Fatima K. et al., 2025: Efficacy of low-intensity extracorporeal shock wave therapy for erectile dysfunction: updated meta-analysis of randomized trials.

Wednesday, 20 August 2025

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Kaneez Fatima 1, Zahra Abbas 1, Anjum Un-Noor 1, Syeda Ilsa Aaqil 2, Rabia Amir 2, Farzeen Nawaz 2, Summiya Zafar 2, Hafsa Ali 2, Ahmed Mustafa Rashid 2
1Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
2Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.

Abstract

Background: Low-intensity extracorporeal shockwave therapy (Li-ESWT) is proposed for the treatment of erectile dysfunction (ED).

Materials and methods: Randomized controlled trials (RCTs) that compared Li-ESWT with sham therapy in patients with vasculogenic ED were included. The International Index of Erectile Function - Erectile Function (IIEF-EF) domain score, increase in the Erection Hardness Score (EHS), and improvement in Sexual Encounter Profile (SEP) 2 and SEP-3 were assessed.

Results: This meta-analysis of 12 RCTs, including 882 men with vasculogenic ED, demonstrated a statistically significant improvement in IIEF-EF score (an improvement from baseline as well as MCID) and EHS (patients with EHS ≥ 3) following LI-ESWT compared to sham therapy.

Conclusion: The results support the role of Li-ESWT as a potential treatment for ED.

Future Sci OA. 2025 Dec;11(1):2511438. doi: 10.1080/20565623.2025.2511438. Epub 2025 Jun 11. PMID: 40497649; PMCID: PMC12160600

Comments 1

Jens Rassweiler on Wednesday, 20 August 2025 11:00

Background:
Low-intensity extracorporeal shockwave therapy (Li-ESWT) is investigated as a potential treatment for erectile dysfunction (ED), particularly in cases caused by blood vessel issues (vasculogenic ED).

Study Overview:
The meta-analysis included 12 randomized controlled trials (RCTs) involving 882 men with vascular ED. The effectiveness of li-eSwt was compared to sham (fake) treatments. Key outcomes measured included improvements in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score, increases in the Erection Hardness Score (EHS), and changes in the Sexual Encounter Profile (SEP) scores (specifically SEP-2 and SEP-3).

Results:
The analysis revealed:
1. Improved Erectile Function: Significant improvements in IIEF-EF scores were noted in the LI-ESWT-group compared to controls.
2. Harder Erections: Participants receiving LI-ESWT exhibited a noticeable increase in EHS.

3. Mixed Results on Sexual Encounters:While improvements in SEP-2 were not significant, significant enhancements were observed in SEP-3 for the LI-ESWT-group.

Discussion
The Discussion focuses on the following issues

1. Interpretation of Findings: Emphasis on the significant improvement in erectile function and erection hardness observed in patients treated with LI-ESWT compared to sham treatments.
Clinical relevance of these findings and how they translate into real-life benefits for men suffering from vasculogenic ED.

2. Comparison with Existing Treatments; Comparison of LI-ESWT with existing treatment modalities such as phosphor-diesterase type 5 inhibitors (PDE5i) and vacuum erection devices. Acknowledgment of the limitations of current treatments which may not work for all patients, highlighting the need for alternative options like LI-ESWT.

3. Mechanism of Action: A brief review of the proposed mechanisms behind how LI-ESWT improves erectile function, such as enhanced blood flow, angiogenesis (the formation of new blood vessels), and tissue regeneration stem cell proliferation. All as a part of mechanotransduction.

4. Limitations of the Study: Acknowledgment of the limitations inherent in the included RCTs (e.g., sample size, duration of studies, assessment methods) and the possible impact these limitations may have on the generalizability of the results.

5. Future Research Directions: Suggestions for future research, such as the need for larger, multicenter trials with longer follow-up periods to truly ascertain the long-term benefits and safety of LI-ESWT. Possibly also the combination with stem cell therapy.
-
Conlusion:
The findings support the potential of LI-ESWT as an effective, noninvasive initial treatment option for ED. Despite these promising outcomes, the article emphasizes the necessity for further high-quality randomized controlled trials with longer follow-up periods to confirm LI-ESWTs efficacy as a standard treatment.

Jens Rassweiler

Study Overview:
The meta-analysis included 12 randomized controlled trials (RCTs) involving 882 men with vascular ED. The effectiveness of li-eSwt was compared to sham (fake) treatments. Key outcomes measured included improvements in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score, increases in the Erection Hardness Score (EHS), and changes in the Sexual Encounter Profile (SEP) scores (specifically SEP-2 and SEP-3).

