English Polski
Vol 16, No 1 (2018)
Review paper
Published online: 2018-08-08

open access

Page views 1848
Article views/downloads 5781
Get Citation

Connect on Social Media

Connect on Social Media

Fala uderzeniowa o niskiej energii w leczeniu zaburzeń erekcji

Dariusz Kałka, Jana Gebala, Ryszard Smoliński, Maciej Womperski, Lesław Rusiecki, Romuald Zdrojowy
DOI: 10.5603/20-35
Seksuologia Polska 2018;16(1).

Abstract

Fala uderzeniowa o niskiej energii i częstotliwości (LESWT) jest nową, innowacyjną opcją terapeutyczną leczenia zaburzeń erekcji (ED). Aktualnie została zaliczona do metod pierwszego rzutu w leczeniu ED. Mechanizm działania LESWT nie jest dokładnie poznany, jednak wiadomo, że sprzyja on neowaskularyzacji, zwiększeniu proliferacji i różnicowania komórek śródbłonka, zwiększeniu liczby komórek mięśni gładkich oraz promocji wytwarzania tlenku azotu. Skuteczność LESWT wykazano przede wszystkim wśród pacjentów z naczyniopochodnymi zaburzeniami erekcji. W wyniku zastosowania tej terapii dochodzi do istotnej poprawy w zakresie domeny funkcji erekcyjnej, funkcji śródbłonka naczyniowego i wzrostu średniej punktacji skali twardości erekcji. Skuteczność LESWT potwierdzono u pacjentów należących do różnych grup w tym u chorych z najbardziej zaawansowanymi naczyniopochodnymi zaburzeniami erekcji nie reagującymi na leczenie PDE5i. W badaniach z udziałem ludzi nie odnotowano skutków ubocznych zarówno podczas leczenia jak i po terapii, a pacjenci deklarowali wysoki poziom zadowolenia z leczenia. Skuteczność poprawy funkcji erekcyjnej utrzymywała się długoterminowo. Mniej oczywiste są efekty uzyskane przy zastosowaniu tej metody w grupach chorych z ED w przebiegu choroby Pyeroniego, po zabiegu radykalnej prostatektomii metodą oszczędzającą pęczki naczyniowo-nerwowe i u chorych z przewlekłym bólem miednicy. Zalety terapii LESWT wiążą się z usuwaniem przyczyny naczyniopochodnych ED, co skutkuje długotrwałą poprawą sprawności seksualnej i pozwala przywrócić chorym spontaniczność prowadzenia życia seksualnego. Dotychczas uzyskane dowody wskazujące na skuteczność, bezpieczeństwo, komfort pacjenta i prostotą przeprowadzenia terapii LESWT skłaniają do szerszego stosowania tej innowacyjnej metody w celu poprawy funkcji erekcyjnej.

