體外震波不是打越多發越好─性功能篇

 

低強度體外震波（LI-ESWT）是男性勃起功能障礙的標準治療選擇之一，

這種治療方法的原理在於，

震波的能量可以促進局部血管生成、改善微循環、從而增強陰莖的勃起功能。

然而，

隨著震波的應用越來越廣泛，

黃醫師在門診常遇到病人提出一個問題：震波治療的脈衝數量是否越多越好？

 

●脈衝數量的影響

根據2022的一篇系統性回顧與薈萃分析研究，

該研究納入了16項隨機對照試驗共1,064名病患，

除了分析體外震波對男性勃起功能障礙(ED)的療效外

另外還分析了體外震波不同的參數對治療結果的影響

 

該研究根據「每次治療的脈衝數」將隨機對照試驗分為三組：

「脈衝數等於 600」、「脈衝數在 1,500 至 2,000 之間」、「脈衝數大於 3,000」。

 

「600脈衝組」的結果：

與對照組相比，

治療組可以提高患者的IIEF，

但差異無統計學意義（MD = 1.50，95% CI = [−1.44, 4.43]，p = . 32）。

 

「脈衝數在1,500至2,000之間」的組別結果：

治療組可以顯著提高患者的IIEF（MD = 4.80，95% CI = [2.61, 7.00]，p < .0001）。

 

「脈衝數大於3000」的組別結果：

與對照組相比，

治療組也能顯著提高患者的IIEF，

差異有統計學意義（MD=3.46，95%CI=[1.89，5.03]，p< .0001 )。

 

然而有趣的是

雖然統計顯示後兩組皆能顯著提升患者勃起功能

但是

在統計圖上

脈衝數大於3000的組別

不僅沒有比脈衝數1,500至2,000之間的組別顯示更優越的結果

甚至還略低一些！

 

●脈衝能量的影響

該研究根據「設定的能量密度」將隨機對照試驗分為兩組：

「能量密度等於0.09 mJ/mm²」和「能量密度在0.1～0.2 mJ/mm²之間」。

結果顯示，

兩種能量密度組別皆可顯著提高患者的IIEF

 

然而有趣的是

在統計圖上

能量設定較高（0.1～0.2 mJ/mm²）的組別

效果反而略低於能量設定較低（0.09 mJ/mm²）的組別！

（0.09 mJ/mm²：MD = 3.81，95% CI = [2.07, 5.55]，p < .0001； 

0.1 –0.2 mJ/mm²：MD = 3.01，95% CI = [0.89, 5.12]，p = .005)。

●研究結論

該研究除了再次肯定體外震波對男性勃起功能障礙(ED)的療效外

並且有了以下發現：

不同能量密度或脈衝數的體外震波對勃起功能有不同的影響。

當能量密度為0.09 mJ/mm²時，IIEF的改善優於能量密度在0.1~0.2 mJ/mm²之間。

每次治療 1,500 或 2,000 次脈衝比 600 或 3,000 次脈衝帶來的改善更大。

不同嚴重程度的ED患者經LI-ESWT治療後IIEF的改善也不同。

透過統合分析，

發現中度 ED 患者的改善比輕度或重度 ED 患者更明顯。

另外，不同追蹤時間下IIEF的改善程度也不同。

追蹤6個月後的改善優於1個月和3個月後的改善。(註)

 

●黃醫師點評：

其實從原理就可以知道

震波並不是打越多發、能量越強效果就一定會越好

原因在於

體外震波的目的是「誘發」人體自我修復、再生能力

因此只要「打足量」能達到「誘發」的效果就好

打更多不但沒有意義

還可能造成反效果

 

因此黃醫師在此特別呼籲

使用體外震波治療男性勃起障礙時，

治療效果並非隨著脈衝數量、能量的增加而無限增強。

醫師應謹慎選擇適當的脈衝參數，

以確保治療的有效性和安全性。

對於重度患者或對治療無效的患者，

也不應盲目增加脈衝數量，

而應考慮其他輔助治療方法的結合使用。

病患也應該了解，

治療成功的關鍵，

不在震波數量的多寡，

而是醫師根據患者的情況制定治療方案，

讓患者獲得更好的療效和治療體驗。

 

References: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949743/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10890328/

 

（註─原文：By analyzing our results, we found that LI-ESWT had different effects on erectile function with different energy density or pulses.

