Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial

Int Urol Nephrol. 2018 Nov;50(11):2007-2014. doi: 10.1007/s11255-018-1987-6. Epub 2018 Sep 19.


Aim: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP).

Materials and methods: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients).

Results: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively).

Conclusions: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.

Keywords: Cystoprostatectomy; Low-intensity shock wave; Nerve sparing; Penile rehabilitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Carcinoma / pathology
  • Carcinoma / surgery*
  • Cystectomy / adverse effects
  • Cystectomy / rehabilitation*
  • Erectile Dysfunction / etiology
  • Erectile Dysfunction / rehabilitation*
  • Extracorporeal Shockwave Therapy / methods*
  • Humans
  • Male
  • Middle Aged
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • Prostatectomy / adverse effects
  • Prostatectomy / rehabilitation*
  • Recovery of Function
  • Treatment Outcome
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / surgery*


  • Phosphodiesterase 5 Inhibitors