The study focused on ability of low-intensity extracorporeal shockwave therapy (LI-ESWT), combination of рlatelet-rich plasma (PRP) plus LI-ESWT to correct erectile dysfunction (ED).

100 men were assigned into 3 groups. Group 1  (n=20) received LI-ESWT per penile (Dornier Aries)  twice weekly for 6 weeks, the median age was 43.5 years (20-60), the duration of ED was 3 years (0.5-12). Group 2 (n=40) received 2 therapy sessions per week during 6 weeks,  the median age was 43 years (19-71), the duration of ED was 3 years (0.5-15). 1st session included LI-ESWT per penile, 2nd session included LI-ESWT per penile and PRP injections into penile, finally PRP was activated with LI-ESWT. Group 3 (n=40) received 2 therapy sessions per week during 6 weeks.  the median age was 48 years (21-71), the duration of ED was 2.25 years (0.5-6). 1st session included LI-ESWT per penile, 2nd session included LI-ESWT per penile and PRP injections into penile, finally PRP was activated with 10.0% CaCl2. All men were evaluated at the beginning and at the end of the study (60 day) using IIEF-5, EHS, SEP, GAQ, total testosterone level, PDDU (median (IQR%).

In group 1 IIEF-5 improved from 14.5 (10.5-17) to 19.5 (15.5-21) (р=0.001894) at 60 days. SEP changed  from 2 (1-2) to 3 (2-4) (р=0.000068) after LI-ESWT. EHS improved from 1.5 (1-2) to 3 (2.5-3) (р=0.000002). Baseline PSV was 16.3 cm/s (12.2-22.7), at 60 days post LI-ESWT was 24 cm/s (19.4-26.8) (р=0.005549) and RI changed  from 0.7 (0.7-0.9) to 0.9 (0.8-1) (р=0.007645) according PDDU. Total testosterone level also increased from 13.6 nmol/l (9.3-16.6) to 14.4 nmol/l (10.9-18.5) (р=0.310357) after LI-ESWT. 14 patients (70 %) noted positive dynamics by GAQ at the last exam. In group 2 IIEF-5 was 13 (11-15) at 0 days,  18 (16-20) at 60 days (р<0.000001). SEP improved from 2 (1.5-2) to 3 (3-4) post combined treatment (р<0.000001). EHS changed from 2 баллов (1-2) to 3 (2-3)  (р<0.000001) at the last exam. PDDU results demonstrated increase median PSV 15.6 cm/s (12.1-22.8) to 27 cm/s (20.6-33.5) (р=0.000002) and median RI from 0.8 (0.7-1) to 1 (0.8-1) (р=0.020009). Total testosterone level elevated from 14.9 nmol/l (9.9-20.7) to 16.4 (11.9-20.8) (р=0.4).  34 men declared positive effects of this therapy according to GAQ (85 %). In group 3 IIEF-5 results improved from 13 (9-15) to 18.5 (15-20.5) (р=0.000003). SEP was 2 (1-2) in 0 days and 3 (3-4) at 60 days (р<0.000001). EHS changed from 1 (1-2) to 3 (3-3) (р<0.000001). PSV increased from 17 cm/s (10.3-25) to 27.8 cm/s (20-36.6) after PRP+LI-ESWT (р=0.000110), RI improved from 0.8 (0.7-0.9) to 0.9 (0.8-1) (р=0.005576). Median baseline total testosterone level was 14.9 nmol/l (10.8-21), after treatment was 17.1 nmol/l (14-22.6)  (р=0.135831). 33 patients respond to an improvement  of erectile functions (82.5 %) by GAQ.

The proposed treatment affects the main links in the pathogenesis of the ED.

These suggested treatments were well-tolerated. We declared a positive trend in terms of improving erectile function and increasing the level of total blood testosterone. Intergroup comparing demonstrates that  combination therapies significantly increase erectile function according to SEP, EHS, PDDU.