Article available in PDF format

View PDF (Polish) Download PDF file

References

  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA . 1993; 270: 83–90.
  2. Sáenz de Tejada I, Anglin G, Knight JR, et al. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care. 2002; 25(12): 2159–2164.
  3. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Urology. 2010; 57(5): 804–814.
  4. Wespes E, Eardley I, Giuliano F i wsp. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. 2013. http://uroweb.org/wp-content/uploads/14_Male-Sexual-Dysfunction_LR.pdf (18.03.2016).
  5. Capaccio P, Torretta S, Pignataro L. Extracorporeal lithotripsy techniques for salivary stones. Otolaryngol Clin North Am. 2009; 42(6): 1139–59, Table of Contents.
  6. Kelley JM. Extracorporeal shock wave lithotripsy of urinary calculi. Theory, efficacy, and adverse effects. West J Med. 1990; 153: 65–69.
  7. Sauerbruch T. Treatment of biliary stones using extracorporeal shock waves (ESWL). Hepatogastroenterology. 1989; 36(5): 309–312.
  8. Palmieri A, Imbimbo C, Longo N, et al. A First Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial Evaluating Extracorporeal Shock Wave Therapy for the Treatment of Peyronie's Disease. European Urology. 2009; 56(2): 363–370.
  9. Saggini R, Di SA, Saggini A, et al. Clinical application of shock wave therapy in mulculoskeletal disorders: part I. J Biol Regul Homeost Agents. 2015; 29: 533–545.
  10. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. : 771–785.
  11. Tara S, Miyamoto M, Takagi G, et al. Low-energy extracorporeal shock wave therapy improves microcirculation blood flow of ischemic limbs in patients with peripheral arterial disease: pilot study. J Nippon Med Sch. 2014; 81(1): 19–27.
  12. Young SR, Dyson M. Effect of therapeutic ultrasound on the healing of full-thickness excised skin lesions. Ultrasonics. 1990; 28(3): 175–180.
  13. Nishida T, Shimokawa H, Oi K, et al. Extracorporeal cardiac shock wave therapy markedly ameliorates ischemia-induced myocardial dysfunction in pigs in vivo. Circulation. 2004; 110(19): 3055–3061.
  14. Nurzynska D, Di Meglio F, Castaldo C, et al. Shock waves activate in vitro cultured progenitors and precursors of cardiac cell lineages from the human heart. Ultrasound Med Biol. 2008; 34(2): 334–342.
  15. Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003; 21(6): 984–989.
  16. Gotte G, Amelio E, Russo S, et al. Short-time non-enzymatic nitric oxide synthesis from L-arginine and hydrogen peroxide induced by shock waves treatment. FEBS Lett. 2002; 520(1-3): 153–155.
  17. Lew-Starowicz M, Lew-Starowicz Z. Znaczenie utlenowania krwi w patofizjologii i leczeniu zaburzen erekcji. Przegl Seksuol 2006; wyd. speclajne. 2006: 3–10.
  18. Kikuchi Y, Ito K, Ito Y, et al. Double-blind and placebo-controlled study of the effectiveness and safety of extracorporeal cardiac shock wave therapy for severe angina pectoris. Circ J. 2010; 74(3): 589–591.
  19. Qureshi AA, Ross KM, Ogawa R, et al. Shock wave therapy in wound healing. Plast Reconstr Surg. 2011; 128(6): 721e–7e.
  20. Vardi Y, Appel B, Jacob G, et al. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010; 58(2): 243–248.
  21. Hisasue Si, China T, Horiuchi A, et al. Impact of aging and comorbidity on the efficacy of low-intensity shock wave therapy for erectile dysfunction. Int J Urol. 2016; 23(1): 80–84.
  22. Pelayo-Nieto M, Linden-Castro E, Alias-Melgar A, et al. Linear shock wave therapy in the treatment of erectile dysfunction. Actas Urol Esp. 2015; 39(7): 456–459.
  23. Ruffo A, Capece M, Prezioso D, et al. Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction. Int Braz J Urol. 2015; 41(5): 967–974.
  24. Reisman Y, Hind A, Varaneckas A, et al. Initial experience with linear focused shockwave treatment for erectile dysfunction: a 6-month follow-up pilot study. Int J Impot Res. 2015; 27(3): 108–112.
  25. Gruenwald I, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy--a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med. 2012; 9(1): 259–264.
  26. Bechara A, Casabe A, De BW, et al. Effectiveness of low-intensity extracorporeal shock wave therapy on patients with Erectile Dysfunction (ED) who have failed to respond to PDE5i therapy. A pilot study. Arch Esp Urol. 2015; 68: 152–160.
  27. Bechara A, Casabé A, De Bonis W, et al. Twelve-Month Efficacy and Safety of Low-Intensity Shockwave Therapy for Erectile Dysfunction in Patients Who Do Not Respond to Phosphodiesterase Type 5 Inhibitors. Sex Med. 2016; 4(4): e225–e232.
  28. Vardi Y, Appel B, Kilchevsky A, et al. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012; 187(5): 1769–1775.
  29. Srini VS, Reddy RK, Shultz T, et al. Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population. Can J Urol. 2015; 22(1): 7614–7622.
  30. Kitrey ND, Gruenwald I, Appel B, et al. Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study. J Urol. 2016; 195(5): 1550–1555.
  31. Yee CH, Chan ESy, Hou SSM, et al. Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study. Int J Urol. 2014; 21(10): 1041–1045.
  32. Olsen AB, Persiani M, Boie S, et al. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol. 2015; 49(4): 329–333.
  33. Fojecki GL, Tiessen S, Osther PJS. Effect of low-eEnergy linear shockwave therapy on erectile dysfunction - a double-blinded, sham-controlled, randomized clinical trial. J Sex Med. 2017; 14(1): 106–112.
