Long-Term Prospective Evaluation of Li-ESWT with or without PDE5 Inhibitors for Erectile Dysfunction following Nerve-Sparing Radical Prostatectomy.

INTRODUCTION

Erectile dysfunction (ED) is a common complication following radical prostatectomy (RP). Although phosphodiesterase type 5 inhibitors (PDE5is) are used for penile rehabilitation, their efficacy post-RP is limited. Low-intensity extracorporeal shockwave therapy (Li-ESWT) has emerged as a potential noninvasive treatment, promoting tissue regeneration. This study evaluates the effectiveness of Li-ESWT, with or without PDE5i, for post-RP ED.

METHODS

This prospective study included 104 patients who underwent nerve-sparing RP and received Li-ESWT. Patients were divided into two groups: group 1 received daily 5 mg tadalafil along with Li-ESWT, while group 2 received Li-ESWT alone. Erectile function was assessed using the International Index of Erectile Function (IIEF-5) at baseline, 6, 12, and 24 months postoperatively.

RESULTS

The preoperative mean IIEF-5 score was 15.7 ± 4.7, with 54.8% of patients scoring below 17. Postoperatively, significant improvements in IIEF-5 scores were observed at 12 and 24 months in both groups compared to the 6th month. In patients with preoperative IIEF-5 <17, group 1 showed significantly greater improvement in IIEF-5 scores compared to group 2 (p = 0.008). No significant difference was observed between the groups in patients with preoperative IIEF-5 ≥17 (p = 0.893).

CONCLUSION

Li-ESWT is an effective treatment for ED following nerve-sparing RP, with or without PDE5i. In patients with mild-to-moderate or greater preoperative ED, the combination of PDE5i and Li-ESWT may provide additional benefits, whereas Li-ESWT alone appears sufficient for those with milder cases.