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Lu Z et al, 2016: Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis.

Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF.
Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China.
Department of Urology, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, USA.

Abstract

CONTEXT: As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED. OBJECTIVE: A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality.
EVIDENCE ACQUISITION: A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. 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.
EVIDENCE SYNTHESIS: There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99-3.00; p<0.0001) and EHS (risk difference: 0.16; 95% CI, 0.04-0.29; p=0.01). Therapeutic efficacy could last at least 3 mo. The patients with mild-moderate ED had better therapeutic efficacy after treatment than patients with more severe ED or comorbidities. Energy flux density, number of shock waves per treatment, and duration of LI-ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement. CONCLUSIONS: The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients.
PATIENT SUMMARY: We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED). There was evidence that these men experienced improvements in their ED following LI-ESWT. 

Eur Urol. 2016 Jun 16. pii: S0302-2838(16)30259-7. doi: 10.1016/j.eururo.2016.05.050. [Epub ahead of print] Review

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Comments 1

Hans-Göran Tiselius on Monday, 28 November 2016 12:12

Occasional reports have shown that low-intensity extracorporeal shockwave therapy (LI-ESWT) might be useful for patients with erectile dysfunction (ED).

The present article is a summarizing analysis of reports comprising 7 RCTs and 7 cohort studies. The meta-analysis was based on 5 RCTs.

In most of the RCTs, LI-ESWT had a favourable effect on IIEF-score (International Index for Erectile Function). The overall effect was improved IIEF and that effect was, as could be expected, most pronounced in patients with mild ED. The simultaneous presence of Peyronie’s disease was a combination that affected the result negatively.

The recommended treatment was as follows: Energy density 0.09 mJ/mm2, number of SW 3000, one treatment per week during 6 weeks.

I am not aware of how extensively LI-ESWT is used clinically for patients with ED, but from the results shown in this article it seems worthwhile to try this approach according to the recommendations shown above. LI-ESWT might at least have a temporary effect.

Occasional reports have shown that low-intensity extracorporeal shockwave therapy (LI-ESWT) might be useful for patients with erectile dysfunction (ED). The present article is a summarizing analysis of reports comprising 7 RCTs and 7 cohort studies. The meta-analysis was based on 5 RCTs. In most of the RCTs, LI-ESWT had a favourable effect on IIEF-score (International Index for Erectile Function). The overall effect was improved IIEF and that effect was, as could be expected, most pronounced in patients with mild ED. The simultaneous presence of Peyronie’s disease was a combination that affected the result negatively. The recommended treatment was as follows: Energy density 0.09 mJ/mm2, number of SW 3000, one treatment per week during 6 weeks. I am not aware of how extensively LI-ESWT is used clinically for patients with ED, but from the results shown in this article it seems worthwhile to try this approach according to the recommendations shown above. LI-ESWT might at least have a temporary effect.
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