Extracorporeal Shockwave Therapy in the Treatment for Erectile Dysfunction in Male Renal Transplant Recipients

Study Overview
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Brief Summary
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The primary objective of this study is to determine the impact of the shock wave application in renal transplant patients with diagnosis of erectile dysfunction. Secondary objectives are to assess the effects of therapy on quality of life and depression. It is expected that with the study is defined the usefulness of the therapy and the dissemination of knowledge generated for change in clinical management in renal transplant patients with erectile dysfunction.

Detailed Description
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The Renal Transplant Unit, performs about 230 kidney transplants per year and has a screening service for registration of candidates for renal transplantation, interviewing about 70 patients a month. Since the potential and likely benefits of extracorporeal shock wave therapy in these patients as well as the anticipation of mild side effects, there is no reason for refusal to participate in the study. Patients who meet the inclusion criteria will be divided into 2 groups using a randomization table created by computer. Patients will be followed for 2 years. The study procedure and monitoring will be performed on an outpatient basis. Patients are divided into a group of extracorporeal shockwave (ESWT) treatment and placebo in a ratio of 1: 1 using a table of random numbers generated by computer. The ESWT protocol is protocol-based suggested by Vardi et al. 6. Patients will undergo a 2 treatment sessions per week for 3 weeks. The penis is pulled manually, and shock waves are applied throughout the penile shaft (except the glans) and the crura bilaterally. The duration of each ESWT session will be approximately 10 minutes and 2000 shocks will be applied per session with an intensity of energy of 1 mJ / mm 2. The volume of penile tissue exposed to shock waves at each site will be cilyndric (diameter: 18 mm, height 100 mm). No local or systemic analgesia is required during the procedure. To placebo therapy will be used the same device. The effective probe will be replaced by a similar one that emits zero energy during each treatment. Local application generates noise and a feeling of popping at the application site which will also be experienced by patients in the placebo group being impossible for the patient to discern which treatment group belongs. Penile ultrasound Doppler and drug erection will be performed before therapy and after treatment to evaluate the results. The diameter of the cavernous arteries is measured before and after intracavernosal injection application 20 mcg alprostadil (Caverject ®). In addition, vascular disorders, or stenotic atheromatous lesions will be investigated. The systolic and diastolic velocities of the cavernous arteries are evaluated 5,10 and 15 minutes after drug injection. After obtaining the patient signed informed consent , will be included in the study. Laboratory tests will be held at the Hospital Laboratory. Studied variables The following parameters will be studied during the initial evaluation and follow-up: Clinical Quality of life questionnaire -WHO QOL (World Health Organization - Quality of Life) Sexual questionnaire IIEF (International Index of Erectile Function) Comorbidities such as hypertension, diabetes and cardiovascular disease Smoking Laboratory Total testosterone, free testosterone, progesterone, albumin, SHBG, FSH, LH, prolactin, complete blood count, urea, creatinine, total cholesterol and fractions, triglycerides, T3, T4F and TSH. Imaging tests Ultrasound Doppler penile before and 3 months after treatment. - Calculation sample To define the sample size, the investigators must take into account: data variability (within each group) and the difference the investigators want to observe the parameters to be studied before and after treatment, beyond the level of significance and power of the test. The investigators will assume that the data follow a normal distribution and will use the paired t-test methodology, considering that the same patients will be evaluated in both conditions. The level of significance that work is 5%. Suitable power will be considered to be greater than 80%. The investigators observe a difference to 5 points required amount of samples is very small, whereas only 3 patients t-test. for the non-parametric test we consider a sample of 4 patients.

Official Title
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Extracorporeal Shockwave Therapy in the Treatment for Erectile Dysfunction in Male Renal Transplant Recipients

Conditions
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Erectile Dysfunction, Renal Transplant

Intervention / Treatment
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* Procedure: Extracorporeal shockwave therapy
* Procedure: Extracorporeal shockwave therapy - sham treatment
* Other: Penile ultrasound Doppler with intracavernosal injection application 20 mcg alprostadil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male patients between 40 and 70 years Kidney transplant for at least 6 months Erectile dysfunction (ED) for at least 6 months. Patients with IIEF score <21 Functioning kidney graft. Exclusion Criteria: ED because of known endocrine disease (e.g., hypogonadism, hypothyroidism) ED due to drug treatment (androgen deprivation therapy, for example) ED due to neurological disease (spinal cord injury, for example) ED due to structural abnormality of the penis History of radical prostatectomy or other pelvic surgery History of pelvic irradiation penile implant coagulopathies or on anticoagulants

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Extracorporeal Shockwave therapy<br>Extracorporeal shockwave therapy at the penis. 6 sessions. | Procedure: Extracorporeal shockwave therapy<br> <br> Other: Penile ultrasound Doppler with intracavernosal injection application 20 mcg alprostadil<br>* Diagnostic test will be performed before treatment and after 3 to 4 months after therapy.<br>|
| Sham Comparator: Sham treatment<br>Extracorporal shockwave therapy with a placebo probe. 6 sessions | Procedure: Extracorporeal shockwave therapy - sham treatment<br>* A probe similar to the treatment group will be used. The noise and appearance is similar. The probe emits zero energy during each treatment. Local application generates noise and a feeling of popping at the application site which will also be experienced by patients in the placebo group being impossible for the patient to discern which treatment group belongs.<br>Other: Penile ultrasound Doppler with intracavernosal injection application 20 mcg alprostadil<br>* Diagnostic test will be performed before treatment and after 3 to 4 months after therapy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changing in International Index of Erectile Function (IIEF-5) from baseline |  | 1 month, 3 months, 6 months, 1 year, 2 years | 
| Changing in Erection Hardness score from baseline |  | 1 month, 3 months, 6 months, 1 year, 2 years | 
| Changing in The World Health Organization Quality of Life (WHOQOL) from baseline |  | 1 month, 3 months, 6 months, 1 year, 2 years | 
| Changing in Peak systolic velocity by Penile doppler ultrasonography |  | baseline ( previous to treatment) and 3 months after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Erectile Dysfunction, Shockwave therapy, Renal Transplant, Male, Renal Transplant Recipients