(251) WHICH PATIENTS CHOOSE SHOCKWAVE THERAPY? AN ANALYSIS OF PATIENT DIRECTED UTILIZATION OF LISWT AT AN ACADEMIC INSTITUTION

Abstract Introduction Low-intensity shockwave therapy (LiSWT) is an increasingly popular treatment for mild to moderate erectile dysfunction (ED). While considered investigational, a wide range of patients are progressively seeking and obtaining LiSWT in a variety of settings overseen by a wide range of providers in various medical and non-medical settings. Objective Assess which patients are more likely to elect for LiSWT when administered and overseen by fellowship trained sexual medicine providers in an academic medical setting. Methods Retrospective review of consecutive patients suspected of having arterial insufficiency predominant ED presenting for diagnostic Duplex Doppler ultrasound of the penis with intention to undergo LiSWT. Patient demographics, comorbidities, baseline, in-treatment, and post treatment sexual health inventory for men (SHIM) score, prior ED treatments, and insurance status was collected. Patients who elected to undergo LiSWT were compared to those who did not. Patients were specifically counseled on expected outcomes based on prior published efficacy data for baseline SHIM score and ED severity based on peak systolic velocity. All patients who utilized LiSWT underwent a standard protocol using the Storz Duolith SD1 with 6 consecutive weekly sessions of 3,000 shocks per session at 0.25 mJ/mm2 at 6 Hz divided between the penile shaft and crura. Results 100 consecutive patients with vasculogenic ED received a diagnostic Duplex Doppler ultrasound in the office. Of these patients, 22 elected to undergo LiSWT. Patients who elected to have LiSWT were older compared those who did not (58 versus 52 years old, p < 0.05). There was no statistically significant difference in ethnicity, baseline SHIM score, maximum arterial blood flow on doppler US, or insurance type/status. The most commonly cited barrier to pursuing treatment was cost compared to expected outcomes. Baseline mean PSV in the LiSWT cohort was 37.5 cm/s versus 42.9 cm/s in the non LiSWT group. 100% of patients in either group had prior PDE5i exposure. Conclusions In an academic practice with fellowship trained sexual medicine urologists, there does not appear to any significant differences patients who decide to undergo LiSWT. Many patients choose to pursue LiSWT despite low normal PSV or mild arterial insufficiency ED. Despite extensive counseling, most patients appear eager for non-invasive treatment alternatives to PDE5i, even with a lack of definitive evidence in efficacy. The biggest barrier to treatment remains cost for many patients. Disclosure No.