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Erectile dysfunction: they don't talk, we don't ask.

A Rakovac Tisdall, T F J King, W A W Mahmood, C S Keat, R Ali, R Abdin, C M Koo, M Alali, S Sreenan, J H McDermott
Diabetic Medicine: a Journal of the British Diabetic Association 2018 February 19

Erectile dysfunction is an under-reported complication of diabetes mellitus affecting over half of male patients [1]. Although many men with diabetes consider that erectile dysfunction has a negative influence on their quality of life, they are reluctant to report it; and while most would like treatment, they prefer physicians to start the conversation [2-4]. Erectile dysfunction predicts future cardiovascular disease, and screening for erectile dysfunction is advocated in several cardiovascular risk assessment algorithms [5]. This article is protected by copyright. All rights reserved.
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Non-invasive Management Options for Erectile Dysfunction When a Phosphodiesterase Type 5 Inhibitor Fails

Mary Lee, Roohollah Sharifi
Drugs & Aging 2018 February 20
Phosphodiesterase type 5 inhibitors (PDE5Is) are the drug of choice for medical management of erectile dysfunction (ED). On-demand PDE5Is have an overall efficacy of 60-70% for ED; 30-35% of patients fail to respond to a PDE5I, and 30-50% of non-responders can be salvaged with detailed counseling on proper use and physician follow-up to ensure that the patient has been prescribed an appropriate and full PDE5I clinical trial. True non-responders may be offered intracavernosal injections of erectogenic drugs, intraurethral alprostadil, or surgical insertion of a penile prosthesis. Such options are not discreet and are associated with more adverse effects than PDE5Is. Thus patients may request additional non-invasive medical management options. This review describes published literature on patients who failed to respond to an on-demand PDE5I regimen and were treated with a non-invasive PDEI-based regimen, including switching from one PDE5I to another; increasing the dose of PDE5I above the labeled dosage range; using two PDE5Is concurrently; using a daily PDE5I regimen; or combining a PDE5I with a testosterone supplement, α-adrenergic antagonist, intraurethral or intracavernosal alprostadil, vacuum erection device, or low-intensity shock wave therapy. The limitations of published clinical trials do not allow for sufficient evidence to recommend one option over another. Therefore, in PDE5I-refractory patients, the choice of a specific next step should be individualized based on the preference of the patient and his sexual partner, the advantages and disadvantages of the various options, the concurrent medical illnesses and medications of the patient, and the patient's response to treatment.

Report from Men’s Health Summit January 29, 2016 | ED Shockwave TherapyED Treatment | 1 |

On Saturday, January 15, 2016, the third annual Men’s Health Summit was held in Toronto. Attended by 150 participants, mostly family physicians, topics were presented by experts in various therapeutic areas related to men’s health, including prostate cancer, sexual health, osteoporosis, cardiovascular disease and diabetes.
Dr Dean Elterman presented on a novel and effective erectile dysfunction treatment option – erectile dysfunction shock wave therapy, or EDSWT. Half of men over the age of 50 suffer from symptoms of erectile dysfunction, and 75% of these men can attribute poor blood flow as the cause of their ED symptoms.
Dr Elterman began his presentation noting the significant limitations to many ED treatment options – such as pills, pumps, injections – in that they are all temporary or band-aid ED treatments. These options all require a significant amount of planning and, for some, come with significant side effects or contraindications that prevent their use in some patients. In short, these erectile dysfunction treatments do not offer the level of spontaneity many patients are hoping to regain.
Dr Elterman then reviewed the data supporting the use of EDSWT as an erectile dysfunction treatment. The review included double-blind, placebo-controlled studies showing statistically significant improvement in erectile function scores for patients who underwent active treatment with the ED1000 compared to patients who received treatment with a sham (placebo) control.
Dr Elterman demonstrated benefits in using both the rigorous and internationally accepted IIEF-ED domain score, and also the patient focused EHS (erection hardness score). He explained the ED1000 works by stimulating new blood vessel growth and – unlike the other ED treatments which provide a temporary reprieve from symptoms – truly addresses the underlying cause of the condition.
3 out of 4 patients who underwent treatment with ED1000 had a statistically significant improvement, with the majority having a sustained benefit for two years and beyond. This demonstrates that ED1000 is a highly effective and durable ED treatment option.
It was noted that although there are several manufacturers offering EDSWT devices, these devices come with varying degrees of evidence and efficacy, and the data presented today was based on the device with the deepest and most rigorous clinical trial program, the ED1000, manufactured by Medispec Ltd and distributed in Canada by Men’s Health Solutions.
In summary, the benefits of EDSWT as an ED treatment are that it is effective, well-tolerated, painless, non-invasive, and truly addresses the underlying cause of erectile dysfunction.

Clinical Data

Penile low-intensity shockwave treatment is able to shift PDE5i non-responders to responders: A double-blind sham-controlled study

Kitrey ND, Gruenwald I, Appel B, Shechter A, Massarwa O, Vardi Y

Sham-controlled evaluation of penile low-intensity shockwave treatment (LIST) effect on patients unable to have sexual intercourse with phosphodiesterase 5 inhibitors.

The Safety and Efficacy of Li-ESWT in 604 patients for Erectile Dysfunction: Summary of Current and Evolving Evidence

Robert A. Feldman, Bela S. Denes, Boaz Appel, Satya S. Vasan, Tamar Shultz and Arthur L. Burnett
Candian Urology Assocation (CUA) Annual Meeting 2015

Low intensity shock wave therapy (Li-ESWT) is currently approved in over 20 countries and available at over 200 clinics worldwide. A US multicenter study has been completed and the data are currently under FDA review. Herein we provide an overview of the clinical experience to date on the safety and efficacy of Li-ESWT for the treatment of erectile dysfunction. Studies were conducted in men with ED considered responders and in men considered poor responders to PDE5i. We report pooled data from 5 randomized, placebo-controlled studies (USA, Israel, Greece and India) and 3 single-arm open label studies (Israel, Japan). Li-ESWT for ED has been recently included in the European Association of Urology guideline 2013 for male sexual dysfunction.

Low Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: a Study in an Indian Population

Srini Satya Vasan, Reddy Kumar Rahul, Shultz Tamar, Denes Bela
The Canadian Journal of Urology, Feb 2015 (Volume 22, Issue 1, Pages 7614 - 7622)

Erectile dysfunction (ED) has been shown to be associated with a number of physical conditions and affects not only physical but also psychosocial health. Currently oral, on-demand phosphodiesterase type 5 inhibitors (PDE5i) are preferred first line treatment. Though effective, these drugs have limitations and are associated with significant non-compliance, side effects and do not reverse the underlying pathology. Non-invasive low intensity shockwave therapy (LISWT) has been shown to significantly improve erectile function in men previously PDE5i dependent. The study describe the experience and results with this therapy in an Indian population of men with ED. It assessed the efficacy of low intensity extracorporeal shockwave therapy (LI-ESWT) on Indian men with organic ED who had previously responded to PDE5i.

The Low-Intensity Shock Wave Therapy for Erectile Dysfunction

Shin-ichi Hisasue, M.D. Ph.D.
Was presented during the 4th Congress of Asian Prostate Association (APPS 2014)

I'Phosphodiesterase type 5 inhibitors (PDE5i) revolutionized the treatment of erectile dysfunction (ED). However, even in vasculogenic ED patients, one fifth of them showed poor response to PDE5i. Low-intensity shock wave therapy (LI-ESWT) is a novel and promising modality for the patients with mild to moderate erectile dysfunction (ED).

Shockwave Treatment of Erectile Dysfunction

Ilan Gruenwald, Boaz Appel, Noam D. Kitrey and Yoram Vardi
Therapeutic Advances in Urology, April 2013 vol. 5 no. 2 95-99

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections.

Why ED Shockwave Therapy is a revolutionary treatment of ED

from the journal Therapeutic Advances in Urology

“ED Shockwave Therapy is a revolutionary treatment of ED, and probably possesses unprecedented qualities that can rehabilitate erectile tissue. The clinical improvement in subjective erectile function together with the significant improvement in penile hemodynamics following LI-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-ESWT is both feasible and tolerable and without any adverse or unwanted effects. Its main advantage is its ability to improve and potentially restore erectile function in men with ED without additional pharmacotherapy.”

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