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

Abstract

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.Methods: A total of 5 and 11 patients underwent early and delayed intervention with LIESWT, respectively. SF was assessed with the Expanded Prostate Cancer Index Composite (EPIC). The same surgeon performed RALP on 178 patients, and these patients were assigned to the non-LIESWT group to establish a control group. The SF score of EPIC was investigated longitudinally before RALP and 3, 6, 9, and 12 months after RALP.Results: Our results show that penile rehabilitation with LIESWT immediately before urethral catheter removal improved SF scores. In the baseline, the SF score was significantly higher in the early LIESWT group (P=0.0001). The SF score was significantly lower at postoperative 6 months (early 19.2, delayed 17.9, and non-LIESWT 8.1; P=0.0171), 9 months (20.9, 25.8, and 10.2; P=0.0188), and 12 months (28.0, 21.3, and 9.5; P=0.0051) in the non-LIESWT group. We regret that there was no significant difference in the recovery of SF between the early and delayed protocol with LIESWT at all points. In keeping with our results, LIESWT demonstrated the potential to be efficacious in treatment options for severe postradical prostatectomy (RP) erectile dysfunction (ED) as it may indirectly support its promotion of nerve regeneration in severe ED due to RP.Conclusions: This is the first study in which LIESWT has been shown to deliver a clinical benefit on its early or delayed intervention to patients after RALP to penile rehabilitation in terms of restoring SF. Our preliminary results suggest that LIESWT could be used as a treatment option in penile rehabilitation.

Efficacy of Low-Intensity Extracorporeal Shock Wave Treatment in Erectile Dysfunction Following Radical Prostatectomy: A Systematic Review and Meta-Analysis

“…In all non-RCT studies, there were no major problems, except for the selection of the control and non-response rates. However, in the study by Inoue et al [ 21 ], the size difference between the control and experimental groups was too large.…”

“…Three studies were RCTs [ 19 , 23 , 24 ], whereas the others [ 21 , 22 ] were retrospective case-control studies.…”

“…The results of the quality assessment using the Newcastle–Ottawa scale for non-RCT studies are shown in Table 2 [ 21 , 22 ]. Two studies received six [ 21 ] and seven [ 22 ] points, respectively, indicating a high quality.…”

“…The results of the quality assessment using the Newcastle–Ottawa scale for non-RCT studies are shown in Table 2 [ 21 , 22 ]. Two studies received six [ 21 ] and seven [ 22 ] points, respectively, indicating a high quality. In all non-RCT studies, there were no major problems, except for the selection of the control and non-response rates.…”

“…The use of LI-ESWT in overall ED patients has also been reported in recent meta-analyses, with good results [ 17 , 18 ]. However, there are few LI-ESWT studies in patients with ED following RP, and the number of patients included is small [ 19 , 20 , 21 , 22 , 23 , 24 ]. Therefore, an integrated analysis of these studies is necessary.…”