Can Li-ESWT in the treatment of mild and mild/moderate erectile dysfunction affect the sexual functions of male patient and female partner?

Puede Bi-TOCE en el tratamiento de la disfunción eréctil leve y leve/moderada afectar la función sexual del paciente masculino y su pareja femenina?

Background: This study retrospectively evaluated the efficacy of low-intensity extra-corporeal shock wave therapy (Li-ESWT) in the treatment of mild and mild/moderate erectile dysfunction (ED) and compared changes in sexual function parameters of couples before and after the procedure. Methods: This study included 32 couples. The five-item International Index of Erectile Function (IIEF-5), the Erection Hardness Scale (EHS), and the male Arizona Sexual Experiences Scale (mASEX) were administered to patients who presented to the urology outpatient clinic with mild and mild/moderate ED. In addition, the female Arizona Sexual Experiences Scale (fASEX) was by their partners before the procedure. All male patients then underwent Li-ESWT. At the sixth month after the procedure, IIEF-5, EHS, and mASEX were again completed by the male patients, while fASEX was completed by their female partners. Pre-procedure and post-procedure values were compared statistically. Results: The differences between pre-and post-procedure IIEF-5 and EHS scores of male patients were statistically significant (p < 0.05). The total mASEX score and four sub-scores of male patients decreased compared to pre-procedure levels, and the differences were statistically significant (p < 0.05). However, the difference in the psychological stimulation score was not statistically significant (p > 0.05). The total fASEX score and all sub-scores of female partners decreased after the procedure compared to pre-procedure scores, and these differences were statistically significant (p < 0.05). The decrease in the number of cases of male/female sexual dysfunction in both groups after the procedure was also significant (p < 0.05). Conclusions: In young patients with mild or mild/moderate ED, Li-ESWT resulted in a high treatment success rate at six months after the procedure. Furthermore, both male and female sexual dysfunction improved simultaneously, with improvements observed in all female sexual function parameters. In male patients, improvements were observed in four different sexual functions, while psychological stimulation remained unchanged.

Resumen

Antecedentes: Este estudio evaluó retrospectivamente la eficacia de baja intensidad: terapia con ondas de choque extracorpóreas (Bi-TOCE) en el tratamiento de la disfunción eréctil (DE) leve y leve/moderada y comparó los cambios en los parámetros de función sexual de las parejas antes y después del procedimiento. Métodos: Este estudio incluyó a 32 parejas. Se aplicaron a los pacientes masculinos el Índice Internacional de Función Eréctil de cinco ítems (IIEF-5), la Escala de Dureza de la Erección (EHS) y la Escala de Experiencias Sexuales de Arizona masculina (mASEX). Además, la Escala de Experiencias Sexuales de Arizona femenina (fASEX) fue completada por sus parejas antes del procedimiento. Todos los pacientes masculinos se sometieron a Bi-TOCE. Al sexto mes posterior al procedimiento, los pacientes completaron nuevamente IIEF-5, EHS y mASEX, mientras que sus parejas femeninas completaron fASEX. Los valores pre- y post-procedimiento se compararon estadísticamente. Resultados: Las diferencias entre los puntajes pre- y post-procedimiento de IIEF-5 y EHS de los pacientes masculinos fueron estadísticamente significativas (p < 0.05). La puntuación total de mASEX y cuatro subpuntuaciones de los pacientes masculinos disminuyeron en comparación con los niveles pre-procedimiento, siendo estas diferencias estadísticamente significativas (p < 0.05). Sin embargo, la diferencia en la subpuntuación de estimulación psicológica no fue significativa (p > 0.05). La puntuación total del fASEX y todas las subpuntuaciones de las parejas femeninas disminuyeron respecto a los puntajes previos al procedimiento, siendo estas diferencias estadísticamente significativas (p < 0.05). La disminución en el número de casos de disfunción sexual (DS) masculina y femenina en ambos grupos después del procedimiento también fue significativa (p < 0.05). Conclusiónes: En pacientes jóvenes con DE leve o leve/moderada, Bi-TOCE resultó en una alta tasa de éxito terapéutico a los seis meses del procedimiento. Además, tanto los hombres como las mujeres con DS mostraron una mejoría simultánea y se observaron mejoras en todos los parámetros de la función sexual femenina. En los pacientes masculinos, se observaron mejoras en cuatro funciones sexuales diferentes, mientras que la estimulación psicológica permaneció sin cambios.

Li-ESWT; Male patient; Female partner; mASEX; fASEX; IIEF-5; EHS; Erectile dysfunction; Sexual dysfunction

Palabras Clave

Bi-TOCE; Paciente masculino; Pareja femenina; mASEX; fASEX; IIEF-5; EHS; Disfunción eréctil; Disfunción sexual

[1] Montorsi F, Padma-Nathan H, Glina S. Erectile function and assessments of erection hardness correlate positively with measures of emotional well-being, sexual satisfaction, and treatment satisfaction in men with erectile dysfunction treated with sildenafil citrate (Viagra®). Urology. 2006; 68: 26–37.

[2] Ho CC, Singam P, Hong GE, Zainuddin ZM. Male sexual dysfunction in Asia. Asian Journal of Andrology. 2011; 13: 537–542.

[3] Bayraktar N. Non-invasive alternative for phosphodiesterase inhibitor-refractory erectile dysfunction: real-life experience with low-intensity extracorporeal shockwave therapy. Medicine. 2023; 102: e35939.

[4] Reed MA. Female sexual dysfunction. Clinics in Plastic Surgery. 2022; 49: 495–504.