When the energy density is 0.09 mJ/mm2, the improvement of IIEF is better than that in the energy density between 0.1 and 0.2 mJ/mm2. 

And 1,500 or 2,000 pulses per treatment bring more improvement than 600 or 3,000 pulses. 

The improvement of IIEF in patients with different severity of ED after LI-ESWT treatment is also different. 

Through our meta-analysis, we found that the improvement was more obvious in patients with moderate ED than in patients with mild or severe ED. 

In addition, the improvement of IIEF is different under different follow-up times. 

The improvement after 6 months follow-up is better than that after 1 month and 3 months. ）

 

 

Extracorporeal Shock Wave Therapy: More is Not Always Better – A Focus on Erectile Dysfunction

 

Low-intensity extracorporeal shock wave therapy (LI-ESWT) has become one of the standard treatment options for erectile dysfunction (ED) in men. 

The principle behind this therapy is that the energy from shock waves promotes local angiogenesis and improves microcirculation, thereby enhancing erectile function. 

However, as the application of shock wave therapy becomes more widespread, I frequently encounter a common question from patients in my clinic: Is more always better when it comes to the number of shock wave pulses used in treatment?

 

l  The Impact of Pulse Numbers

According to a systematic review and meta-analysis published in 2022, which included 16 randomized controlled trials (RCTs) with a total of 1,064 patients, the efficacy of LI-ESWT in treating ED was examined alongside the influence of different treatment parameters.

The study categorized the RCTs into three groups based on the number of pulses per treatment session:

• 600 pulses
• 1,500 to 2,000 pulses
• More than 3,000 pulses

 

Results for the 600-pulse group: Compared to the control group, the treatment group showed an increase in the International Index of Erectile Function (IIEF) score, but the difference was not statistically significant (MD = 1.50, 95% CI = [-1.44, 4.43], p = .32).

 

Results for the 1,500 to 2,000-pulse group: The treatment group showed a significant increase in IIEF score (MD = 4.80, 95% CI = [2.61, 7.00], p < .0001).

 

Results for the group with more than 3,000 pulses: Although this group also showed a statistically significant improvement in IIEF compared to the control group (MD = 3.46, 95% CI = [1.89, 5.03], p < .0001), interestingly, the results were slightly lower than those seen in the 1,500 to 2,000-pulse group.

l  The Impact of Energy Density

The study further categorized the RCTs into two groups based on energy density settings:

• 0.09 mJ/mm²
• 0.1 to 0.2 mJ/mm²

The results indicated that both energy density settings could significantly improve the IIEF scores. 

However, the group with a higher energy density (0.1 to 0.2 mJ/mm²) showed slightly lower effectiveness compared to the group with a lower energy setting (0.09 mJ/mm²). Specifically:

• 0.09 mJ/mm²: MD = 3.81, 95% CI = [2.07, 5.55], p < .0001
• 0.1 to 0.2 mJ/mm²: MD = 3.01, 95% CI = [0.89, 5.12], p = .005

 

l  Conclusion of the Study

This study not only reaffirms the effectiveness of LI-ESWT in treating ED but also highlights the varying effects of different energy densities and pulse numbers on erectile function. The study found that:

• An energy density of 0.09 mJ/mm² led to greater improvement in IIEF scores compared to an energy density between 0.1 to 0.2 mJ/mm².
• Treatment with 1,500 or 2,000 pulses per session resulted in greater improvement than with 600 or 3,000 pulses.
• Patients with moderate ED showed more significant improvements in IIEF than those with mild or severe ED after LI-ESWT treatment.
• The degree of improvement in IIEF also varied with follow-up time, with greater improvements observed at 6 months compared to 1 or 3 months of follow-up. 

l  Dr. Huang's Commentary:

From a theoretical standpoint, it's clear that simply increasing the number of shock wave pulses or the energy level does not necessarily lead to better results. 

The purpose of shock wave therapy is to "induce" the body's self-repair and regenerative capabilities. 

Therefore, as long as an adequate amount is applied to achieve this "induction," it is sufficient. 

Applying more than necessary has no added benefit.

Therefore, I urge that when using LI-ESWT to treat ED, the treatment efficacy does not increase indefinitely with the number of pulses or energy level. 

