To assess the efficacy of low-energy extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED), a systematic review and meta-analysis was undertaken.
A comprehensive search of the PubMed, Cochrane Register, and Embase databases to March 2017 was performed for randomized controlled trials reporting on patients with ED treated with LI-ESWT. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT.
There were 9 studies including 637 patients from 2005 to 2017. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference [MD]: 2.54; 95% confidence interval [CI], 0.83-4.25; P = .004) and EHS (risk difference [RD]: 0.16; 95% CI, 0.03-0.28; P = .01). Therapeutic efficacy could last at least 3 months (MD: 4.15; 95% CI, 1.40-6.90; P = .003). Lower energy density (0.09 mJ/mm2, MD: 4.14; 95% CI, 0.87-7.42; P = .01) increased the number of pulses (3000 pulses per treatment, MD: 5.11; 95% CI, 3.18-7.05, P < .0001) and shorter total treatment courses (<6 weeks, MD: 3.73; 95% CI, 0.54-6.93; P = .02) resulted in better therapeutic efficacy.
These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of patients with ED. The publication of robust evidence from additional randomized controlled trials and longer-term follow-up would provide more confidence regarding the use of LI-ESWT for patients with ED.
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- Tadalafil 5 mg once daily for the treatment of erectile dysfunction during a 6-month observational study (EDATE): impact of patient characteristics and comorbidities.BMC Urol. 2015; 15: 111
- Mechanoreception by the endothelium: mediators and mechanisms of pressure- and flow-induced vascular responses.Blood Vessels. 1990; 27: 246-257
- The paracrine control of vascular motion. A historical perspective.Pharmacol Res. 2016; 113: 125-145
- Shock wave technology and application: an update.Eur Urol. 2011; 59: 784-796
- Periodontal cytokines profile under orthodontic force and extracorporeal shock wave stimuli in a rat model.J Periodontal Res. 2015; 50: 389-396
- Myocardial effects of local shock wave therapy in a Langendorff model.Ultrasonics. 2014; 54: 131-136
- Low-energy extracorporeal shock wave therapy enhances skin wound healing in diabetic mice: a critical role of endothelial nitric oxide synthase.Wound Repair Regen. 2012; 20: 887-895
- Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study.Scand J Urol. 2015; 49: 329-333
- Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population.Can J Urol. 2015; 22: 7614-7622
- Penile low intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham controlled study.J Urol. 2016; 195: 1550-1555
- Effect of low-energy linear shockwave therapy on erectile dysfunction—A double-blinded, sham-controlled, randomized clinical trial.J Sex Med. 2017; 14: 106-112
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Extracorporeal shockwave therapy for Peyronie's disease: an alternative treatment?.Asian J Androl. 2006; 8: 361-366
- Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-con- trolled study.Eur Urol. 2009; 56: 418-424
- Limited shock wave therapy vs sham treatment in men with Peyronie's disease: results of a prospective randomized controlled double-blind trial.BJU Int. 2010; 106: 1352-1356
- Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study.J Urol. 2012; 187: 1769-1775
- Extracorporeal shock wave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study.Int J Urol. 2014; 21: 1041-1045
- Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.J Orthop Res. 2003; 21: 984-989
- Shock waves activate in vitro cultured progenitors and precursors of cardiac cell lineages from the human heart.Ultrasound Med Biol. 2008; 34: 334-342
- Short-time non-enzymatic nitric oxide synthesis from l-arginine and hydrogen peroxide induced by shock waves treatment.FEBS Lett. 2002; 520: 153-155
- Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.J Tissue Eng Regen Med. 2016; 10: 1057-1064
- Improvement of blood flow, expression of nitric oxide, and vascular endothelial growth factor by low-energy shockwave therapy in random-pattern skin flap model.Ann Plast Surg. 2008; 61: 646-653
- Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model.J Sex Med. 2013; 10: 738-746
- Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of strepto-zotocin (STZ)-induced diabetic rats.Int J Mol Sci. 2013; 14: 10661-10673
- Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil.Eur Urol. 2006; 50: 134-140
- Low intensity extracorporeal shockwave therapy (Li-ESWT) improves erectile function in a model of type II diabetes independently of NO/cGMP pathway.J Urol. 2016; 196: 950-956
- The dose-related effects of extracorporeal shock wave therapy for knee osteoarthritis.Ann Rehabil Med. 2015; 39: 616-623
- Is there a role for extracorporeal shock wave therapy for erectile dysfunction unresponsive to phosphodiesterase type 5 inhibitors?.World J Urol. 2017; 35: 167-171
- Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis.Eur Urol. 2017; 71: 223-233
- Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis.J Sex Med. 2017; 14: 27-35
- Attenuation of brain response to vascular endothelial growth factor-mediated angiogenesis and neurogenesis in aged mice.Stroke. 2009; 40: 3596-3600
Published online: September 26, 2017
Accepted: September 16, 2017
Received: April 9, 2017
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work was supported by Beijing Municipal Science & Technology Commission No.Z171100001017133.
© 2017 Elsevier Inc. All rights reserved.