[No Abstract] Vieiralves RR., 2022: Editorial Comment: The effect of low-intensity shock wave therapy on moderate erectile dysfunction: A double-blind, randomized, sham-controlled clinical trial.

This is an interesting comment on a recently published study using Li-ESWT for moderate erectile dysfunction. The author focuses on various aspects of this very important study including 70 patients randomized to either Li-ESWT or sham-treatment. Overall, two third of the patients responded well. The following needs to be assessed closer:

- the diagnosis of vasculogenic ED was not based on Duplex Sonography.
- the application technique was not exactly described
- use of PDE5-inhibitors were prohibited
- only a single institution study

All these points might be fair arguments, however, apart from the correct diagnosis of vasculogenic ED (i.e. confirmed by Duplex Sonography), I disagree with the points risen by the author:

The application technique has been described previously. The main treatment parameters have been described (5000 impulses at five sites, 0.096 mJ/mm2 and a frequency of 5 Hz (level 7 at the ARIES 2 electromagnetic generator, Dornier MedTech, Wessling). Of course, there are other protocols applying 3000 impulses at 6 sites. But in these studies other types of shock wave devices have been used.

The authors wanted to proof the effect of Li-ESWT instead of PDE-5-inhibitors. Therefore, PDE-%-inhibitors were prohibited!
Of course, such a study design should now be applied in a multi-centric design. For me, the most important information and message of this trial was indeed, that Li-ESWT may obviate the need for PDE-5-inhibitors, because it may be possible to improve the quality of the cavernous tissue rather than supporting temporarily it`s function by medication.

Jens Rassweiler