection Hardness Score (EHS) was 3 (IQR 1). At 6 weeks after randomization, the mean change in the IIEF-EF score was 3.4 (95% confidence interval [CI] 1.5-5.2) in the RW group and 4.2 (95% CI 2.5-5.9) in the control group. No differences were observed between groups (P value =.742). No change was observed in the median EHS score in the evaluations. No serious adverse events occurred in 2 (5%) patients after radial wave therapy, and in 1 (2.5%) patient after sham therapy. CLINICAL IMPLICATIONS Knowledge of the effectiveness of radial waves protocols used for the treatment of moderate erectile dysfunction, helps doctors and patients in making decisions about the use of this therapy. STRENGTHS & LIMITATIONS One strength is conducting the study with high methodological standards to minimize risk biases. Our results are limited to the evaluation of 1 specific protocol in moderate and mild to moderate erectile dysfunction. CONCLUSIONS No difference was found in this study between men with moderate and mild to moderate erectile dysfunction treated with radial waves and men treated with placebo sham therapy. Studies with different protocols of radial waves are necessary. Sandoval-Salinas C, Saffon JP, Martínez JM, et al. Are Radial Pressure Waves Effective for the Treatment of Moderate or Mild to Moderate Erectile Dysfunction? A Randomized Sham Therapy Controlled Clinical Trial. J Sex Med 2022;19:738-744.
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Affiliation(s)
| | - José P Saffon
- Elexial research center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
| | - Juan M Martínez
- Elexial research center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
| | - Hector A Corredor
- Elexial research center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
| | - Andrés Gallego
- Elexial research center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
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Oginski N, Apel H, Richterstetter M, Lieb V, Fiebig C, Goebell PJ, Wullich B, Sikic D. Analysis of the Impact of Clinical Factors on Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction. Urol Int 2022; 106:1041-1049. [PMID: 35144264 DOI: 10.1159/000520705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Predictive factors for the treatment success of low-intensity extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) are still under debate. METHODS Li-ESWT was performed in 50 patients suffering from ED by applying 3,000 shock waves once a week over a period of 6 weeks. Treatment success was defined as an increase in the International Index of Erectile Function 5 (IIEF-5) score by ≥5 points or an Erectile Hardness Score (EHS) of ≥3 points. IIEF-5 and EHS were measured at baseline and at 3 and 6 months of follow-up. RESULTS Treatment success according to either the IIEF-5 score or EHS at any time of follow-up was achieved in 28 patients (56%). Twenty-five patients (50%) experienced an improvement during the first 3 months, which lasted for 6 months in 8 cases (16%). Three patients reported improved erectile function only after 6 months. When stratifying the cohort with regard to potential influencing factors, a significantly improved IIEF-5 score could be achieved in men with cardiovascular risk factors (p = 0.026) and in men with antihypertensive medication (p = 0.009). Men without cardiovascular risk factors showed no therapeutic benefit from Li-ESWT. DISCUSSION/CONCLUSION Li-ESWT is a valid but often short-lived treatment option for ED, especially in men with cardiovascular risk factors or controlled hypertension. Future studies should assess the feasibility and safety of repeated applications of Li-ESWT.
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Affiliation(s)
- Natalie Oginski
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mario Richterstetter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter J Goebell
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Campbell JD, Matti D, Abed H, Di Pierdominico A. Technological Advancements for Treating Erectile Dysfunction and Peyronie's Disease. Urol Clin North Am 2021; 49:175-184. [PMID: 34776050 DOI: 10.1016/j.ucl.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, there have been several advancements in the technologies available to treatment erectile dysfunction and Peyronie's disease. Vacuum erection devices, penile traction devices, low-intensity extracorporeal shockwave therapy, and penile prosthesis surgery have evolved and are changing the way we treat men's health. Although significant improvements have been made, further work is needed to standardize treatment, create universal algorithms for technological applications, and simply their use.
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Affiliation(s)
- Jeffrey D Campbell
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
| | - Danny Matti
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Haider Abed
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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Pai R, Ory J, Delgado C, Ramasamy R. Energy-Based Therapies for Erectile Dysfunction: Current and Future Directions. Urol Clin North Am 2021; 48:603-610. [PMID: 34602179 DOI: 10.1016/j.ucl.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Energy-based therapies are novel treatments for erectile dysfunction that are thought to work by stimulation of tissue vasodilation, neoangiogenesis, and so forth. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is the energy-based therapy with the most robust evidence basis demonstrating efficacy and safety. Among this evidence, randomized controlled trials (RCTs) evaluating Li-ESWT have largely been focused on responders to phosphodiesterase-5 inhibitors. Many of these RCTs have limitations including short follow-up durations, inconsistent protocols, and small sample sizes. Until more diverse patient populations are studied and these limitations are addressed, the use of Li-ESWT should remain limited to IRB-approved clinical research trials.