Results: 
The analysis revealed:
1. Improved Erectile Function: Significant improvements in IIEF-EF scores were noted in the LI-ESWT-group compared to controls.
2. Harder Erections: Participants receiving LI-ESWT exhibited a noticeable increase in EHS.
	[img]https://www.storzmedical.com/images/blog/Fatima.PNG[/img]
3. Mixed Results on Sexual Encounters:While improvements in SEP-2 were not significant, significant enhancements were observed in SEP-3 for the LI-ESWT-group.

Discussion
The Discussion focuses on the following issues

1. Interpretation of Findings: Emphasis on the significant improvement in erectile function and erection hardness observed in patients treated with LI-ESWT compared to sham treatments.
Clinical relevance of these findings and how they translate into real-life benefits for men suffering from vasculogenic ED.

2. Comparison with Existing Treatments; Comparison of LI-ESWT with existing treatment modalities such as phosphor-diesterase type 5 inhibitors (PDE5i) and vacuum erection devices. Acknowledgment of the limitations of current treatments which may not work for all patients, highlighting the need for alternative options like LI-ESWT.

3. Mechanism of Action: A brief review of the proposed mechanisms behind how LI-ESWT improves erectile function, such as enhanced blood flow, angiogenesis (the formation of new blood vessels), and tissue regeneration stem cell proliferation. All as a part of mechanotransduction.

4. Limitations of the Study: Acknowledgment of the limitations inherent in the included RCTs (e.g., sample size, duration of studies, assessment methods) and the possible impact these limitations may have on the generalizability of the results.

5. Future Research Directions: Suggestions for future research, such as the need for larger, multicenter trials with longer follow-up periods to truly ascertain the long-term benefits and safety of LI-ESWT. Possibly also the combination with stem cell therapy.
   - 
Conlusion:
The findings support the potential of LI-ESWT as an effective, noninvasive initial treatment option for ED. Despite these promising outcomes, the article emphasizes the necessity for further high-quality randomized controlled trials with longer follow-up periods to confirm LI-ESWTs efficacy as a standard treatment.

Jens Rassweiler

Background: Low-intensity extracorporeal shockwave therapy (Li-ESWT) is investigated as a potential treatment for erectile dysfunction (ED), particularly in cases caused by blood vessel issues (vasculogenic ED). Study Overview: The meta-analysis included 12 randomized controlled trials (RCTs) involving 882 men with vascular ED. The effectiveness of li-eSwt was compared to sham (fake) treatments. Key outcomes measured included improvements in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score, increases in the Erection Hardness Score (EHS), and changes in the Sexual Encounter Profile (SEP) scores (specifically SEP-2 and SEP-3). Results: The analysis revealed: 1. Improved Erectile Function: Significant improvements in IIEF-EF scores were noted in the LI-ESWT-group compared to controls. 2. Harder Erections: Participants receiving LI-ESWT exhibited a noticeable increase in EHS. [img]https://www.storzmedical.com/images/blog/Fatima.PNG[/img] 3. Mixed Results on Sexual Encounters:While improvements in SEP-2 were not significant, significant enhancements were observed in SEP-3 for the LI-ESWT-group. Discussion The Discussion focuses on the following issues 1. Interpretation of Findings: Emphasis on the significant improvement in erectile function and erection hardness observed in patients treated with LI-ESWT compared to sham treatments. Clinical relevance of these findings and how they translate into real-life benefits for men suffering from vasculogenic ED. 2. Comparison with Existing Treatments; Comparison of LI-ESWT with existing treatment modalities such as phosphor-diesterase type 5 inhibitors (PDE5i) and vacuum erection devices. Acknowledgment of the limitations of current treatments which may not work for all patients, highlighting the need for alternative options like LI-ESWT. 3. Mechanism of Action: A brief review of the proposed mechanisms behind how LI-ESWT improves erectile function, such as enhanced blood flow, angiogenesis (the formation of new blood vessels), and tissue regeneration stem cell proliferation. All as a part of mechanotransduction. 4. Limitations of the Study: Acknowledgment of the limitations inherent in the included RCTs (e.g., sample size, duration of studies, assessment methods) and the possible impact these limitations may have on the generalizability of the results. 5. Future Research Directions: Suggestions for future research, such as the need for larger, multicenter trials with longer follow-up periods to truly ascertain the long-term benefits and safety of LI-ESWT. Possibly also the combination with stem cell therapy. - Conlusion: The findings support the potential of LI-ESWT as an effective, noninvasive initial treatment option for ED. Despite these promising outcomes, the article emphasizes the necessity for further high-quality randomized controlled trials with longer follow-up periods to confirm LI-ESWTs efficacy as a standard treatment. Jens Rassweiler

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