Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography

International Journal of Impotence Research volume 31, pages 195–203 (2019)Cite this article

Subjects

Abstract

Objectives:

To study the efficacy of Low intensity Extracorporeal Shockwave Therapy (Li- ESWT) for the treatment of erectile dysfunction (ED) in kidney transplanted men.

Methods:

Twenty men (mean age = 53.7 years) were selected. This was a double-blinded, prospective, randomized, sham-controlled trial. The ESWT protocol was based in a 2 treatment sessions per week for 3 weeks. The sham treatment was performed using the same device replacing the effective probe for one that emits zero energy. Baseline and follow-up assessment was performed with International Index of Erectile Function Questionnaire (IIEF) score and Erection Hardness Score (EHS) after 1, 4 and 12 months. Penile Doppler was performed before and after treatment.

Results:

A total of 20 patients were recruited, 10 patients in each group. Baseline scores were similar. The mean EHS in after 1 month were 2.5 ± 0.85 (Li-EWST) and 2.4 ± 0.7 (Sham therapy), p = 0.724 . After 4 months it was 2.4 ± 0.7 and 2.6 ± 0.84, p = 0,0004 (between the moments) . The baseline IIEF score was 14.9 ± 3(Sham Theraphy) and 10.9 ± 5.1 (Li-EWST). The mean IIEF score after 1 month was 15.6 ± 6.1 (Li-EWST) and 16.6 ± 5.4 (Sham therapy). The mean IIEF score after 4 months was 17.2 ± 5.7 (Li-EWST) and 16.5 ± 5 (Sham therapy), p < 0.0001 (between the moments). IIEF score improvement was higher than 5 in 70% (ranged from 0-10) and in 10% (ranged from 1-14) in Li-ESWT and Sham groups, respectively. The mean change in IIEF score after 12 months was 4.8 in Li-ESWT group .Penile Doppler parameters were similar between groups and did not present improvements.

Conclusions:

Li-ESWT is a treatment with clinical efficacy. Despite evidences suggesting neoagiogenesis, our short protocol had no impact in penile Doppler parameters.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol. 1994;151:54–61.

    Article  CAS  Google Scholar 

  2. Althof SE. Quality of life and erectile dysfunction. Urology. 2002;59:803–10.

    Article  Google Scholar 

  3. El-Assmy A, El-Bahnasawy MS, Dawood A, AboBieh E, Ali-El Dein B, El-Dein AB, et al. Vasculogenic erectile dysfunction in renal transplant recipients--assessment of potential risk factors. Scand J Urol Nephrol. 2004;38:511–6.

    Article  Google Scholar 

  4. Jensen J, Lendorf A, Stimpel H, Frost J, Ibsen H, Rosenkilde P. The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens. 1999;12:271–5.

    Article  CAS  Google Scholar 

  5. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381:153–65.

    Article  CAS  Google Scholar 

  6. Malavaud B, Rostaing L, Rischmann P, Sarramon JP, Durand D. High prevalence of erectile dysfunction after renal transplantation. Transplantation. 2000;69:2121–4.

    Article  CAS  Google Scholar 

  7. Toorians AW, Janssen E, Laan E, Gooren LJ, Giltay EJ, Oe PL, et al. Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response. Nephrol, Dial, Transplant: Off Publ Eur Dial Transplant Assoc - Eur Ren Assoc. 1997;12:2654–63.

    Article  CAS  Google Scholar 

  8. Eardley I, Donatucci C, Corbin J, El-Meliegy A, Hatzimouratidis K, McVary K, et al. Pharmacotherapy for erectile dysfunction. J Sex Med. 2010;7(1 Pt 2):524–40.

    Article  CAS  Google Scholar 

  9. Aversa A, Bruzziches R, Vitale C, Marazzi G, Francomano D, Barbaro G, et al. Chronic sildenafil in men with diabetes and erectile dysfunction. Expert Opin Drug Metab Toxicol. 2007;3:451–64.

    Article  CAS  Google Scholar 

  10. Porst H, Rajfer J, Casabe A, Feldman R, Ralph D, Vieiralves LF, et al. Long-term safety and efficacy of tadalafil 5 mg dosed once daily in men with erectile dysfunction. J Sex Med. 2008;5:2160–9.

    Article  CAS  Google Scholar 

  11. Vardi Y, Appel B, Ofer Y, Greunwald I, Dayan L, Jacob G. Effect of chronic sildenafil treatment on penile endothelial function: a randomized, double-blind, placebo controlled study. J Urol. 2009;182:2850–5.

