Hypothesis / aims of study
Rehabilitation of patients after radical prostatectomy (RPE) remains an important problem, since most men develop erectile dysfunction (ED) in the postoperative period, even taking into account nerve-sparing techniques. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after robot-assisted nerve-sparing radical prostatectomy.
Study design, materials and methods
The pilot study included 14 men who underwent one or two side robot-assisted nerve-sparing RPE more than 3 months ago, PSA total was less than 0.2 ng/ml 3 months or more after surgery in all men. The mean age was 57.8±6.2 years (49-72), the mean ED duration was 7.6±3.9 months (3-16). Pathologic stage: T1c - 2 (14.3%), T2a - 4 (28.6%), T2b - 2 (14.3%), T2c - 4 (28.6%), T3a - 1 (7.14%), T3b - 1 (7.14%). All patients receive 2 sessions. Session 1 included ESWT (Dornier Aries) per penile and PRP injections into penile, finally PRP was activated with ESWT, session 2 included ESWT per penile. Each ESWT sessions were comprised 5000 pulses (0.05-0.096 mJ/mm2) and 8-5 Hz of frequency. The patients were examined on 0 and 60 days of the research using IIEF-5, EHS, SEP, GAQ, D-PDU, IPSS, QOL, total serum testosterone. Inclusion criterias: absence of metastases to distant organs and lymph nodes, IIEF-5 less than 21 points after RPE, PSV less than 30 cm/s and/or RI less than 0.8 according to the D-PDU after RPE, the presence of erections before RPE. The study was approved by Ethics Committee of the RUDN Medical Institute.
Results
No side effects were recorded. IIEF-5 increased from 9.86±6.02 (0-20) to 17.93±4.5 (11-24) (p<0.05). SEP increased from 1.93±1.49 (0-5) to 3.29±1.69 (2-5) (p=0.002). EHS increased from 1 (IQR%, 1-2) to 3 (IQR%, 2-3) (p=0.002). IPSS c 5±3.46 (0-11) decreased to 3.21±2.75 (0-7) (p=0.007). QOL changed from 4.29±1.68 (1-6) to 4.43±1.6 (1-6) (p=0.58). According to D-PDU data, PSV along the left cavernous artery (CA) increased from 17.9 cm/s (IQR%, 14-20.2) to 26.3 cm/s (IQR%, 21.1-29.7) (p=0.001). RI on the left CA increased from 0.85±0.14 (0.58-1) to 0.9±0.09 (0.77-1) (p=0.018). Total blood testosterone changed from 15.79±3.52 nmol/L (9.2-20.83) to 16.31±3.84 nmol/L (10.9-23.4) (p=0.192). According to GAQ, 11 patients (78.5%) noted a positive effect of treatment.
Interpretation of results
There is a positive trend in relation to a significant improvement in erectile function in all patients according to validated questionnaires and D-PDU. The proposed treatment is a promising method of rehabilitation of men in this population.