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

Background: Erectile dysfunction (ED) is a common complication following radical prostatectomy (RP). Although phosphodiesterase type 5 inhibitors (PDE5i) are used for penile rehabilitation, their efficacy post-RP is limited. Low-intensity extracorporeal shockwave therapy (Li-ESWT) has emerged as a potential non-invasive 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.

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Research Article
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S. Karger AG, Basel
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2025
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