This research is a pilote study in the field in collaboration with dr. Nadim yamine (urologist) and jad wakim.

Did you know that erectile dysfunction will visit 40 % of man at the age of 40, and that half of man are suffering from ED at their 50s, and put in mind the longer ED hangs around, the worse it will get

The occasional difficulty in getting or keeping an erection is normal.1 It starts to become a problem when you have a persistent difficulty getting or maintaining an adequate erection for satisfactory sexual activity in the last 3 months

ED can occur because of problems at any stage of the erection process, and can be caused by many factors, like medications, surgeries, and psychological problems,, but The most common etiology for ED is vasculogenic disorder due to diabetes or cardio vascular disease not to forget the normal aging of the tissue when the penile arteries may be damaged to open properly and allow blood to enter in the 2 chambers of the corpora cavernosa to provoque erection

Patients with ED are effectively treated oraly with 20 milligrams of Phosphodiesterase type 5 inhibitors before the intercourse, and moderately with 5mg per day, these 2 treatments are associated with few side effects and don’t modify the pathophysiology of the erectile process , nevertheless a proportion of men do not respond to these therapies

For non responders alternative options could be: urethral suppositories for erection, PRP and penile prostheses. These options are effective, hence, long-term usage rates have side effects and complications.

extracorporeal focused or radial shock wave therapies are modalities that has been recently studied and developed for the treatment of the physiopathology of the erectile mechanism

When shock waves are applied to an organ, they cause mechanical stress and microtrauma, inducing a cascade of biological reactions that result in the release of angiogenic factors which inturn triggers neovascularization of the tissue with subsequent improvement of the blood supply.

Wang and colleagues discovered that ESWT stimulates the expression of angiogenesis-related growth factors, such as endothelial nitric oxide synthase and vascular endothelial growth factor, and endothelial cell proliferation factors, such as proliferating cell nuclear antigen. They also reported that ESWT induces neovascularization, and consequently improves blood supply.

The purpose of this study is: Will the radial extracorporeal shock wave therapy improve more the short and long term results for patients suffering from ED and taking 5mg of PDE-5 Inhibitors versus patients treated with only a same dosage of PDE-5 Inhibitors?

To answer these questions a single-blinded randomized controlled trial was conducted over 2 years, on 62 ED patients aged between 40 and 60 years referred by the urologist and undergoing the 5mg of PDE-5 Inhibitors treatment since minimum of 1 month

An experimental group composed of 32 ED patients with a daily intake of 5 mg of PDE-5 inhibitors for 6 months who received on the penile tissue 8 sessions, once per week, each session is executed by the same therapist(A). 9000 shocks of radial shock wave therapy every session at a pressure of 2 bars, and a frequency of 12hz.

The Comparative group is composed of 30 ED patients receiving only 5 mg of PDE-5 inhibitors per day for 6 months

Therapist B used the simplified International Index of Erectile function Questionaire :The possible scores range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25)

AT THE Start line (t0) and after 8 weeks from the beginning (t1), in addition to a follow-up after 6 months from the first day (t2) were tested by therapist B for the 5 criteria issued from the “International Index of Erectile Function IIEF-5” FOR both experimental and comparative groups

After using the statistical test “Shapiro-Wilk” both groups were normally distributed at T0. Independent T-test at t0 gave a non-significant difference between both groups, meaning both groups look similar at baseline

Dependent T-test was used to evaluate each group at T1 and T2 in comparison with T0 and gave significant results for each, meaning both treatments were efficient treating ED

Independent T-test was used to compare comparative group to the experimental group at t1 and t2 and gave a significant result,meaning that Li-ESWT combined to 5mg of PDE-5 was more efficient after 8 weeks and also after 6 months

To conclude We note that radial shockwave therapy combined to 5mg of PDE5is could have an important action on stimulating angiogenic factors and promoting neovascularization of the treated tissue which resulted in a higher increase in the score of the simplified international index of erectile function than PDE5is treatment alone even after 4 months from the last session

There is a big advantage in introducing radial shockwave therapy in the rehabilitation for patients suffering from ED and responding to 5mg of PDE-5 inhibitors. We can add this technique to our physical therapy field since its not an invasive technique to improve men’s health. This study is an added value to previous studies done around the globe to proove that extracorporeal shock wave therapy can help in the long term treatment of erectile dysfunction