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Affiliation(s)
- Raghav Pai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Carlos Delgado
- Technologico de Monterrey, School of Medicine and Health Science, Avenue Morones Prieto 3000, Monterrey, Nuevo León 64710, Mexico
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Sandoval-Salinas C, Saffon JP, Corredor HA, Fonseca L, Manrique L, Solis G. Are Radial Pressure Waves Effective in Treating Erectile Dysfunction? A Systematic Review of Preclinical and Clinical Studies. Sex Med 2021; 9:100393. [PMID: 34274822 PMCID: PMC8360928 DOI: 10.1016/j.esxm.2021.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 12/09/2022] Open
Abstract
Introduction Radial waves are used to treat erectile dysfunction; however, they are different than focal waves, and their mechanism of action or effect on improving this condition is not known. Aim To evaluate the effect of radial waves at the cellular level and their effectiveness at the clinical level for the treatment of erectile dysfunction. Methods Systematic literature review. Electronic database searches and manual searches were performed to identify (i) clinical trials or cohort studies evaluating the effectiveness of radial waves in men with erectile dysfunction and (ii) preclinical trials in animal models or cell cultures in which the production of nitric oxide or endothelial growth factor was evaluated. Study quality was assessed, and data were extracted from each study. A narrative synthesis of the results was performed given the high heterogeneity between the selected studies. Main outcomes measures Nitric oxide production, endothelial growth factor expression, and changes in the Erection Hardness Score (EHS) and the International Index of Erectile Function (IIEF) Questionnaire score. Results Four studies in animal models and 1 randomized clinical trial in men with erectile dysfunction and kidney transplantation were identified that met the selection criteria. Preclinical studies in animals suggest that radial waves increase cellular apoptosis in penile tissue, while vascular endothelial growth factor expression increases in brain tissue. In men with erectile dysfunction, no differences were found between radial wave therapy and placebo therapy in the mean IIEF score (15.6 ± 6.1 vs 16.6 ± 5.4 at 1 month after treatment), EHS (2.5 ± 0.85 vs 2.4 ± 0.7 at 1 month after treatment), or penile Doppler parameters. Conclusions No quality evidence was found to support the use of radial waves in humans for the treatment of erectile dysfunction. In animal models and at the cellular level, the results are contradictory. More research is needed. Sandoval-Salinas C, Saffon JP, Corredor HA, et al. Are Radial Pressure Waves Effective in Treating Erectile Dysfunction? A Systematic Review of Preclinical and Clinical Studies. Sex Med 2021;9:100393.
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Affiliation(s)
| | - José P Saffon
- Elexial Research Center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
| | - Hector A Corredor
- Elexial Research Center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
| | | | - Laura Manrique
- Elexial Research Center, Bogotá, Colombia; Boston Medical Group, Bogotá, Colombia
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Fansa A, Talsania AJ, Kennedy JG, O'Malley MJ. Efficacy of Unfocused Medium-Intensity Extracorporeal Shock Wave Therapy (MI-ESWT) for Plantar Fasciitis. J Foot Ankle Surg 2021; 60:471-476. [PMID: 33551229 DOI: 10.1053/j.jfas.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/30/2020] [Indexed: 02/03/2023]
Abstract
Extracorporeal shock wave therapy (ESWT) is a promising treatment for plantar fasciitis (PF), however, treatment results have varied due to inconsistencies among types of shock wave treatment and devices used. This retrospective chart review includes patients who underwent ESWT using the OrthoGold 100™ shock wave device (MTS, Konstanz, Germany) for PF between January, 2013 and September, 2018. There were 108 patients (119 heels) identified, with a mean age of 51.7 ± 16.5 (Range 21-83) years. Patients were treated weekly for 3 weeks, with 2000 impulses per session at an energy flux density between 0.10 and 0.17 mJ/mm2. Mean follow-up duration was 11.5 ± 9.7 (Range 3-51) months. Mean pre-ESWT pain visual assessment scale improved from 6.7 ± 1.7 to 2.6 ± 2.7 (p < .001). The Foot and Ankle Outcome Score subscales: pain, function of daily living, function of sports and recreational activities and quality of life domains improved from 53.7 ± 14.9 to 75.7 ± 16.7 (p < .001), from 38 ± 15.2 to 71.8 ± 23 (p < .001), from 55.8 ± 16.4 to 71.4 ± 18 (p < .001), from 42.4 ± 21.5 to 59.4 ± 20.3 (p < .001) and from 44.9 ± 16.4 to 69 ± 23.9 (p < .001), respectively. Eighty-eight (81.5%) patients were satisfied with the procedure at final follow-up. Treatment of PF with unfocused shock waves was well tolerated and led to significant pain reduction, functional improvement, and patient satisfaction.
