Investigating the effectiveness and safety of combining low-intensity extracorporeal shock wave therapy with tadalafil and L-arginine for the treatment of erectile dysfunction.

This study investigated the effectiveness and safety of combining low-intensity extracorporeal shock wave therapy (Li-ESWT) with tadalafil (Cialis) and L-arginine for the treatment of patients with mild and moderate erectile dysfunction (ED). The data showed that daily therapy with tadalafil and L-arginine increased the effectiveness and the duration of benefits of Li-ESWT for these patients.

ED consists of the inability to get and keep an erection firm enough for sex. This has a negative impact on the quality of life of men. The standard primary treatment is with phosphodiesterase-5 (PDE5) inhibitors. PDE5 inhibitor such as tadalafil has been shown to improve ED symptoms by increasing the blood flow to the penis and helping to maintain an erection. L-arginine is an amino acid found in food. It can improve the functioning of blood vessels. However, a significant number of these patients still do not manage to have satisfactory intercourse despite treatment with these medications.

Low-intensity extracorporeal shock wave therapy (Li-ESWT) has recently been introduced as a new therapeutic approach for treating ED. Li-ESWT allows for an increase in penile blood flow by delivering low-intensity (non-harmful) shock waves to the penis. These are believed to stimulate the formation of new blood vessels, which is important in achieving an erection. Li-ESWT is an alternative treatment option for men who do not respond to or tolerate, drug therapy with PDE5 inhibitors. However, there are no studies investigating the effectiveness and safety of combining Li-ESWT with tadalafil and L-arginine for the treatment of patients with mild and moderate ED.

This study involved 100 patients with mild and moderate ED. Patients were randomly assigned into 2 groups. Group 1 included 50 patients who received Li-ESWT plus daily oral therapy with tadalafil (5 mg) and L-arginine (2500 mg). Group 2 included 50 patients who received Li-ESWT alone. The patients were followed up for 12 months.

Erectile function was evaluated through a standardized International Index of Erectile Function domain (IIEF-EF) questionnaire. Patients were also evaluated using the Erection Hardness Score (EHS). An EHS of higher than 2 indicates the penis is hard enough for penetration.

After 1, 6, and 12 months of follow-up, the average IIEF scores measuring erectile function improved in group 1 compared to group 2. After 1 and 6 months of follow-up, the average EHS scores also improved in group 1 compared to group 2.

There were no side effects reported in either group.

This study concluded that daily therapy with tadalafil and L-arginine was safe and effective in increasing the effectiveness and the duration of benefits of Li-ESWT for the treatment of patients with mild and moderate ED.

This study did not include patients with severe ED. This study did not include a placebo group.