Multimodal rehabilitation for hard flaccid syndrome in a retrospective case series
Abstract
Introduction Hard flaccid syndrome (HFS) is an emerging condition of male sexual dysfunction characterized by a persistent semi-rigid penis in the flaccid state, altered penile sensation, erectile dysfunction, and pelvic or perineal pain. Single-modality treatments have shown limited success, and multimodal protocols have been reported only in single-patient case studies. Aim To describe clinical outcomes associated with completion of an integrative multimodal rehabilitation protocol in a retrospective case series of men with HFS. Methods Thirty-two men with HFS completed a comprehensive protocol combining class IV laser therapy, dry needling, radial pressure wave shockwave therapy, therapeutic ultrasound, biofeedback training, manual therapy, therapeutic exercise, behavioral coaching, and daily oral tadalafil. Patient-reported outcomes were collected at treatment initiation and completion. Outcomes Erection Hardness Scale (EHS), penile function satisfaction, PROMIS Interest in Sexual Activity, and PROMIS Global Health Physical and Mental Component scores. Results Median EHS increased from 2 to 4 and median penile satisfaction increased from 2 to 5 (both P < 0.01). All 32 patients achieved EHS ≥3 by treatment end, compared to 8 of 32 (25%) at baseline. PROMIS Interest in Sexual Activity, Global Physical Health, and Global Mental Health scores all improved significantly (P < 0.01). Common comorbid features included low back pain (53%), hip or groin pain (38%), pelvic floor…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 32 participants or records.
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