A Prospective, Randomized, Double-Blinded, Clinical Trial Using a Second-Generation Duolith SD1 Low-Intensity Shockwave Machine in Males with Vascular Erectile Dysfunction

Chung Eric,Bailey William,Wang Juan 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: To evaluate the clinical efficacy and patient satisfaction rates of low-intensity extracorporeal shockwave therapy LIESWT) in men with vasculogenic erectile dysfunction (ED) using Duolith SD1 machine. Materials and Methods: This prospective, randomized, double-blinded clinical trial included 60 men who were randomly as-signed to LIESWT (n=30, active group) or placebo (n=30) over 6 weeks. Patient demographics, change in International Index of Erectile Function (IIEF)-5, Erection Hardness Score (EHS) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, and an overall satisfaction score (on a 5-point scale), were recorded. All patients were reviewed at 1, 3, and 6 months after completion of therapy. Results: There were 21 (70%) patients in the LIESWT group and 3 (10%) patients in the placebo group who had a 5-point or greater increase in IIEF-5 score (p=0.018). At 6-month study period, the mean IIEF-5 score was 18.8 (standard deviation [SD], 3.8) in the LIESWT group versus 14.8 (SD, 3.6) in the placebo group, difference in means between groups was 4.0 (95% con-fidence interval, 2.1–5.9; p<0.001). The EHS scores were higher in the LIESWT group with a mean of greater than 1.2 across the 1, 3, and 6 months compared to the placebo group (p<0.05). All patients completed the treatment study and there was no adverse event reported in terms of penile pain, bruising or deformity. There was a positive correlation between men who reported improvement in EF and treatment satisfaction level with LiESWT (p=0.008). Conclusions: LIESWT improves erectile function in the short-term especially in men with mild to moderate ED, and those without a cardiometabolic disease.

Guaranteed A Posteriori Error Estimates for a Staggered Discontinuous Galerkin Method

Chung, Eric T.,Park, Eun-Jae,Zhao, Lina Springer-Verlag 2018 Journal of scientific computing Vol.75 No.2

Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis?

Eric Chung,Brian Ng Hung Shin,Juan Wang 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.3

Purpose: A buried penis causes voiding dysfunction and limits penetrative sexual intercourse. This pilot study evaluates the urinary outcomes in men with buried penis following insertion of malleable penile implants. Materials and Methods: Men with buried penis and co-existing urinary problems and erectile dysfunction underwent malleable penile prosthesis implantation were reviewed in a prospective ethics approved database. Patient demographics, flow rate (Qmax), International Prostate Symptom Score (IPSS), Patient Global Impression of Improvement (PGI-I) score, International Index of Erectile Function (IIEF)-5 score, Sexual Encounter Profile (SEP) and overall satisfaction score (on a 5-point scale) were recorded. Results: A total of 12 men (age 55 to 72 years) were reviewed, and the average gain in penile length post-implant, as measured from the pubis to the tip of the glans penis, was 6.8 (3 to 8) cm. There was a significant improvement in IIEF-5 score (8.2 vs. 22.5; p=0.029) post-implant, and more than half of patients were able to resume normal sexual intercourse and positive SEP-2 and SEP-4 were reported in 9 (75%) and 8 (67%) patients. There were no significant intraoperative or postoperative complication. Significant improvement in Qmax (8.4 ml/s vs. 18.6 ml/s; p=0.042) and IPSS (24.5±5.5 vs 15.5±3.5; p=0.038) were observed. More than two-thirds (83%) reported PGI-I score at 1 or 2, while 9 (75%) patients scored a 5/5 in overall satisfaction rate. Conclusions: Malleable penile implants increases penile length and improves urinary function in a highly select group of men with a buried penis and erectile dysfunction.

Penile Reconstructive Surgery in Peyronie Disease: Challenges in Restoring Normal Penis Size, Shape, and Function

Eric Chung 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.1

To provide an overview of current approaches to penile reconstructive surgery in Peyronie disease (PD), and to discuss the challenges in restoring normal penile size and function. A systematic literature search was conducted to identify the published literature relevant to PD and penile reconstructive surgery. A summary of the published guidelines from major organisations is included in this review paper. Penile plication is simple and minimally invasive, and tends to preserve potency in most patients. However, plication invariably results in penile length loss and may, in fact, worsen the existing hour-glass or hinge effect. In contrast, graft reconstructive surgery can address issues relating to the loss of penile length and complex penile deformities, but long-term data highlight the risks of altered glans sensation, recurrent curvature, and/or loss of penile length from graft contracture, as well as the development of erectile dysfunction. Complex penile reconstruction with the concurrent placement of a penile prosthesis and/or graft material is a demanding operation that should be performed by surgeons with extensive prosthetic and reconstructive experience, as the risk of sensory loss, glans ischemia/necrosis, prosthesis-related complications, and failure to gain any meaningful length are serious concerns and cannot be underestimated. While surgical approaches remain the standard of care, they pose considerable risks and require prolonged postoperative rehabilitation. Obtaining proper informed consent and establishing realistic outcome expectations are imperative for successful postoperative outcomes.