  34. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. : 1–7.
  35. Kalyvianakis D, Hatzichristou D. Low-Intensity Shockwave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial. J Sex Med. 2017; 14(7): 891–897.
  36. Lu Z, Lin G, Reed-Maldonado A, et al. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. European Urology. 2017; 71(2): 223–233.
  37. Man L, Li G. Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: a Systematic Review and Meta-Analysis. Urology. 2017 [Epub ahead of print].
  38. Zou ZJ, Tang LY, Liu ZH, et al. Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis. Int Braz J Urol. 2017; 43(5): 805–821.
  39. Clavijo RI, Kohn TP, Kohn JR, et al. Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2017; 14(1): 27–35.
  40. Angulo JC, Arance I, de Las Heras MM, et al. Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis. Actas Urol Esp. 2017; 41(8): 479–490.
  41. Kałka D, Gebala J, Smoliński R, et al. Low-energy Shock Wave Therapy-A Novel Treatment Option for Erectile Dysfunction in Men With Cardiovascular Disease. Urology. 2017; 109: 19–26.
  42. Poulakis V, Skriapas K, de Vries R, et al. Extracorporeal shockwave therapy for Peyronie's disease: an alternative treatment? Asian J Androl. 2006; 8(3): 361–366.
  43. Skolarikos A, Alargof E, Rigas A, et al. Shockwave therapy as first-line treatment for Peyronie's disease: a prospective study. J Endourol. 2005; 19(1): 11–14.
  44. Palmieri A, Imbimbo C, Creta M, et al. Tadalafil once daily and extracorporeal shock wave therapy in the management of patients with Peyronie's disease and erectile dysfunction: results from a prospective randomized trial. Int J Androl. 2012; 35(2): 190–195.
  45. Chitale S, Morsey M, Swift L, et al. Limited shock wave therapy vs sham treatment in men with Peyronie's disease: results of a prospective randomized controlled double-blind trial. BJU Int. 2010; 106(9): 1352–1356.
  46. Hauck EW, Mueller UO, Bschleipfer T, et al. Extracorporeal shock wave therapy for Peyronie's disease: exploratory meta-analysis of clinical trials. J Urol. 2004; 171(2 Pt 1): 740–745.
  47. Gao L, Qian S, Tang Z, et al. A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease. Int J Impot Res. 2016; 28(5): 161–166.
  48. Frey A, Sønksen J, Fode M. Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study. Scand J Urol. 2016; 50(2): 123–127.
  49. Zimmermann R, Cumpanas A, Miclea F, et al. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol. 2009; 56(3): 418–424.
  50. Qi T, Ye L, Wang B. Comparison of the effects of extracorporeal shock wave therapy and a vacuum erectile device on penile erectile dysfunction. Medicine. 2018; 97(12): e0262.
  51. Ayala HA, Cuartas JP, Cleves DC. Impact on the Quality of Erections after Completing a Low-Intensity Extracorporeal Shock Wave Treatment Cycle on a Group of 710 Patients. Adv Urol. 2017; 2017: 1843687.
  52. ARIES for Vasculogenic Erectile Dysfunction. NCT02620982. 2018. https://www.smartpatients.com/trials/NCT02620982 (18.01.2018).
  53. ESSWT for ED - from basic research to implementation. 20th Congress of the European Society for Sexual Medicine; 21st World Meeting of the International Society for Sexual Medicine; 2018.
  54. Brock GB, McMahon CG, Chen KK, et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol. 2002; 168(4 Pt 1): 1332–1336.
  55. Carson CC, Hatzichristou DG, Carrier S, et al. Patient Response with Vardenafil in Slidenafil Non-Responders (PROVEN) Study Group. Erectile response with vardenafil in sildenafil nonresponders: a multicentre, double-blind, 12-week, flexible-dose, placebo-controlled erectile dysfunction clinical trial. BJU Int. 2004; 94(9): 1301–1309.
  56. Moreland RB. Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism. Int J Impot Res. 2000; 12 Suppl 4: S39–S46.
  57. De Berardinis E, Busetto GM, Antonini G, et al. Extracorporeal shock wave therapy in the treatment of Peyronie's disease: long-term results. Arch Ital Urol Androl. 2010; 82(2): 128–133.
  58. Feldman R, Denes B, Appel B, et al. PD45-10 THE SAFETY AND EFFICACY OF LI-ESWT IN 604 PATIENTS FOR ERECTILE DYSFUNCTION: SUMMARY OF CURRENT AND EVOLVING EVIDENCE. The Journal of Urology. 2015; 193(4): e905–e906.
  59. Müller A, Akin-Olugbade Y, Deveci S, et al. The impact of shock wave therapy at varied energy and dose levels on functional and structural changes in erectile tissue. Eur Urol. 2008; 53(3): 635–642.
  60. Jeon SH, Shrestha KR, Kim RY, et al. Combination Therapy Using Human Adipose-derived Stem Cells on the Cavernous Nerve and Low-energy Shockwaves on the Corpus Cavernosum in a Rat Model of Post-prostatectomy Erectile Dysfunction. Urology. 2016; 88: 226.e1–226.e9.
  61. Haahr MK, Jensen CH, Toyserkani NM, et al. Safety and Potential Effect of a Single Intracavernous Injection of Autologous Adipose-Derived Regenerative Cells in Patients with Erectile Dysfunction Following Radical Prostatectomy: An Open-Label Phase I Clinical Trial. EBioMedicine. 2016; 5: 204–210.
  62. Kałka D, Domagała Z, Rakowska A, et al. Modifiable risk factors for erectile dysfunction: an assessment of the awareness of such factors in patients suffering from ischaemic heart disease. Int J Impot Res. 2016; 28(1): 14–19.



Journal of Sexual and Mental Health