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Affiliation(s)
| | - Alec J Talsania
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - John G Kennedy
- Professor and Chief, Foot and Ankle Department, NYU Langone, New York, NY
| | - Martin J O'Malley
- Hospital for Special Surgery, New York, NY; Associate Professor of Orthopedics, Weill Medical College of Cornell University, New York, NY.
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de Oliveira PS, Ziegelmann MJ. Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes. Transl Androl Urol 2021; 10:2617-2628. [PMID: 34295748 PMCID: PMC8261418 DOI: 10.21037/tau-20-1286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022] Open
Abstract
Erectile dysfunction (ED) impacts a significant portion of the aging male population. Standard treatments such as oral medications, intracavernosal injections, intraurethral suppositories, vacuum erection aids, and penile prosthesis placement have stood the test of time. Recently, there has been a growing interest in the concept of regenerative medicine with the goal of restoring or renewing functional tissue. Low intensity shock wave therapy (LiSWT) is one example of a regenerative therapy. A strong body of basic science data suggests that shockwaves, when applied to local tissue, will encourage blood vessel and nerve regeneration. Clinical evidence supports the use of LiSWT to treat conditions ranging from ischemic heart disease, musculoskeletal injuries, and even chronic non-healing wounds. LiSWT is also being used to treat male sexual dysfunction conditions such as Peyronie's Disease and ED. The first studied application of LiSWT for ED was published in 2010. Since then multiple randomized, sham-controlled trials have sought to evaluate outcomes for this novel therapy in men with vasculogenic ED. Additionally, several meta-analyses are available with pooled data suggesting that LiSWT results in a significantly greater improvement in erectile function relative to sham-control. Despite these promising findings, the current body of literature is marred by significant heterogeneity relating to treatment protocols, patient populations, and follow-up duration. Further work is necessary to determine optimal device technologies, patient characteristics, and treatment duration prior to considering LiSWT as standard of care for men with ED.
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Affiliation(s)
- Pedro Simoes de Oliveira
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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20
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Evaluation of immediate and short-term efficacy of DualStim therapy with and without intracavernosal umbilical cord-derived Wharton's jelly in patients with erectile dysfunction: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2021; 23:100790. [PMID: 34278040 PMCID: PMC8267434 DOI: 10.1016/j.conctc.2021.100790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/21/2021] [Accepted: 05/16/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Erectile dysfunction (ED) affects a significant portion of the United States population and causes negative psychological burdens that affects men and their partner's quality of life and satisfaction. Extracorporeal shock therapy (ESWT) utilizing focused ESWT and radial ESWT in Low-intensity shock wave therapy has been used to treat ED with some success. Wharton's Jelly (WJ) is a biologic substance with large amounts of stem cells, growth factors, cytokines and extracellular components. The use of combined focused and radial ESWT (DualStim therapy) with injected WJ have potential uses in ED that may have advantages over current treatments. Materials A randomized, single-blinded, controlled clinical trial will be conducted to evaluate the efficacy and safety of DualStim therapy and intracavernosal injection of WJ in moderate to severe ED. A total of 60 patients with moderate to severe ED will be enrolled and treated with DualStim therapy with intracavernosal injection of WJ or saline for a period of 7 weeks. The International Index of Erectile Function – Erectile Function score will be used to gauge the treatment related changes in relation to the subject's baseline. The scores will be recorded at baseline and compared to follow-ups 1,3 and 6 months post-treatment. Any adverse events or severe adverse events will be recorded in the corresponding case report forms. Sexual Encounter Profile, as well as the Global Assessment Questionnaire and the Erection Hardness Score will be used to determine the sexual activity improvement from baseline leading to optimal penetration at follow-ups 1,3 and 6 months post-treatment. Discussion This clinical trial is one of the first studies to determine the immediate and short-term efficacy of DualStim therapy, with and without intracavernosal injection of formulated umbilical cord-derived WJ to improve and/or restore erectile function in patients with moderate to severe ED. This study will also provide insight into the safety and efficacy of WJ. We anticipate clinically significant improvement in patients suffering from moderate and severe ED treated with DualStim therapy with WJ compared to their baseline and DualStim with saline.
