Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg increases efficacy and duration of benefits of low-intensity extracorporeal shock wave therapy for erectile dysfunction: A prospective, randomized, single-blinded study with 1-year follow-up

Purpose: To investigate a therapeutic protocol for erectile dysfunction (ED) based on the combination of low-intensity extracorporeal shock wave therapy (Li-ESWT), tadalafil, and L-arginine. Materials and Methods: Recruited patients completed the International Index of Erectile Function erectile function domain (IIEFEF) and the Erection Hardness Score (EHS) questionnaires at baseline and were randomly assigned in two groups: A (treatment group) and B (control group). Men in both groups received six weekly applications of Li-ESWT. Group A was prescribed adjuvant oral therapy with tadalafil 5 mg and L-arginine 2,500 mg. Follow-up visits were scheduled 1, 6, and 12 months after the last Li-ES-WT application. At each follow-up visit, the IIEF-EF and EHS questionnaires were administered again. The main outcome measures were the changes from baseline to every follow-up visit in IIEF-EF and EHS scores. Results: The mean IIEF-EF score in group A was 16.0 +/- 4.0, 24.8 +/- 3.4, 23.3 +/- 4.6, and 21.6 +/- 5.5 at baseline, 1, 6, and 12 months of follow-up, respectively, whereas in group B the mean IIEF-EF score was 16.5 +/- 4.1, 22.7 +/- 4.2, 21.5 +/- 4.5, and 19.5 +/- 4.9, respectively. We reported an increase in the mean EHS score in group A from 2.07 +/- 0.72 at baseline to 3.39 +/- 0.59, 3.17 +/- 0.67, and 2.98 +/- 0.72 at 1, 6, and 12 months, respectively, and in group B from 2.12 +/- 0.80 at baseline to 3.07 +/- 0.78 and 2.95 +/- 0.76 at 1 and 6 months, respectively. Conclusions: Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg was safe and effective in increasing the efficacy and the duration of benefits of Li-ESWT.