    Article  Google Scholar 

  12. Aicher A, Heeschen C, Sasaki K, Urbich C, Zeiher AM, Dimmeler S. Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: a new modality to increase efficacy of cell therapy in chronic hind limb ischemia. Circulation. 2006;114:2823–30.

    Article  Google Scholar 

  13. Young Academic Urologists Men’s Health Group. Fode M, Hatzichristodoulou G, Serefoglu EC, Verze P, Albersen M. Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough. Nat Rev Urol. 2017;14:593–606.

    Article  Google Scholar 

  14. Gotte G, Amelio E, Russo S, Marlinghaus E, Musci G, Suzuki H. Short-time non-enzymatic nitric oxide synthesis from L-arginine and hydrogen peroxide induced by shock waves treatment. FEBS Lett. 2002;520:153–5.

    Article  CAS  Google Scholar 

  15. Eardley I. Can an erectogenic pharmacotherapy regimen after radical prostatectomy improve postoperative erectile function? Nat Clin Pract Urol. 2006;3:72–73.

    Article  Google Scholar 

  16. Gonzales AI, Sties SW, Wittkopf PG, Mara LS, Ulbrich AZ, Cardoso FL, et al. Validation of the International Index of Erectile Function (IIFE) for use in Brazil. Arq Bras Cardiol. 2013;101:176–82.

    PubMed  PubMed Central  Google Scholar 

  17. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the international index of erectile function. Urology. 1999;54:346–51.

    Article  CAS  Google Scholar 

  18. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Validation of the erection hardness score. J Sex Med. 2007;4:1626–34.

    Article  Google Scholar 

  19. Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. 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;58:243–8.

    Article  Google Scholar 

  20. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res: Off Publ Orthop Res Soc. 2003;21:984–9.

    Article  Google Scholar 

  21. Kovanecz I, Nolazco G, Ferrini MG, Toblli JE, Heydarkhan S, Vernet D, et al. Early onset of fibrosis within the arterial media in a rat model of type 2 diabetes mellitus with erectile dysfunction. BJU Int. 2009;103:1396–404.

    Article  Google Scholar 

  22. Petschnik AE, Fell B, Kruse C, Danner S. The role of alpha-smooth muscle actin in myogenic differentiation of human glandular stem cells and their potential for smooth muscle cell replacement therapies. Expert Opin Biol Ther. 2010;10:853–61.

    Article  CAS  Google Scholar 

  23. Liu J, Zhou F, Li GY, Wang L, Li HX, Bai GY, et al. Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci. 2013;14:10661–73.

    Article  Google Scholar 

  24. Vardi Y, Appel B, Kilchevsky A, Gruenwald I. 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;187:1769–75.

    Article  Google Scholar 

  25. Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. 2017;71:223–33.

    Article  Google Scholar 

  26. 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;9:259–64.

    Article  Google Scholar 

  27. Olsen AB, Persiani M, Boie S, Hanna M, Lund L. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol. 2015;49:329–33.

    Article  Google Scholar 

  28. Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D. Low-intensity shockwave therapy for erectile dysfunction: a randomized clinical trial comparing 2 treatment protocols and the impact of repeating treatment. J Sex Med. 2018;15:334–45.

    Article  Google Scholar 

Download references

Author's contribution

KGRY: manuscript writing and data collection; FC: data management; JC: project management and data analysis; RL: data collection and treatment application; PCF: data collection; ACP: manuscript revision; MS: project management and data analysis; WCN: project management; and IMA: manuscript editing and project design.

Author information

Authors and Affiliations

  1. Division of Urology, Renal Transplantation Unit, University of São Paulo Medical School, São Paulo, Brazil

    Kleiton G. R. Yamaçake, Jose Cury, Rodolfo Lourenço, Affonso C. Piovesan & Ioannis M. Antonopoulos

  2. Division of Radiology, University of São Paulo Medical School, São Paulo, Brazil

    Felipe Carneiro & Peter C. Françolin

  3. Renal Transplantation Unit, Division of Urology, University of São Paulo Medical School, São Paulo, Brazil

    Miguel Srougi & Willian C. Nahas

Authors
  1. Kleiton G. R. Yamaçake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Felipe Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jose Cury
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodolfo Lourenço
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter C. Françolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Affonso C. Piovesan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miguel Srougi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Willian C. Nahas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ioannis M. Antonopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kleiton G. R. Yamaçake.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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

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 the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamaçake, K.G.R., Carneiro, F., Cury, J. et al. Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography. Int J Impot Res 31, 195–203 (2019). https://doi.org/10.1038/s41443-018-0062-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-018-0062-2

This article is cited by

Search

Advanced search

Quick links