COVID Pandemic Impact on Healthcare Provision and Patient Psychosocial Distress: A Multi-National Cross-Sectional Survey among Asia-Pacific Countries

Chung Eric,Jiann Bang-Ping,Nagao Koichi,Hakim Lukman,Huang William,Lee Joe,Lin Haocheng,Mai Dung Ba Tien,Nguyen Quang,박현준,Sato Yoshikazu,Tantiwongse Kavirach,Yuan Yiming,Park Kwangsung 대한남성과학회 2021 The World Journal of Men's Health Vol.39 No.4

Purpose: COVID pandemic significantly affected the delivery and maintenance of healthcare system, resulting in greater utilization of digital health interventions. Materials and Methods: This multi-national cross-sectional survey was administered to clinicians working in major Asia-Pacific cities during the mandatory social lockdown period in June 2020. Clinical demographics and professional data, delivery of Andrology-related healthcare services, and patient distress based on validated questionnaires such as Depression and Anxiety Stress Scales (DASS) and Decisional Engagement Scale (DES) were collected. Results: Telehealth medicine was instituted in all the centres with the majority of centres (92.9%) reported a 50% or more reduction in out-patient related services. The numbers of phone calls, emails correspondence and educational webinars have significantly increased. Despite the provision of reasons for changes in healthcare service and delay in surgery, more than half of the patients (57.1%) rated 2 on the DASS score for the item on patients over-react to situations, while a third of the patients (35.7%) scored a 2 for DASS item on patients being more demanding or unreasonable. The DES scores were more positive with most patients reported a score above 7 out of 10 in terms of items on accepting current arrangement (85.7%), confident in clinician decision-making about treatment (92.9%) and comfortable that the decision is consistent with their preferences (71.4%). Most patients (85.7%) indicated their preferences for more detailed information on healthcare provision. Conclusions: Our study showed telehealth services were integrated early and successfully during the COVID pandemic and patients were generally receptive with minimal psychosocial distress.

Impact of Physical Exercise Program Interventions on Erectile Function and Cardiovascular Health in Males with Prostate Cancer

Chung Eric,Rhee Handoo 대한남성과학회 2022 The World Journal of Men's Health Vol.40 No.3

Prostate cancer (PC) and its associated treatments can cause significant cardiovascular and sexual dysfunctions. While structured exercise interventions can induce positive outcomes in males with PC, there are limited data on its effects on cardiovascular health, erectile function, or the combination of these outcomes. It has been proposed that positive changes in biomarkers of cardiovascular health through physical exercise programs, can result in cardiovascular remodelling and improve penile haemodynamic and erectile function recovery in those with metabolic syndrome and/or cardiovascular diseases, although the data is accruing in males who are diagnosed and/or treated for PC. While the results of this review article support structured physical exercise interventions to effectively prevent and mitigate the development of both sexual and cardiovascular dysfunctions in males with PC, appropriate caution should be maintained and future clinical research should focus on the development of standardised and evidence-based exercise guidelines in the setting of PC survivorship.

Intralesional collagenase Clostridium histolyticum vs. verapamil injections in males with Peyronie’s Disease: A prospective, matched-pair, non-blinded, randomised clinical study comparing clinical outcomes and patient satisfaction rates

Eric Chung,Juan Wang 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.5

Purpose: To compare clinical outcomes and patient satisfaction rates between intralesional verapamil (ILV) and collagenase Clostridium histolyticum (CCH) injections in males with Peyronie’s disease (PD). Materials and Methods: Following ethics approval, PD patients were prospectively enrolled in this open-label non-blinded study. Patients were randomised to receive ILV or CCH injections with penile remodelling every fortnightly for 6 courses. Patient demographics, change in penile curvature, International Index of Erectile Function-15 and Peyronie’s Disease Questionnaire (PDQ) scores as well as overall patient satisfaction and Patient Global Impression of Improvement (PGI-I) scores were recorded at pre-treatment and 6-, 12- and 24-month post-treatment. Results: A total of 50 males were recruited and divided into ILV (n=25) and CCH (n=25) groups. The mean changes in penile curvature were -16.8 (standard deviation [SD] 7.65) degrees in ILV and -28.2 (SD 11.5) degrees in CCH groups (p<0.01). Patients in the CCH group scored better than the ILV group on the PDQ psychosexual symptoms (-2.14 vs. -2.9; p<0.01) and symptom bother score (-3.88 vs. -4.16; p=0.08). Minor treatment-related adverse events were more common in the CCH group. The overall satisfaction rate on a 5-point scale was 4.1 in ILV and 4.5 in CCH groups, and there was no statistically significant difference in the PGI-I scores between the 2 groups (p=0.14). Conclusions: CCH therapy is more effective than ILV to treat a carefully selected group of males with PD, with a reasonable safety profile and a higher high level of patient satisfaction rate in the short term.

