Low-intensity Extracorporeal Shockwave Therapy for the Management of Postprostatectomy Erectile Dysfunction: A Systematic Review of the Literature.

Context: Erectile dysfunction (ED) following radical prostatectomy is a concern for patients and their partners. Low-intensity extracorporeal shockwave therapy (LI-ESWT) can potentially enhance tissue repair and regeneration. The aim of the current study was to systematically review the literature to assess the role of LI-ESWT in the management of patients with postprostatectomy ED. Evidence acquisition: Two authors independently performed a systematic search of the PubMed and Web of Science databases to identify all relevant articles. Non-English reports, case reports, reviews, letters, and editorials were excluded. Risk of bias was assessed according to the GRADE guidelines. Evidence synthesis: Nine articles met the inclusion criteria and were included in the qualitative analysis. All the studies included were published between 2015 and 2022 and the majority of them compared phosphodiesterase type 5 inhibitors (PDE5Is) alone versus a combination of LI-ESWT and PDE5Is. Only three studies were randomized controlled trials (RCTs). In general, there is no standardized protocol for LI-ESWT for postprostatectomy ED. In comparisons of LI-ESWT + PDE5Is versus PDE5Is alone, some authors found a statistically significant improvement in erectile function with LI-ESWT + PDE5Is. The starting time for LI-ESWT differed among the studies, ranging from 3 d to 6 mo after surgery. The main limitations of the review are the scarcity of studies, small sample sizes, high risk of bias, and high heterogeneity among studies. Conclusions: There is currently limited evidence on the use of LI-ESWT either alone or in combination with PDE5Is in penile rehabilitation protocols after prostatectomy. However, small clinical trials with short follow-up show that LI-ESWT could potentially play a role in the management of postprostatectomy ED in the future. Further RCTs with larger sample sizes are needed. Patient summary: Despite limited reports in the literature, low-intensity shockwave therapy after removal of the prostate is a promising noninvasive treatment for dealing with erectile dysfunction after surgery.

Potential effectiveness of pelvic floor rehabilitation treatment for postradical prostatectomy incontinence, climacturia, and erectile dysfunction: a case series.

INTRODUCTION: Radical prostatectomy is the treatment of choice for prostate cancer; although novel techniques have significantly reduced its side effects, the procedure can provoke urinary incontinence of various degrees and/or erectile dysfunction. AIM: We evaluate the effect of a complete pelvic floor rehabilitation program on both incontinence and erectile dysfunction, including climacturia, in a preliminary case series. MAIN OUTCOMES MEASURES: Pad usage and International Index of Erectile Function (IIEF-15) Questionnaire. METHODS: Three male patients, previously submitted to nerve and bladder neck sparing radical prostatectomy, presented with urinary incontinence, climacturia and erectile dysfunction of new onset. We decided to manage those subjects with a pelvic-floor rehabilitation program consisting of active pelvic-floor muscle exercises, electromyography biofeedback for strength and endurance, electrical stimulation. The whole program lasted 4 months, with weekly sessions, including general advices on lifestyle changes. Pad usage for incontinence and IIEF-15 were used to assess symptoms before and after the procedure. RESULTS: Before a complete rehabilitation program, pad usage was 1 per day in all the subjects, and the score for erectile function was set at 17 (range 15-20). After the procedure, all the patients experienced a satisfying urinary continence and an improvement in erectile function (mean IIEF score: 22, range 19-24). Similarly, climacturia seems to be subjectively reduced in all the subjects. CONCLUSION: Pelvic floor muscles exercises seem to result in an improved urinary continence and erectile function after radical prostatectomy. Since this is the first clinical case series dealing with this topic, our outcomes are encouraging and suggest the potential usefulness of such noninvasive treatment modality.

Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: a combined rehabilitative approach for sexual dysfunction associated with urinary incontinence.

INTRODUCTION: Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. AIM: The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. MAIN OUTCOME MEASURES AND METHODS: We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. CONCLUSIONS: A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI.

Advantages of the supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: outcomes based on CT characteristics.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones can be performed in prone or supine position. The aim of this study was to investigate the advantages brought by the supine transgluteal ESWL approach for distal ureteral stones treatment using real-time ultrasound (US), and to show how computerized tomography (CT) scan parameters may be related to the outcomes. METHODS: Seventy consecutive supine transgluteal ESWL of distal ureteral stones were performed. All patients had a pre-treatment CT scan. The following parameter were evaluated: stone size, Hounsfield Units, skin-to-stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone-free status. Stone focusing was obtained US, which allows a real-time visualization of stone location and fragmentation. Follow-up included a kidney ureter bladder (KUB) film and US examination at 2-3 weeks after treatment (median time: 18 days). Stone-free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone-free status. P<0.05 was considered as significant. RESULTS: Median number of SWL sessions for patient was 1 (IQR: 1-1), mean 1.2±0.5. The re-treatment rate for stone-free patients was 18.3%. Stone-free rate was 85.7%. A clear and real time US stone fragmentation was perceived by the surgeon during the treatment in 42/70 (60%) of patients and correlated to the definitive stone-free status (P=0.04). Stone to ureteral ostium distance was the only variable affecting the stone-free condition (P=0.01). CONCLUSIONS: Supine transgluteal SWL of distal ureteral stones provide satisfactory outcomes in terms of stone-free rate. The distance of the stone to the ureteral ostium, measured by CT, appeared to be the only significant variable connected to SWL success.

Benign intratesticular schwannoma: a rare finding.

Schwannoma is a peripheral nerve tumour, occasionally located in the genitourinary tract. We described an extremely rare case of intratesticular neurinoma in a 79-year-old patient.

Chemical and Mineralogical Analysis of Ureteral Stent Encrustation and Associated Risk Factors.

OBJECTIVE: To assess the burden and chemical and mineralogical composition of stent coating at both stent ends, with evaluation of associated risk factors. MATERIALS AND METHODS: A total of 40 consecutive patients submitted to ureteral-stent removal were considered. Stents were previously positioned for both urolithiasis and during the management of other urologic diseases and/or procedures. Mean indwelling time was 59.2 ± 7.5 days. ANALYTICAL PROCEDURES: Encrustations were submitted to chemical-mineralogical analysis as well as to their quantification. Quantification was achieved by measuring the weight of stent fragments before and after oxidative acid treatment to dissolve the deposited (both organic and inorganic) material. The analytical solution obtained by acid attack was used to acquire information on calcium and magnesium content with atomic-absorption spectroscopy. X-ray diffraction was used to determine the mineralogy of encrustations for a group of stent samples characterized by relatively high amounts of deposited material. RESULTS: The composition of encrustations at the proximal coil reflected the composition of stones in patients with urolithiasis. Whewellite was the more common encrustant. In a regression model, the variable mostly related to the burden of proximal encrustation was urolithiasis (P = .04), especially in frequent stone formers. At the distal coil, higher degrees of encrustation were related to urinary tract infection (P = .012) and patient's aging (P = .05), thus suggesting a possible association with a bladder outlet dysfunction. CONCLUSION: The present study highlighted some variables related to stent encrustation and seems to be the first one analyzing separately the two coils. Our outcomes suggest that the so-obtained risk factors have to be considered when positioning a ureteral stent.