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Restorative Therapies for Erectile Dysfunction: Position Statement From the Sexual Medicine Society of North America (SMSNA). Sex Med 2021; 9:100343. [PMID: 34000480 PMCID: PMC8240368 DOI: 10.1016/j.esxm.2021.100343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Current non-invasive treatments for erectile dysfunction (ED) include oral medications, intracavernosal injections, and vacuum-assisted devices. Though these therapies work well for many, a subset of patients have contraindications or are unsatisfied with these options. Restorative therapies for ED are a new frontier of treatments focused on regenerating diseased tissue and providing a potential "cure" for ED. AIM The aim of this position statement is to examine existing clinical trial data for restorative therapies and identify elements that require further research before widespread adoption. METHODS A literature review was performed to identify all clinical trials performed with regenerative therapy for ED. This includes treatments such as stem cell therapy (SCT), platelet rich plasma (PRP), and restorative related technologies like low-intensity shockwave therapy (LiSWT). MAIN OUTCOME MEASURES Most clinical trials in restorative therapies were assessed for safety, feasibility, or efficacy. This included recording adverse events, changes in sexual function and erectile function questionnaires, and diagnostics measures. RESULTS To date there is an absence of robust clinical data supporting the efficacy of restorative therapies regarding ED, though technologies such as LiSWT have established relative safety. CONCLUSIONS Restorative therapies are a promising technology that represents a new frontier of treatment geared towards reversing disease pathology rather than just treating symptoms. However, current published clinical studies are limited. Future work needs to be adequately powered, multi-center, randomized, sham/placebo-controlled trials in well-characterized patient populations to ensure safety and demonstrate efficacy. Until these studies are done, restorative therapies should be reserved for clinical trials and not offered in routine clinical practice. Liu JL, Chu KY, Gabrielson AT, et al. Restorative Therapies for Erectile Dysfunction: Position Statement From the Sexual Medicine Society of North America (SMSNA). J Sex Med 2021;9:100343.
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Sokolakis I, Pyrgidis N, Neisius A, Gierth M, Knoll T, Rassweiler J, Hatzichristodoulou G. The Effect of Low-intensity Shockwave Therapy on Non-neurogenic Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Preclinical and Clinical Studies. Eur Urol Focus 2021; 8:840-850. [PMID: 33985934 DOI: 10.1016/j.euf.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 01/22/2023]
Abstract
CONTEXT Low-intensity shockwave therapy (LiST) has emerged as an effective treatment for pain in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and it has been postulated that LiST may also be effective in patients with lower urinary tract symptoms (LUTS). OBJECTIVE To perform a systematic review and meta-analysis of experimental and clinical studies exploring the effect of LiST on LUTS in an attempt to provide clinical implications for future research. EVIDENCE ACQUISITION We systematically searched PubMed, Cochrane Library, and Scopus databases from inception to March 2021 for relevant studies. We provided a qualitative synthesis regarding the role of LiST in LUTS and performed a single-arm, random-effect meta-analysis to assess the absolute effect of LiST on LUTS only in patients with CP/CPPS (PROSPERO: CRD42021238281). EVIDENCE SYNTHESIS We included 23 studies (11 experimental studies, seven nonrandomized controlled trials [non-RCTs], and five RCTs) in the systematic review and seven in the meta-analysis. All experimental studies were performed on rats with LUTS, and the clinical studies recruited a total of 539 participants. In patients with CP/CPPS, the absolute effect of LiST on maximum flow rate and postvoid residual was clinically insignificant. However, the available studies suggest that LiST is effective for the management of pain in patients with either CP/CPPS or interstitial cystitis/bladder pain syndrome. Additionally, LiST after intravesical instillation of botulinum neurotoxin type A may enhance its absorption and substitute botulinum neurotoxin type A injections in patients with overactive bladder. Furthermore, the available evidence is inconclusive about the role of LiST in patients with benign prostatic obstruction, stress urinary incontinence, or underactive bladder/detrusor hypoactivity. CONCLUSIONS LiST may be effective for some disorders causing LUTS. Still, further studies on the matter are necessary, since the available evidence is scarce. PATIENT SUMMARY Low-intensity shockwave therapy represents a safe, easily applied, indolent, and repeatable on an outpatient basis treatment modality that may improve lower urinary tract symptoms.