Peyronie's disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men

Eric Chung 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.11

Purpose: To evaluate the efficacy, safety and patient satisfaction outcomes following low intensity extracorporeal shock wave therapy (LiESWT) in men with Peyronie's disease (PD) using a standardised protocol. Materials and Methods: In this open-label single arm prospective study, patients with PD were enrolled following informed consent. Patient demographics, change in penile curvature and plaque hardness, International Index of Erectile Function (IIEF)-5 score, and overall satisfaction score (on a 5-point scale) were recorded. Treatment template consists of 3000 shock waves to the Peyronie's plaque over 20 minutes, twice weekly for 6 weeks. Results: The majority of patients have PD history longer than 6 months (mean, 12.8 months; range, 6-28 months). Two thirds of patients have received and failed oral medical therapy. There were improvements in penile curvature (more than 15 degrees in 33% of men), plaque hardness (60% of men) and penile pain (4 out of 6 men) following LiESWT. There was a moderate improvement in IIEF-5 score (>5 points reported in 20% of men). No complication was reported and the majority of patients were satisfied (rated 4 out of 5; 70% of men) and would recommend this therapy to others. Conclusions: In a carefully selected group of men with PD, LiESWT appears to be safe, has moderate efficacy and is associated with high patient satisfaction rate in the short term.

Clinical Practice Guideline Recommendation on the Use of Low Intensity Extracorporeal Shock Wave Therapy and Low Intensity Pulsed Ultrasound Shock Wave Therapy to Treat Erectile Dysfunction: The Asia-Pacific Society for Sexual Medicine Position Statement

Chung Eric,Lee Joe,Liu Chia-Chu,Taniguchi Hisanori,Zhou Hui-Liang,Park Hyun Jun 대한남성과학회 2021 The World Journal of Men's Health Vol.39 No.1

Published literature shows low intensity extracorporeal shock wave therapy (LIESWT) and low intensity pulsed ultrasound (LIPUS) therapy to improve erectile function and penile hemodynamic by inducing neovascularisation and promoting tissue regeneration. Key opinion leaders across the Asia Pacific region attended the recent biennial meeting of the Asia Pacific Society for Sexual Medicine in Australia, and presented the current evidence on LIESWT and LIPUS for erectile dysfunction (ED). The clinical findings were internally discussed, and the quality of evidence was graded based on the Oxford Centre for Evidence- Based Medicine recommendations. Existing literature supports the use of LIESWT and LIPUS in men with ED, with many clinical studies reported encouraging results with improved erectile function, good safety profile and short-term durability. However, controversial exists due to sampling heterogeneity, non-standardised treatment protocol and lack of large multiinstitutional studies. There is a need to better define which subgroup of ED population is best-suited, and specific treatment protocol to optimise shock wave energy delivery. More stringent and larger multi-institutional randomised placebo-controlled trials are warranted before clinical adoption of LIESWT and LIPUS as the new standard of care for men with ED.

Lessons learnt in the management of primary invasive penile cancer in an Australian tertiary referral centre: Clinical outcomes with a minimum 48 months follow-up study

Eric Chung,Sun Yang,Louise White,Simon Wood,David Nicol 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.2

Purpose: To report on lessons learnt in the management of primary invasive penile cancer in a major tertiary hospital in Australia. Materials and Methods: Medical records for all patients who underwent surgery for primary invasive penile cancer betweenJanuary 2000 and January 2011 were obtained. Patient demographics, clinical status of inguinal node, cancer stage and clinicaloutcomes were reviewed. All patients were followed up for a minimum of 48 months postoperative unless patient deceased withinthe first 48 months from the time of penile cancer surgery. Results: Over the 11-year period, a total of 23 cases of invasive penile cancer were identified. Partial penectomy was the mostcommon form of organ preserving surgery and the majority of patients have pT1b disease. Of the 9 patients with clinically palpableinguinal nodes, 7 patients were diagnosed with pN3 disease following inguinal lymphadenectomy. The Kaplan-Meier cancerspecificsurvival at 72 months showed decreasing survival based on tumour stage (83% in pT1, 79% in pT2, and 64% in pT3 disease)and nodal disease (100% in node negative, 50% in superficial inguinal lymphadenopathy, and 38% in patients with deep inguinaland/or pelvic lymphadenopathy) (p=0.082). The Kaplan-Meier cancer-specific survival revealed statistically significant difference insurvival outcome in patients with local recurrence vs. systemic metastasis disease (33% vs. 17%, p=0.008). Conclusions: The presence of high risk features such as tumour stage, lymph node involvement and distant metastasis carries asignificant higher risk of death and tumour recurrence in patients with penile cancer and inguinal lymph node metastasis.