Physicians should carefully select appropriate pulse parameters to ensure both the effectiveness and safety of the treatment. 

For patients with severe ED or those unresponsive to other treatments, it is also important not to blindly increase the number of pulses but to consider combining other adjunctive therapies. 

Patients should understand that the key to successful treatment lies not in the quantity of shock waves but in a treatment plan tailored by the physician to their specific condition, ensuring better outcomes and treatment experiences.

 

 References: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949743/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10890328/

 

 

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什麼是「無明」？What is "Avidyā"?

"無明"（梵文：avidyā）是一個源自佛教的概念，

指的是對現實真相的無知或錯誤認識。

在佛教哲學中，

無明是導致生死輪迴（Samsara）和痛苦的根本原因之一。

具體來說，

無明指的是對「四聖諦」（苦、集、滅、道）以及「緣起法」（即一切事物的因果關係）的無知。

因為無明，

人們無法正確理解生命的本質，

誤以為有一個永恆不變的「自我」（我執），

從而生起貪欲、嗔恨、妄想等煩惱，導致生死輪迴的持續。

佛教教義強調，

要解脫痛苦，

必須通過修行來消除無明，

達到對真理的正確認識，

這樣才能破除煩惱，

最終達到涅槃（nirvana）這一解脫的狀態。

"Avidyā" (Sanskrit: avidyā) is a concept originating from Buddhism, referring to ignorance or misunderstanding of the true nature of reality. 

In Buddhist philosophy, avidyā is considered one of the fundamental causes of the cycle of birth and death (Samsara) and suffering.

Specifically, avidyā refers to ignorance of the "Four Noble Truths" (suffering, its origin, its cessation, and the path leading to its cessation) and "Dependent Origination" (the law of cause and effect underlying all phenomena). 

Due to avidyā, people are unable to correctly understand the nature of existence and mistakenly believe in an eternal, unchanging "self" (ego-clinging). 

This misunderstanding gives rise to desires, hatred, delusions, and other afflictions, perpetuating the cycle of Samsara.

Buddhist teachings emphasize that to be free from suffering, one must eliminate avidyā through spiritual practice, gaining a correct understanding of the truth. 

By doing so, one can overcome afflictions and ultimately attain nirvana, the state of liberation.

References:

《緣起經》

三藏法師玄奘奉詔譯

…

「云何無明？

謂於前際無知，於後際無知，於前後際無知；

於內無知，於外無知，於內外無知；

於業無知，於異熟無知，於業異熟無知；

於佛無知，於法無知，於僧無知；

於苦無知，於集無知，於滅無知，於道無知；

於因無知，於果無知，於因已生諸法無知；

於善無知，於不善無知；

於有罪無知，於無罪無知；

於應修習無知，於不應修習無知；

於下劣無知；

於上妙無知；

於黑無知，於白無知；

於有異分無知，於緣已生或六觸處，如實通達無知。

如是於彼彼處如實無知，無見無現觀，愚癡無明黑闇，是謂無明。」

 

 "The Sutra on Dependent Origination"

Translated by Tripitaka Master Xuanzang by Imperial Decree

...

"What is Ignorance (Avidyā)?

It refers to the ignorance of the past, the ignorance of the future, and the ignorance of both the past and the future;

The ignorance of the internal, the ignorance of the external, and the ignorance of both the internal and the external;

The ignorance of karma, the ignorance of its result, and the ignorance of the relationship between karma and its result;

The ignorance of the Buddha, the ignorance of the Dharma, and the ignorance of the Sangha;

The ignorance of suffering, the ignorance of its origin, the ignorance of its cessation, and the ignorance of the path leading to its cessation;

The ignorance of causes, the ignorance of effects, and the ignorance of the phenomena that arise from causes;

The ignorance of what is wholesome, the ignorance of what is unwholesome;

The ignorance of what is sinful, the ignorance of what is sinless;

The ignorance of what should be cultivated, the ignorance of what should not be cultivated;

The ignorance of what is inferior;

The ignorance of what is superior;

The ignorance of what is dark, the ignorance of what is light;

The ignorance of distinctions and the ignorance of the six sense bases and their corresponding contact as they arise.

In this way, there is ignorance of these various matters, a lack of true knowledge, a lack of insight, and a state of foolishness, ignorance, and darkness. This is called ignorance."