[5] Pozza D, Berardi A, Pozza M, Mosca A, Pozza C. The woman and the penile prosthetic implant. Primary or secondary role? Personal experiences on 355 implanted patients. Archivio Italiano di Urologia e Andrologia. 2021; 93: 53–57.

[6] Chung DY, Ryu JK, Yin GN. Regenerative therapies as a potential treatment of erectile dysfunction. Investigative and Clinical Urology. 2023; 64: 312–324.

[7] Aslan Y, Atan A. ESWT success in erectile dysfunction and Peyronie’s disease. Andrology Bulletin. 2023; 25: 112–118.

[8] Medrano-Sánchez EM, Peña-Cantonero B, Candón-Ballester P, Blanco-Díaz M, Díaz-Mohedo E. Effectiveness of low-intensity extracorporeal shock wave therapy in erectile dysfunction: an analysis of sexual function and penile hardness at erection: an umbrella review. Journal of Personalized Medicine. 2024; 14: 177.

[9] Turunç T, Deveci S, Güvel S, Peşkircioğlu L. The assessment of Turkish validation with 5 question version of International Index of Erectile Function (IIEF-5). Turkish Journal of Urology. 2007; 33: 45–49.

[10] Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. International Journal of Impotence Research. 2004; 16: 531–534.

[11] Tzou KY, Hu SW, Bamodu OA, Wang YH, Wu WL, Wu CC. Efficacy of penile low-intensity shockwave therapy and determinants of treatment response in Taiwanese patients with erectile dysfunction. Biomedicines. 2021; 9: 1670.

[12] Ergün M, Akyüz O. Is Li-ESWT effective in diabetic patients with severe erectile dysfunction? Asian Journal of Andrology. 2022; 24: 521–524.

[13] Fojecki GL, Tiessen S, Osther PJS. Effect of linear low-intensity extracorporeal shockwave therapy for erectile dysfunction—12-month follow-up of a randomized, double-blinded, sham-controlled study. Sexual Medicine. 2018; 6: 1–7.

[14] Wu SS, Ericson KJ, Shoskes DA. Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction. Translational Andrology and Urology. 2020; 9: 2122–2128.

[15] Yao H, Wang X, Liu H, Sun F, Tang G, Bao X, et al. Systematic review and meta-analysis of 16 randomized controlled trials of clinical outcomes of low-intensity extracorporeal shock wave therapy in treating erectile dysfunction. American Journal of Men’s Health. 2022; 16: 15579883221087532.

[16] Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis. The Journal of Sexual Medicine. 2017; 14: 27–35.

[17] Dong L, Chang D, Zhang X, Li J, yang F, Tan K, et al. Effect of low-intensity extracorporeal shock wave on the treatment of erectile dysfunction: a systematic review and meta-analysis. American Journal of Men’s Health. 2019; 13: 1557988319846749.

[18] Ortac M, Özmez A, Cilesiz NC, Demirelli E, Kadıoğlu A. The impact of extracorporeal shock wave therapy for the treatment of young patients with vasculogenic mild erectile dysfunction: a prospective randomized single-blind, sham controlled study. Andrology. 2021; 9: 1571–1578.

[19] Rubino M, Ricapito A, Finati M, Falagario UG, Annese P, Mancini V, et al. Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction. Asian Journal of Andrology. 2024; 26: 344–348.

[20] Fatima K, Abbas Z, Un-Noor A, Aaqil SI, Amir R, Nawaz F, et al. Efficacy of low-intensity extracorporeal shock wave therapy for erectile dysfunction: updated meta-analysis of randomized trials. Future Science OA. 2025; 11: 2511438.

[21] Chung E, Lee J, Liu CC, Taniguchi H, Zhou HL, Park HJ. Clinical practice guideline recommendation on the use of low intensity extracorporeal shock wave therapy and low intensity pulsed ultrasound shock wave therapy to treat erectile dysfunction: the Asia-Pacific Society for Sexual Medicine Position Statement. The World Journal of Men’s Health. 2021; 39: 1–8.

[22] Elnazer HY, Baldwin DS. Structured review of the use of the Arizona sexual experiences scale in clinical settings. Human Psychopharmacology: Clinical and Experimental. 2020; 35: e2730.

[23] Gokalp F, Koras O, Ugur M, Yildirak E, Sigva H, Porgali SB, et al. Bariatric surgery has positive effects on patients’ and their partners’ sexual function: a prospective study. Andrology. 2021; 9: 1119–1125.

[24] Aydogan U, Doganer YC, Haymana C, Kaplan U, Aydogdu A, Demirci I, et al. Evaluation of sexual functional status and consistency of scales in patients with hypogonadotropic hypogonadism before and after testosterone replacement therapy: a single-center experience. Archives of Endocrinology and Metabolism. 2023; 67: 179–188.

[25] Anğın AD, Özkaya E, Çetin M, Gün I, Sakin O, Ertekin LT, et al. Comparison of female sexual function and sexual function of their partners between groups of pregnant and non-pregnant women. Ginekologia Polska. 2020; 91: 235–239.

[26] Gittens P, Moskovic DJ, Avila D III, Chandrashekar A, Khera M, Lipshultz LI. Favorable female sexual function is associated with patient satisfaction after inflatable penile prosthesis implantation. The Journal of Sexual Medicine. 2011; 8: 1996–2001.

[27] Özbay E, Aydın A, Salar R, Durmuş E, Karlıdağ İ, Öncel HF, et al. Sexual experiences between partners after penile prosthesis: who is more satisfied? Andrologia. 2020; 52: e13461.

[28] Öncel HF, Salar R, Özbay E, Elkan H. Changes in the sexual functions of male patients and their partners after obesity surgery. Andrologia. 2021; 53: e13873.