Canguven O. et al., 2021: Low-intensity extracorporeal shockwave therapy for erectile dysfunction
Canguven O, Khalafalla K, Al Ansari A.Arab.
Urology Department, Hamad General Hospital, Doha, Qatar.
Objectives: To review the current evidence of clinical effectiveness of low-intensity extracorporeal shockwave therapy (LI-ESWT) treatment for erectile dysfunction (ED).
Methods: A selective database search using Medical Subject Headings (MeSH) terms 'low intensity extracorporeal shock wave therapy' and 'erectile dysfunction' was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta Analyses (PRISMA) guidelines to review the effectiveness of LI-ESWT for ED. We performed a systematic search of publications using the PubMed and Web of Science databases (January 2010-December 2020) for prospective randomised clinical trials (RCTs). The success rate of LI-ESWT associated with ED were recorded and analysed.
Results: A total of 106 articles were reviewed after searching for the keywords. Overall, 11 RCTs were included in this systematic review. A total of 920 male patients were treated in 11 RCTs. The patients' ages ranged from 18 to 80 years and they had ≥3 months of ED symptoms. Vasculogenic and neurogenic causes were addressed in 81% and 19% of patients, respectively. Of the 920 patients, 348 patients had a statistically significant improvement in their erectile function after LI-ESWT; however, 572 did not have a statistically significant improvement.
Conclusions: The present review found that LI-ESWT has a role in ED treatment in laboratory studies, but its role in human clinical trials is still controversial. Further good quality studies need to be conducted to properly assess its true potential in ED treatment.
Arab J Urol. 2021 Jul 5;19(3):340-345. doi: 10.1080/2090598X.2021.1948158. eCollection 2021. PMID: 34552784. FREE ARTICLE
Patients with erectile dysfunction for a long period of time belonged to a group of patients considered as particularly difficult to treat.
PDE5 inhibitors radically changed the situation albeit it was obvious that several patients still had an insufficient effect of this medical treatment. For that group the value of Li-ESWT has attracted great interest during recent years and several reports have shown successful results with this non-invasive / non-pharmacological therapeutic approach. There is, however, no consensus on which patients that should be offered Li-ESWT and in whom positive effect can be expected. Neither is there any standard regimen for optimal results. The current article is a valuable review of results reported so far.
It of note that of 106 publications for 11 years only 11 were RCTs. Despite randomized comparisons including 920 patients and the fact that a statistically positive role of Li-ESWT was reported in five studies and insignificant improvements in six, the procedure still must be considered as controversial.
No straightforward clinical recommendation can be made and advice on how to carry out the treatment in the best way is still lacking, but the advantage is that the treatment modality is non-invasive!
Future studies will hopefully define an effective treatment strategy for patients who can be expected to benefit from Li-ESWT.