Erektil disfonksiyonda düşük yoğunlukta şok dalga tedavisi

Erektil disfonksiyon ED ; seksüel aktivite için yeterli ereksiyonu sağlayamamak ve/veya sürdürememek olarak tanımlanmaktadır. ED 40-70 yaş arası erkeklerin %50’sinden fazlasını etkilemektedir. ED genellikle penil dolaşımı etkileyen fonksiyonel ve/veya yapısal anormalliklerle ortaya çıkan bir durum olarak düşünülmektedir. Günümüzde erektil disfonksiyonun tedavisinde oral farmakoterapi, kavernöz içi enjeksiyon, penil protez takılması gibi birçok tedavi seçeneği bulunmaktadır. Son yıllarda ED’nun tedavisinde vücut dışından düşük yoğunlukta şok dalga tedavisi DYŞDT gibi bir çok yeni tedavi yöntemleri geliştirilmiştir. DY-ŞDT hücresel mikrotravma oluşturarak angiojenik faktörlerin salınımına yol açmakta ve neticede hedef dokuda yeni damar oluşumuna yol açmaktadır. Hayvan çalışmaları DY-ŞDT’nin penil hemodinamiği ve penisdeki patolojik değişiklikleri düzelttiğini göstermiştir. Son çalışmalarda DYŞDT’nin korpus kavernozumdaki fibromusküler patolojik değişiklikleri, endotelyal disfonksiyonu, ve periferal nöropatiyi düzelttiği bildirilmiştir. Bu derlemede DY-ŞDT’nin tarihçesi, etki mekanizması, in vitro-hayvan çalışmaları ve ED’da klinik uygulamaları özetlenecektir

Anahtar Kelimeler:

Erektil disfonksiyon, tedavi, vücut dışından düşük-yoğunluklu şok dalgaları

Low-intensity extracorporeal shock wave therapy of erectile dysfunction

Erectile dysfunction ED is defined as the inability to achieve and maintain a penile erection adequate for satisfactory sexual intercourse. ED is affecting almost 50% of men in the 40-70 year age range. ED is generally considered as a manifestation of a functional and/or structural abnormality affecting the penile circulation. The current treatment modalities in the management of ED mainly consist of oral pharmocotherapy, intracavernosal injections and implantation of penile prosthesis. In recent years, new therapeutic strategies as lowintensity extracorporeal shock wave therapy LIESWT have been estableshed for the treatment of ED. LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and subsequent neovascularization of the treated tissue. Animal studies have shown that LIESWT significantly improves penile hemodynamics and restores pathological changes in the penis. Recent studies have reported that LI-ESWT could partially restore corpus cavernosum fibromuscular pathological changes, endothelial dysfunction and peripheral neuropathy. In this review, the history, the effect mechanisms, in vitro and animal studies and the clinical use in ED of LI-ESWT were reviewed with current literature

Keywords:

Erectile dysfunction, therapy, low-intensity extracorporeal shock waves,

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