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Medrano-Sánchez EM et al., 2024: Effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy in Erectile Dysfunction: An Analysis of Sexual Function and Penile Hardness at Erection: An Umbrella Review.

Medrano-Sánchez EM, Peña-Cantonero B, Candón-Ballester P, Blanco-Díaz M, Díaz-Mohedo E.
Research Group CTS305, Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, Universidad de Sevilla, 6, Avenzoar St., 41009 Sevilla, Spain.
CitizenFisio, Carmona Rd., 41008 Seville, Spain.
Neus Gramage, Asunción St., 41011 Seville, Spain.
Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, Universidad de Oviedo, 33006 Oviedo, Spain.
Department of Physical Therapy, Universidad de Málaga, Francisco Peñalosa Av., 29071 Málaga, Spain.

Abstract

The present umbrella review of five systematic reviews and meta-analyses was conducted to investigate the effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy (Li-ESWT) in the treatment of vascular origin Erectile Dysfunction (ED). A search was carried out in the databases of Pubmed, Scopus, Medline, Scielo and Embase. Participants were divided into two groups: an experimental group receiving Li-ESWT and a control group receiving simulated shock waves. The main variable of this study is ED, measured using the International Index of Erectile Function-Erectile Function (IIEF-EF) and the Erection Hardness Score (EHS) scale. The results showed a statistically significant increase in the mean IIEF-EF score in the experimental group. Overall, four out of five articles reported an increase in the EHS score in the Li-ESWT group compared to the placebo. Concerning the treatment parameters, better outcomes were observed with an energy density of 0.09 mJ/mm2 and the application of 1500-2000 pulses. Additionally, a follow-up of 6-12 months resulted in greater improvement in ED compared to 3 months, although more studies investigating follow-ups beyond 12 months are needed. Obtaining conclusive and clear results is challenging; however, everything indicates that Li-ESWT is an innovative therapeutic alternative for vascular-origin ED due to its low risk and improvement in erectile function.

J Pers Med. 2024 Feb 4;14(2):177. doi: 10.3390/jpm14020177. PMID: 38392610 FREE PMC ARTICLE

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Comments 1

Jens Rassweiler on Monday, 27 May 2024 11:00

This umbrella review analyzed five systematic reviews and meta-analyses to assess the effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy (Li-ESWT) in treating Erectile Dysfunction (ED) of vascular origin.
An umbrella review is a systematic review of systematic reviews and meta-analyses. It synthesizes the findings from multiple existing reviews on a particular topic to provide an overview of the evidence available. By pooling together the results of various reviews, an umbrella review aims to offer a comprehensive understanding of the current state of knowledge on a specific subject.
Umbrella reviews are valuable because they allow researchers and clinicians to examine the overall consistency, quality, and strength of evidence across multiple studies. They can help identify areas of agreement or disagreement among different reviews, highlight gaps in knowledge, and provide insights into the effectiveness of interventions or the association between variables.
Thus, the study searched multiple databases and compared participants receiving Li-ESWT to those receiving simulated shock waves. The main variables measured were ED severity using the International Index of Erectile Function-Erectile Function (IIEF-EF) and penile hardness using the Erection Hardness Score (EHS) scale.
The results indicated a statistically significant increase in the mean IIEF-EF score in the group receiving Li-ESWT. Furthermore, four out of five articles reported an improvement in the EHS score in the Li-ESWT group compared to the placebo. Optimal treatment parameters included an energy density of 0.09 mJ/mm2 and the application of 1500–2000 pulses. Longer follow-up periods of 6–12 months showed greater improvement in ED compared to 3-month follow-ups, although more studies with longer follow-up durations are needed.
Standard treatment parameters for using Extracorporeal Shock Wave Therapy (ESWT) for Erectile Dysfunction (ED) typically include the following:
1. Energy Density: The energy density refers to the amount of energy delivered per unit area and is measured in mJ/mm². Commonly used energy densities for ESWT in treating ED range from 0.09 mJ/mm² to 0.25 mJ/mm². However, optimal energy density may vary depending on the specific device used and individual patient factors.
2. Number of Pulses: The number of shockwaves or pulses delivered during each treatment session is also an important parameter. Typically, treatment protocols involve delivering a certain number of pulses per session, often ranging from 1500 to 3000 pulses. The total number of pulses administered may vary based on the severity of the condition and the treatment protocol chosen by the healthcare provider.
3. Frequency of Sessions: ESWT treatment for ED is typically administered in multiple sessions over a specified period. The frequency of sessions can vary, but it is common for patients to undergo treatment once or twice a week for several weeks. The total number of sessions may range from 6 to 12 sessions, although this can vary based on individual patient response and treatment goals.
4. Follow-up Period: After completing the initial series of treatment sessions, patients may undergo follow-up assessments to evaluate the effectiveness of ESWT for ED. Follow-up periods often range from 3 months to 12 months post-treatment, with assessments of erectile function and other relevant outcomes.
5. Patient Selection and Assessment: Prior to initiating ESWT for ED, patients typically undergo a thorough evaluation by a healthcare provider specializing in sexual medicine or urology. This assessment may include a review of medical history, physical examination, laboratory tests, and assessment of erectile function using standardized questionnaires such as the International Index of Erectile Function (IIEF).
It's essential for healthcare providers to tailor the treatment parameters based on individual patient characteristics, including the severity of ED, underlying medical conditions, and treatment response. Additionally, ongoing research and clinical experience may lead to further refinement of standard treatment parameters for ESWT in the management of ED.
Overall, while obtaining conclusive and clear results is challenging, the findings suggest that Li-ESWT represents an innovative therapeutic option for vascular-origin ED due to its low risk and improvement in erectile function.

This umbrella review analyzed five systematic reviews and meta-analyses to assess the effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy (Li-ESWT) in treating Erectile Dysfunction (ED) of vascular origin. An umbrella review is a systematic review of systematic reviews and meta-analyses. It synthesizes the findings from multiple existing reviews on a particular topic to provide an overview of the evidence available. By pooling together the results of various reviews, an umbrella review aims to offer a comprehensive understanding of the current state of knowledge on a specific subject. Umbrella reviews are valuable because they allow researchers and clinicians to examine the overall consistency, quality, and strength of evidence across multiple studies. They can help identify areas of agreement or disagreement among different reviews, highlight gaps in knowledge, and provide insights into the effectiveness of interventions or the association between variables. Thus, the study searched multiple databases and compared participants receiving Li-ESWT to those receiving simulated shock waves. The main variables measured were ED severity using the International Index of Erectile Function-Erectile Function (IIEF-EF) and penile hardness using the Erection Hardness Score (EHS) scale. The results indicated a statistically significant increase in the mean IIEF-EF score in the group receiving Li-ESWT. Furthermore, four out of five articles reported an improvement in the EHS score in the Li-ESWT group compared to the placebo. Optimal treatment parameters included an energy density of 0.09 mJ/mm2 and the application of 1500–2000 pulses. Longer follow-up periods of 6–12 months showed greater improvement in ED compared to 3-month follow-ups, although more studies with longer follow-up durations are needed. Standard treatment parameters for using Extracorporeal Shock Wave Therapy (ESWT) for Erectile Dysfunction (ED) typically include the following: 1. Energy Density: The energy density refers to the amount of energy delivered per unit area and is measured in mJ/mm². Commonly used energy densities for ESWT in treating ED range from 0.09 mJ/mm² to 0.25 mJ/mm². However, optimal energy density may vary depending on the specific device used and individual patient factors. 2. Number of Pulses: The number of shockwaves or pulses delivered during each treatment session is also an important parameter. Typically, treatment protocols involve delivering a certain number of pulses per session, often ranging from 1500 to 3000 pulses. The total number of pulses administered may vary based on the severity of the condition and the treatment protocol chosen by the healthcare provider. 3. Frequency of Sessions: ESWT treatment for ED is typically administered in multiple sessions over a specified period. The frequency of sessions can vary, but it is common for patients to undergo treatment once or twice a week for several weeks. The total number of sessions may range from 6 to 12 sessions, although this can vary based on individual patient response and treatment goals. 4. Follow-up Period: After completing the initial series of treatment sessions, patients may undergo follow-up assessments to evaluate the effectiveness of ESWT for ED. Follow-up periods often range from 3 months to 12 months post-treatment, with assessments of erectile function and other relevant outcomes. 5. Patient Selection and Assessment: Prior to initiating ESWT for ED, patients typically undergo a thorough evaluation by a healthcare provider specializing in sexual medicine or urology. This assessment may include a review of medical history, physical examination, laboratory tests, and assessment of erectile function using standardized questionnaires such as the International Index of Erectile Function (IIEF). It's essential for healthcare providers to tailor the treatment parameters based on individual patient characteristics, including the severity of ED, underlying medical conditions, and treatment response. Additionally, ongoing research and clinical experience may lead to further refinement of standard treatment parameters for ESWT in the management of ED. Overall, while obtaining conclusive and clear results is challenging, the findings suggest that Li-ESWT represents an innovative therapeutic option for vascular-origin ED due to its low risk and improvement in erectile function.
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