# Ramadhani T. et al., 2025: . Comparative effectiveness radial shockwave therapy versus focused linear shockwave therapy as an erectile dysfunction treatment systematic review and meta-analysis.
Jens Rassweiler
Monday, 22 September 2025
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Taufik Ramadhani 1, Syah Mirsya Warli 2 3, Ramlan Nasution 2, Dhirajaya Dharma Kadar 2, Muhammad Haritsyah Warli 2
1Department of Urology, Faculty of Medicine, Universitas Indonesia-Adam Malik Hospital, Medan, Indonesia.
2Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Adam Malik Hospital, Medan, Indonesia.
3Department of Urology, Faculty of Medicine, Universitas Sumatera Utara-Unviersitas Sumatera Utara Hospital, Medan, Indonesia.
## Abstract
Low-intensity shockwave therapy (SWT) is a promising non-invasive treatment for vasculogenic erectile dysfunction (ED). Two primary modalities, focused linear shockwave therapy (fSWT) and radial shockwave therapy (rSWT), differ in energy delivery and tissue penetration. While fSWT is well-studied, rSWT remains less explored for ED despite its growing use. This study compares the effectiveness of fSWT and rSWT in improving erectile function. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Relevant studies published between 2009 and 2024 were identified through searches in PubMed, ScienceDirect, and Cochrane Library. Studies assessing erectile function using the International Index of Erectile Function (IIEF-5), Sexual Health Inventory for Men (SHIM), or Erection Hardness Score (EHS) were included. A random-effects model was applied to analyze standardized mean differences (SMD) and address heterogeneity. Fifteen studies met the inclusion criteria. Meta-analysis revealed that fSWT demonstrated superior efficacy compared to rSWT, with an SMD of 0.45 (95% CI: 0.04-0.86; P < 0.005). High heterogeneity was observed (I² = 80% for rSWT; I² = 99% for fSWT). fSWT and rSWT improved erectile function, but fSWT consistently produces better outcomes across IIEF-5, SHIM, and EHS scores.
Urol Ann. 2025 Apr-Jun;17(2):84-91. doi: 10.4103/ua.ua\_13\_25. Epub 2025 Apr 17.
PMID: 40352088; PMCID: PMC12063912
0
#### Comments 1
Jens Rassweiler on Monday, 22 September 2025 11:00
Purpose: The article presents a systematic review and meta-analysis comparing the effectiveness of focused linear shockwave therapy (fSWT) and radial shockwave therapy (rSWT) for treating vasculogenic erectile dysfunction (ED). The study highlights that while fSWT has been extensively researched, rSWT is still emerging as a treatment option despite its increasing utilization.
Material and Methods: The researchers conducted a thorough search for studies published between 2009 and 2024 in databases such as PubMed, ScienceDirect, and the Cochrane Library. They focused on studies that assessed erectile function using tools like the International Index of Erectile Function (IIEF-5), Sexual Health Inventory for Men (SHIM), or Erection Hardness Score (EHS).
Results: Fifteen studies met the inclusion criteria for the review. The meta-analysis used a random-effects model to analyze the data and found that fSWT was significantly more effective than rSWT, yielding a standardized mean difference (SMD) of 0.45 (95% CI: 0.04–0.86; P less 0.005). The analysis indicated high heterogeneity among the studies, with I² values of 80% for rSWT and 99% for fSWT.
Overall, both fSWT and rSWT were found to improve erectile function, but fSWT consistently provided better outcomes across various assessment scores (IIEF-5, SHIM, and EHS).
Conclusions: While rSWT represents also a non-invasive and generally safe treatment option for erectile dysfunction, its limitations in energy delivery, treatment protocols, and biological effects may explain its poorer results compared to fSWT in studies. Further research is needed to clarify these differences, optimize treatment protocols, and identify the ideal candidates for both therapies. It might be possible, that rSWT may be less effective in stem cell activation.
Jens Rassweiler
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