全方位勃起功能障礙治療
Comprehensive Treatment of Erectile Dysfunction
#Dr. Po-Jen Huang
#Urologist #Surgeon #PainSpecialist
#ErectileDysfunctionTreatment #SexualDysfunctionTreatment
這裡引用歐洲泌尿科醫學會治療指引的評論來做總結：
Here, I summarize by quoting the comments from the European Association of Urology guidelines：
5.6.11.2。靜脈結紮手術
由於長期效果不佳，不再建議治療靜脈閉塞功能障礙的靜脈結紮手術
5.6.11.2. Venous ligation surgery
Venous ligation surgery for veno-occlusive dysfunction is no longer recommended because of poor long-term results.
Reference:
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:
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:
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:
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:
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949743/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10890328/
高壓氧治療（Hyperbaric Oxygen Therapy，HBOT）是一種在醫學領域中被廣泛應用的治療方法，
其主要通過將患者置於高於大氣壓的環境中吸入純氧來達到治療效果。
這種治療方式最初應用於潛水減壓症(潛水夫症)、壞疽和一氧化碳中毒等急性病症，
隨著研究的深入，
其適應症逐漸擴展到慢性病及其他臨床領域(註一)。
高壓氧治療原理：
在高壓氧環境下，
患者血液中的氧氣含量顯著增加，
改善組織缺氧狀態，
促進細胞修復和再生。
氧氣的高滲透性和高擴散性使其能夠更有效地到達受損組織，
提高細胞的新陳代謝能力，
促進傷口癒合和感染控制。
此外，
研究還顯示，
高壓氧治療具有抗炎、抗菌和改善血管生成等多種生理作用，
這使得其在多種臨床應用中表現出色。
高壓氧治療男性勃起功能障礙：
2018年以色列的研究(https://www.nature.com/articles/s41443-018-0023-9)表明，
高壓氧治療在性功能障礙，
特別是勃起功能障礙（Erectile Dysfunction，ED）的治療中，
也展現出潛在的療效。
該前瞻性研究找來30位平均年齡59歲、患有勃起障礙平均4.2年的患者
進行每週 5 天、共 40 次的高壓氧治療(註二)
除了IIEF問卷
亦在治療前及治療後用核磁共振(MRI)追蹤海綿體血流
結果發現
高達八成(24/30)患者自覺勃起功能改善
MRI也顯示海綿體有顯著的血管生成，
海綿體內 K-trans 值顯著增加153.3±43.2%（p<0.0001）
高壓氧治療通過改善陰莖海綿體的血流和組織氧合，
提供了一種新穎且潛力巨大的替代療法。
黃醫師總結：
高壓氧治療不僅在急性病症的處理上顯示出顯著的效果，
還在慢性病症和功能障礙的治療中展現出廣泛的應用前景。
隨著更多臨床試驗和研究的開展，
我們期待有更多有效的勃起功能治療方式
為患者提供更加全面、個人化的治療方案！
註一：
以下為高壓氧治療適應症：
空氣或氣體栓塞
急性燒燙傷
一氧化碳中毒
視網膜中央動脈阻塞
產氣性壞疽
受損的移植物和皮瓣
腔室症候群等急性缺血
減壓症(潛水夫症)
遲發性放射損傷
促進傷口癒合
突發聽力損失
顱內膿腫
壞死性軟組織感染
難治性骨髓炎
嚴重貧血
自體免疫疾病
新冠後遺症
癌症輔助治療
勃起功能障礙
缺血性中風和腦損傷
抗老化潛力
註二：
高壓氧艙（HAUXLife-Support GmbH，德國）
在 2 大氣壓下暴露於 100% 氧氣中 90 分鐘，每 30 分鐘休息 5 分鐘。
References:
A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities
https://www.mdpi.com/1648-9144/57/9/864
Hyperbaric Oxygen Therapy (HBOT) is a widely used treatment method in the medical field that primarily involves placing patients in an environment with higher-than-atmospheric pressure to inhale pure oxygen.
Initially, this treatment was applied to acute conditions such as decompression sickness (the bends), gangrene, and carbon monoxide poisoning.
As research has progressed, its indications have gradually expanded to include chronic diseases and other clinical applications (Note 1).
Principles of Hyperbaric Oxygen Therapy:
In a hyperbaric oxygen environment, the oxygen content in the patient's blood significantly increases, improving tissue hypoxia, and promoting cell repair and regeneration.
The high permeability and diffusibility of oxygen allow it to more effectively reach damaged tissues, enhance cellular metabolism, and promote wound healing and infection control.
Additionally, studies have shown that HBOT has anti-inflammatory, antibacterial, and angiogenic properties, making it effective in various clinical applications.
HBOT for Erectile Dysfunction:
A 2018 study from Israel (https://www.nature.com/articles/s41443-018-0023-9) demonstrated that HBOT shows potential efficacy in treating sexual dysfunction, particularly erectile dysfunction (ED).
This prospective study involved 30 patients with an average age of 59, who had experienced erectile dysfunction for an average of 4.2 years.
They underwent HBOT five days a week for a total of 40 sessions (Note 2).
Besides the International Index of Erectile Function (IIEF) questionnaire, MRI was used to track penile blood flow before and after treatment.
The results showed that up to 80% (24/30) of patients reported an improvement in erectile function.
MRI also revealed significant angiogenesis in the corpora cavernosa, with the K-trans value increasing by 153.3±43.2% (p<0.0001).
HBOT improves blood flow and tissue oxygenation in the penile corpora cavernosa, providing a novel and potentially significant alternative therapy.
Dr. Huang's Conclusion:
HBOT not only shows remarkable effects in managing acute conditions but also demonstrates extensive potential in treating chronic diseases and functional disorders.
As more clinical trials and research are conducted, we look forward to more effective treatments for erectile dysfunction, offering patients more comprehensive and personalized therapeutic options!
Note 1:
Indications for HBOT include:
1. Air or gas embolism
2. Acute burns
3. Carbon monoxide poisoning
4. Central retinal artery occlusion
5. Gas gangrene
6. Compromised grafts and flaps
7. Acute ischemias like compartment syndrome
8. Decompression sickness (the bends)
9. Delayed radiation injuries
10. Enhanced wound healing
11. Sudden hearing loss
12. Intracranial abscess
13. Necrotizing soft tissue infections
14. Refractory osteomyelitis
15. Severe anemia
16. Autoimmune diseases
17. Post-COVID syndrome
18. Cancer adjunctive treatment
19. Erectile dysfunction
20. Ischemic stroke and brain injuries
21. Anti-aging potential
Note 2:
Patients were treated in a hyperbaric chamber (HAUX-Life-Support GmbH, Germany) at 2 atmospheres absolute (ATA) with 100% oxygen for 90 minutes, with a 5-minute break every 30 minutes.
References:
A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities
