Li H. et al., 2025: Therapeutic Effect of Micro-Energy Treatment for Erectile Dysfunction: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.

Jens Rassweiler

Wednesday, 11 February 2026

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Hao Li 1, Wenchao Xu 1, Tao Wang 1, Jihong Liu 1, Meiliyang Wu 2
1Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
2Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Purpose: As an emerging therapeutic option for erectile dysfunction (ED), micro-energy treatment (MET) including low-intensity extracorporeal shockwave therapy, low-intensity pulsed ultrasound, and electromagnetic fields, has attracted increasing attention. We summarized the current literature to assess the therapeutic effect and find optimal treatment scheme of MET for ED.

Materials and methods: A comprehensive search of PubMed, Web of Science, and Embase up to April 2025 was performed. Studies reporting on ED treated with various METs were included. The International Index of Erectile Function and the Erection Hardness Score were used to evaluate the therapeutic effect. Subgroup analysis was performed to explore the influence of energy type, treatment course, treatment frequency, patients' characteristics, combination therapy, and setup parameters on efficacy.

Results: A total of 32 randomized controlled trials with 1,986 patients were enrolled. MET group demonstrated better erectile function than control at 1, 3, 6, and 12 months post-treatment (p<0.05). No significant difference was observed among different energy types, treatment courses, or setup parameters. Patients' comorbidities and responsiveness to phosphodiesterase 5 inhibitors did not influence efficacy. Treatment twice weekly was superior to once (p<0.05). Vasculogenic ED responded better than neurogenic ED (p<0.05). Combination with other basic therapies enhanced efficacy of MET (p<0.05).

Conclusions: MET was effective for various types of ED, especially vasculogenic ones, with efficacy lasting up to 1 year and no discrepancy among different energy forms. Twice-weekly treatment with course no more than 4 weeks was an appropriate therapeutic protocol. Moreover, combining MET with other therapies could produce synergistic effect.

World J Mens Health. 2025 Sep 17. doi: 10.5534/wjmh.250151. Epub ahead of print.
PMID: 41047356 FREE ARTICLE

Comments 1

Jens Rassweiler on Wednesday, 11 February 2026 10:00

This systematic review and meta-analysis by provides an important contribution to the understanding of micro-energy treatment (MET) for erectile dysfunction (ED), particularly in light of the growing interest in non-invasive treatment options.
Forms of Micro-Energy Treatment
Even if Li-ESWT is well-known, the other two therapeutic options need further explanation.
1. Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT)
Mechanism: Li-ESWT involves delivering low-intensity acoustic waves to the penile tissue, which is believed to stimulate neovascularization (formation of new blood vessels), improve blood flow, and enhance tissue regeneration.
Treatment Protocol: Typically involves multiple sessions over several weeks, with each session lasting around 15-20 minutes.
Improvement in Erectile Function: Studies have shown that Li-ESWT can result in significant improvements in erectile function in men with ED, particularly those who are not responsive to oral medications.
Safety: It is generally considered safe, with few reported side effects, primarily mild pain or discomfort during treatment.
2. Low-Intensity Pulsed Ultrasound (LIPUS)
Mechanism: LIPUS uses low-intensity ultrasound waves to stimulate tissue healing and regeneration. It is thought to enhance cellular metabolism, increase blood flow, and promote collagen synthesis.
Treatment Protocol: Similar to Li-ESWT, LIPUS treatments are typically delivered in a series of sessions over a set period
Tissue Repair: LIPUS has been used to promote healing in various musculoskeletal injuries and has been explored for its potential effects on erectile function.
Erectile Function Improvement: Some studies suggest that LIPUS may help improve erectile function by enhancing blood flow and promoting tissue health.
3. Electromagnetic Fields (EMF)
Mechanism: EMF therapy involves the application of electromagnetic fields to stimulate cellular processes. It is thought to enhance blood flow, reduce inflammation, and promote tissue healing through various biological mechanisms.
Treatment Protocol: EMF treatments can vary widely in terms of frequency, duration, and intensity, depending on the specific device used and the condition being treated
Cellular Activation: EMF can potentially activate cellular pathways that lead to improved blood vessel function and tissue repair.
Erectile Function: Some research indicates that EMF therapy may help improve erectile function by enhancing vascular health and promoting tissue regeneration.
Results
A total of 32 randomized controlled trials with 1,986 patients were enrolled. MET group demonstrated better erectile function than control at 1, 3, 6, and 12 months post-treatment (phe evolving landscape of ED treatment options, highlighting the potential of MET as an effective therapeutic modality. The findings suggest that MET could be a valuable alternative for patients who do not respond well to traditional pharmacotherapy, such as phosphodiesterase type 5 inhibitors (PDE5I). However, further well-designed RCTs with longer follow-up periods and standardized treatment protocols are warranted to confirm these findings and optimize treatment strategies.
Micro-energy treatments, including Li-ESWT, LIPUS, and EMF, represent promising non-invasive options for treating erectile dysfunction. Each modality appears to work through different mechanisms aimed at improving blood flow and tissue health, which are critical for achieving and maintaining an erection. The effectiveness and optimal treatment protocols for these therapies are still subjects of ongoing research, but they have gained attention as alternatives or adjuncts to traditional ED treatments. Most importantly, the effect of LIPUS and EMF needs further clarification.

