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Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial

International Urology and Nephrology volume 50, pages 2007–2014 (2018)Cite this article

Abstract

Aim

To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP).

Materials and methods

This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients).

Results

Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively).

Conclusions

During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.

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Author information

Affiliations

  1. Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt

    Tamer S. Zewin, Ahmed El-Assmy, Ahmed M. Harraz, Mahmoud Bazeed, Ahmed A. Shokeir, Khaled Sheir & Ahmed Mosbah

Authors
  1. Tamer S. Zewin
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  2. Ahmed El-Assmy
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  3. Ahmed M. Harraz
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  4. Mahmoud Bazeed
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  5. Ahmed A. Shokeir
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  6. Khaled Sheir
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  7. Ahmed Mosbah
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Corresponding author

Correspondence to Ahmed El-Assmy.

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Conflict of interest

Tamer S. Zewin, Ahmed El-Assmy, Ahmed M. Harraz, Mahmoud Bazeed, Ahmed A. Shokeir, Khaled Sheir, and Ahmed Mosbah declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Zewin, T.S., El-Assmy, A., Harraz, A.M. et al. Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial. Int Urol Nephrol 50, 2007–2014 (2018). https://doi.org/10.1007/s11255-018-1987-6

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  • DOI: https://doi.org/10.1007/s11255-018-1987-6

Keywords

  • Low-intensity shock wave
  • Penile rehabilitation
  • Nerve sparing
  • Cystoprostatectomy