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

May 1, 2018 updated by: Kleiton Gabriel Ribeiro Yamaçake, University of Sao Paulo

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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:

  1. 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

  2. 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.

  3. 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.

Study Type

Interventional

Enrollment (Actual)

20

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
      • Sao Paulo, Brazil, 05403000
        • Kleiton Gabriel Ribeiro Yamaçake

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Extracorporeal Shockwave therapy
Extracorporeal shockwave therapy at the penis. 6 sessions.
Procedure: Extracorporeal shockwave therapy
Other: Penile ultrasound Doppler with intracavernosal injection application 20 mcg alprostadil
Diagnostic test will be performed before treatment and after 3 to 4 months after therapy.
Sham Comparator: Sham treatment
Extracorporal shockwave therapy with a placebo probe. 6 sessions
Other: Penile ultrasound Doppler with intracavernosal injection application 20 mcg alprostadil
Diagnostic test will be performed before treatment and after 3 to 4 months after therapy.
Procedure: Extracorporeal shockwave therapy - sham treatment
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.

What is the study measuring?

Primary Outcome Measures

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

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Sao Paulo

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2015

Primary Completion (Actual)

May 1, 2018

Study Completion (Actual)

May 1, 2018

Study Registration Dates

First Submitted

March 15, 2015

First Submitted That Met QC Criteria

April 5, 2015

First Posted (Estimate)

April 9, 2015

Study Record Updates

Last Update Posted (Actual)

May 2, 2018

Last Update Submitted That Met QC Criteria

May 1, 2018

Last Verified

May 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 41528915.5.0000.0068
  • 964.653 (Other Identifier: number of the opinion of the committee of ethics and research)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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