Jens Rassweiler

This systematic review and meta-analysis by provides an important contribution to the understanding of micro-energy treatment (MET) for erectile dysfunction (ED), particularly in light of the growing interest in non-invasive treatment options. 
Forms of Micro-Energy Treatment 
Even if Li-ESWT is well-known, the other two therapeutic options need further explanation.
1. Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT)
Mechanism: Li-ESWT involves delivering low-intensity acoustic waves to the penile tissue, which is believed to stimulate neovascularization (formation of new blood vessels), improve blood flow, and enhance tissue regeneration.
Treatment Protocol: Typically involves multiple sessions over several weeks, with each session lasting around 15-20 minutes.
Improvement in Erectile Function: Studies have shown that Li-ESWT can result in significant improvements in erectile function in men with ED, particularly those who are not responsive to oral medications.
Safety: It is generally considered safe, with few reported side effects, primarily mild pain or discomfort during treatment.
2. Low-Intensity Pulsed Ultrasound (LIPUS)
Mechanism: LIPUS uses low-intensity ultrasound waves to stimulate tissue healing and regeneration. It is thought to enhance cellular metabolism, increase blood flow, and promote collagen synthesis.
Treatment Protocol: Similar to Li-ESWT, LIPUS treatments are typically delivered in a series of sessions over a set period
Tissue Repair: LIPUS has been used to promote healing in various musculoskeletal injuries and has been explored for its potential effects on erectile function.
Erectile Function Improvement: Some studies suggest that LIPUS may help improve erectile function by enhancing blood flow and promoting tissue health.
3. Electromagnetic Fields (EMF)
Mechanism: EMF therapy involves the application of electromagnetic fields to stimulate cellular processes. It is thought to enhance blood flow, reduce inflammation, and promote tissue healing through various biological mechanisms.
Treatment Protocol: EMF treatments can vary widely in terms of frequency, duration, and intensity, depending on the specific device used and the condition being treated
Cellular Activation: EMF can potentially activate cellular pathways that lead to improved blood vessel function and tissue repair.
Erectile Function: Some research indicates that EMF therapy may help improve erectile function by enhancing vascular health and promoting tissue regeneration.
Results 
A total of 32 randomized controlled trials with 1,986 patients were enrolled. MET group demonstrated better erectile function than control at 1, 3, 6, and 12 months post-treatment (phe evolving landscape of ED treatment options, highlighting the potential of MET as an effective therapeutic modality. The findings suggest that MET could be a valuable alternative for patients who do not respond well to traditional pharmacotherapy, such as phosphodiesterase type 5 inhibitors (PDE5I). However, further well-designed RCTs with longer follow-up periods and standardized treatment protocols are warranted to confirm these findings and optimize treatment strategies. 
Micro-energy treatments, including Li-ESWT, LIPUS, and EMF, represent promising non-invasive options for treating erectile dysfunction. Each modality appears to work through different mechanisms aimed at improving blood flow and tissue health, which are critical for achieving and maintaining an erection. The effectiveness and optimal treatment protocols for these therapies are still subjects of ongoing research, but they have gained attention as alternatives or adjuncts to traditional ED treatments. Most importantly, the effect of LIPUS and EMF needs further clarification.

Jens Rassweiler									</div>

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