Effects of Low-intensity Shockwave Therapy Versus Kegel Exercises on Arteriogenic Erectile Dysfunction in DM Patients

* To assess the effectiveness of low-intensity shockwave therapy (Li-ESWT) in the management of Arteriogenic erectile dysfunction in diabetic patients.
* To assess the effectiveness of Kegel Exercises in the management of Arteriogenic erectile dysfunction in diabetic patients.
* To compare the effectiveness of Li-ESWT and Kegel Exercises in the management of Arteriogenic erectile dysfunction in diabetic patients.

Erectile dysfunction is defined as the persistent inability to attain and maintain an erection enough to permit satisfactory sexual performance. Although ED is a benign disorder, it may affect physical and psychosocial health and may have a significant impact on the quality of life of sufferers and their partners.

According to the underlying causes, ED can be classified as psychogenic, endocrinologic, neurogenic, and vasculogenic. Vasculogenic erectile dysfunction is defined as an inability to get or keep an erection firm enough for sexual intercourse due to diseases such as diabetes mellitus and atherosclerotic vascular occlusive disease .

ED has been reported to occur in ≥50% of men with DM worldwide. It is usually present within 10 years of diagnosis of DM. The incidence of ED was reported to be higher in men with DM than for men without DM and up to 12% of men who present with ED were found to have previously undiagnosed DM.

Low-intensity extracorporeal shock wave therapy (Li-ESWT) was used in both in vitro and in vivo studies and the results showed that this energy can stimulate angiogenesis. The idea of applying Li-ESWT to the penis came from animal studies in which Li-ESWT was applied to the myocardium of pigs, where it has been reported that there was an improvement in ischemia-induced myocardial dysfunction.

Low-intensity extracorporeal SW therapy (Li-ESWT) of the penis would improve penile blood flow and endothelial function by stimulating angiogenesis in the corpora.

Oral phosphodiesterase-5 inhibitors (PDE-5 inhibitors), such as sildenafil and tadalafil, are usually the first-line treatment of erectile dysfunction. They are effective in a wide range of etiologies including cardiovascular disease, diabetes, and hypogonadism.

Contraction of the ischiocavernosus participates in the process of enhancing erectile rigidity by compressing the roots of the corpora cavernosa and inducing short-term suprasystolic intracavernosal pressures.

Further, bulbospongiosus contraction leads to temporary engorgement of the glans penis and corpus spongiosum and results in similar short-term increases in intra spongiosal pressures.

Eligibility Criteria:
Inclusion Criteria:

1. Ninety married men were diagnosed with T2DM participated in this study.
2. The patients complained from arteriogenic ED \> 6 months (Reisman et al., 2015) before the participation in this study
3. All patients aged between 35-55 years old.
4. Glycated hemoglobin (HbA1c) less than 9%.
5. Body mass index of the patients was \< 30 Kg/m2.

Exclusion Criteria:

1. Alcohol-abuse, illegal drug consumer patients.
2. Patients with cardiac diseases that prevent or affect sexual activity (heart attack, stroke, heart failure, myocardial infarction life-threatening, arrhythmia, etc within the previous 6 months).
3. Patients with any pulmonary, liver, or kidney diseases.
4. Patients with neurological insults, spinal cord injuries, stroke, polyneuropathy, etc.
5. Patients with diagnosed psychiatric/mental complaints.
6. Patients with blood pressure of more than 140/90 mmHg.
7. Patients with peripheral vascular disease.
8. Patients with venogenic ED.
9. Patients with past radical prostatectomy, extensive pelvic surgery, or previous pelvic trauma.
10. Patients recovering from cancer in the past 5 years
11. Penile anatomical abnormalities.
12. Patients with clinically significant chronic hematological disease.
13. Patients who received Anti-androgens or radiotherapy treatment of pelvic region.
14. Patients with untreated hypogonadism.
15. Patients with psychogenic ED (normal nocturnal penile tumescence parameters)
16. Patient with penile prosthesis