Erektiv dysfunktion og ESWT

Transkript

1 Erektiv dysfunktion og ESWT Lars Lund Professor, overlæge, dr.med. Urologisk Afdeling L Odense Universitetshospital

2 Hvad er erektiv dysfunktion? ED er den manglende evne til at få eller beholde en erektion fast nok til samleje. ED kan være en total manglende evne til at opnå en erektion eller en tendens til at opretholde kun korte erektioner. I bestræbelserne på at afhjælp ED, er det også vigtigt at huske på, at en erektionsproblem kan føre til: depression, angst, tab af selvværd og påvirker begge parter i et forhold.

3

4 Mechanics of erection (A) In the flaccid state, arterial vessels are constricted and venous vessels are noncompressed. (B)On erection, smooth muscle relaxation in the trabeculaeand arterial vasculature results in increased blood flow, which rapidly fills and dilates the cavernosal spaces. Venous outflow drops as the expanding cavernosal spaces compress the venous plexus and the larger veins passing through the tunica albuginea.

5

6

7

8 ESWT

9 System features & benefits Plug & play system User friendly Applicator Portable Cost Ease effective of use No special electrical requirements needed. Touch screen control panel. Operator can be easily trained. Shockwave Countdown for ease Entire of applicator use. replacement - the only consumable. Very compact; easily moved from room to room; stores easily. Low cost maintenance. Simple, comfortable and reliable.

10 Shock waves - principles Generated by electro-hydraulic effect: High voltage creates electric spark discharge The water vaporizes and creates an explosion Generating high energy Shock Waves Reflected by the Semi-Ellipsoid Focused onto the treatment area

11

12 Treatment for ED in patients responding to oral mediction 20 Non- Naive Vasculogenic ED patients, average age 56.1 years, who were responders to PDE5i therapy. Duration of ED- range months (median 34.7 months) The Criteria for success was the change in the IIEF ED Domain and the reduction in the use of Oral medication

13 Results: IIEF ED Domain Change from baseline An increase of more then 5 points in the IIEF ED Domain is considered as clinical success In 14/20 patients (70%) there was an improvement of >5 points in the IIEF ED Domain In 7/20 patients (35%) there was improvement of >10 points in the IIEF ED Domain

14 Results: Intake of PDE5i Change from baseline 10/20 patients (50%) do not require the use of PDE5i 5/20 patients (25%) using PDE5i Occasionally

15 Treatment for ED in patients not responding to oral medication 29 Non- Naive Vasculogenic ED patients, median age 62 years, who were true non-responders to PDE5i therapy. Duration of ED- range months (median 60 months) The Criteria for success was the response to PDE5i after the ED-1000 treatment according to the IIEF ED Domain and Rigid Score in comparison to results prior to the ED treatment

16 Rigidity Score Changes from baseline using PDE5i s 21 out of 29 subjects (72.41%, P<0.0001) improved from a score 2 to a score of 3. This significant improvement means that 72.4 % of patients converted from non responders to PDE5i therapy to responders!! Today these severe ED patients can have sexual intercourse unachievable for them before this intervention

17 Double Blind Placebo Controlled study in ED patients responding to oral medication 60 Non- Naive Vasculogenic ED patients, median age 56.5 years, who were responders to PDE5i therapy. The Criteria for success was the change in the IIEF ED Domain in the treated group in comparison to the Placebo group

18 Double blind placebo controlled study (n=60, 2:1 ratio between active to placebo group) IIEF ED Domain Score Visit 1 month post last treatment

19 Conclusions These studies emphasized the feasibility and tolerability of penile low intensity EDSWT therapy in vasculogenic ED patients that are beneficial for PDE5i responders and severe ED patients that are not responders to PDE5i. Treatments were well tolerable by the patients. No reported side effects. Study show significant improvement in patient erectile function remaining for at least 1 year.

20 Dyrestudier Extracorporeal shock-wave therapy improves erectile tissues and induces angiogenesis in an animal model of streptozotocin induced diabetes

21 Dyrestudier Rotterne blev aflivet med 100% CO 2 Blod blev udtaget fra hjertet til senere analyser. Nyrer og penis blev fjernet fra rotten, og kom i formalin og sendt til patolog med henblik påp analyser.

22 Formål At t undersøge, om ESWT kan bruges som en behandling til mænd m med erektiv dysfunktion (ED).

23 Materiale og metode 15 mænd m med ED indgik i denne pilot undersøgelse. Ni mænd m havde prøvet PDE-5 hæmmere og 5 havde prøvet injektionsbehandling. En havde ikke modtaget medicinsk behandling. Mændene fik 1 ESWT behandling om ugen i 5 uger. Evaluering af patienterne incl.. deres erektile funktion og tilstand blev gennemført før f r start og umiddelbart efter behandlingerne samt 1 mdr. efter.

24 Resultater Gennemsnitsalderen var 58 år r (range 42-67). BMI 25 (range 18-33). Den gennemsnitlige varighed af den erektile dysfunktion var 69 måneder. m 10 mænd m (67%) havde co-morbiditet morbiditet. Alle gennemførte behandlingerne, og der blev ikke observeret nogen bivirkning eller smerte under/efter behandlingen.

25 Konklusion 11 mænd m (73%) havde umiddelbar effekt af ESWT behandling af penis for ED. Behandling er patientvenlig, har ingen bivirkning og kan gennemføres hos alle incl. patienter i AK-behandling behandling. Internationalt multicenter, placebo kontrolleret studie er planlagt mhp.. at kunne påvise p samme behandlings gevinst.