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Affiliation(s)
- Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Andreas Neisius
- Department of Urology, Barmherzige Brüder Hospital Trier, Trier, Germany
| | - Michael Gierth
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Knoll
- Department of Urology, Klinikverbund Südwest, Sindelfingen Hospital, Sindelfingen, Germany
| | - Jens Rassweiler
- Department of Urology, SLK Hospital Heilbronn, Heilbronn, Germany
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Prognostic Indicators for Successful Low-intensity Extracorporeal Shock Wave Therapy Treatment of Erectile Dysfunction. Urology 2021; 149:133-139. [DOI: 10.1016/j.urology.2020.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/05/2020] [Accepted: 12/13/2020] [Indexed: 12/18/2022]
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Drury R, Natale C, Hellstrom WJG. Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction. Ther Adv Urol 2021; 13:17562872211002059. [PMID: 33796149 PMCID: PMC7968013 DOI: 10.1177/17562872211002059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is both a common and complex disease process. Existing ED treatments do not always achieve adequate results. There is clinical interest in employing regenerative therapies, including low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet rich plasma (PRP), and stem cell therapy (SCT), in the treatment of ED as adjunct or alternative treatments. Here, we present evidence for emerging shockwave- and cell-based regenerative therapies for the treatment of ED following a thorough review of the existing PubMed literature pertaining to Li-ESWT, PRP, and SCT in relation to the treatment of ED. Li-ESWT causes microtrauma in tissue that hypothetically upregulates angiogenesis and recruits stem cells. Several large-scale systematic reviews and meta-analyses have reported that Li-ESWT improved ED in humans. Additionally, evidence has commenced to show that Li-ESWT may be effective against two recognized and complex etiologies of ED: diabetic and neurogenic. PRP delivers an autologous sample rich in growth factors to damaged tissue. Animal model studies have demonstrated improved erectile function recovery as well as preservation of cavernous nerve axons. Studies with PRP in humans are limited. SCT utilizes the regenerative potential of stem cells for healing of damaged tissue. In the treatment of ED, SCT has been used in the setting of diabetic and post-prostatectomy ED. Results of human studies are varied, although SCT treatments did result in increased erectile rigidity with some patients recovering the ability to achieve penetration. While these regenerative therapies show potential to augment the current treatment regimen for ED, there is a paucity of evidence to support the safety and efficacy of these treatments. Further research is necessary to define the role of these alternative therapies in the treatment of ED.
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Affiliation(s)
- Robert Drury
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Caleb Natale
- Tulane University School of Medicine, New Orleans, LA, USA
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Wu SS, Ericson KJ, Shoskes DA. Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction. Transl Androl Urol 2020; 9:2122-2128. [PMID: 33209675 PMCID: PMC7658170 DOI: 10.21037/tau-20-911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Low-intensity shockwave therapy (SWT) is an emerging treatment for erectile dysfunction (ED). Devices used for SWT include focused shockwave therapy (fSWT) or radial wave therapy (rWT), which differ in how the waves are generated, their tissue penetration, and the shape of their pressure waves. Most studies of SWT for ED to date have utilized fSWT. Although widely used, the efficacy of rWT for ED is unknown. Our objective is to compare the efficacy of rWT and fSWT for ED at our institution. Methods A retrospective chart review was performed to identify all men with ED treated by fSWT or rWT. Men with history suggesting non-vasculogenic ED were excluded. All men received 6 consecutive weekly treatments. The fSWT group received 3,000 shocks per treatment at 0.09 mJ/mm2. The rWT group received 10,000 shocks per treatment at 90 mJ and 15 Hz. Pre-treatment and 6-week post-treatment Sexual Health Inventory in Men (SHIM) scores were measured. Treatment response was categorized on a scale of 1–3 (1 if no improvement, 2 if erections sufficient for intercourse with phosphodiesterase 5 inhibitors (PDE5i), or 3 if sufficient erections without PDE5i). Primary endpoint was self-reported improvement score of 2 or greater. Results A total of 48 men were included: 24 treated by fSWT and 24 by rWT. There were no significant differences in age, duration of ED, pre-treatment PDE5i use, or pre-treatment SHIM scores between the groups. Following treatment with rWT, the mean SHIM score improved from 9.3 to 16.1 (P<0.001). The mean SHIM following fSWT improved from 9.3 to 15.5 (P<0.001). The mean improvement in SHIM score did not differ between rWT (6.8) and fSWT (6.2) (P=0.42). 54% of men treated by fSWT experienced a significant clinical improvement (≥ grade 2 response) compared to 75% in the rWT group (P=0.42). There were no reported side effects with either device. Conclusions In our patient population, both fSWT and rWT were moderately effective treatments for arteriogenic ED with no observable difference in efficacy between the two modalities.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Kyle J Ericson
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Daniel A Shoskes
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, USA
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