Dong L. et al., 2019: Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis
Dong L, Chang D, Zhang X, Li J, Yang F, Tan K, Yang Y, Yong S, Yu X.
Department of Andrology, The Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, P.R. China.
Department of Urology and Andrology, Hospital of Chengdu University of Traditional Chinese Medicine, P.R. China.
Low-intensity extracorporeal shockwave therapy (Li-ESWT) has been reported as a useful and noninvasive treatment for erectile dysfunction (ED). Systematic review and meta-analysis are utilized to evaluate the efficacy of Li-ESWT by comparing the changes in the International Index of Erectile Function erectile function domain (IIEF-EF) and the Erection Hardness Score (EHS) versus sham therapy in men with ED. A systematic search of the MEDLINE, EMBASE, ClinicalTrials.gov, CBM, CNKI, WANGFANG, and VIP was conducted to obtain randomized controlled trials (RCTs) published in peer-reviewed journals or presented in abstract forms of Li-ESWT for ED treatment from January 2010 to June 2018. If RCTs are published in peer-reviewed literature and IIEF-EF scores and EHS are used to assess erectile function outcomes, they are eligible for inclusion. A meta-analysis was used to summarize the estimates. The meta-analysis included seven RCTs involving 522 participants. The data revealed that men treated with Li-ESWT showed significant improvement in pooled mean IIEF-EF scores from baseline to follow-up compared with sham therapy (MD: 1.99 points; 95% CI [1.35, 2.63]; p < .00001). Changes in the IIEF-EF score increased significantly in the treatment group (MD: 3.62; 95% CI [2.99, 4.25]; p < .00001). The EHS increased significantly in the treatment group in four studies (OR: 16.02; 95% CI [7.93, 32.37]; p < .00001). Patients with moderate and/or severe ED reported better results in mean IIEF scores (MD: 3.95; 95% CI [2.44, 5.46]; p < .00001). In meta-analysis of seven RCTs with men who received Li-ESWT for ED, there was evidence that the IIEF-EF and EHS experienced improvements following Li-ESWT.
Am J Mens Health. 2019 Mar-Apr;13(2):1557988319846749. doi: 10.1177/1557988319846749. FREE ARTICLE
After approximately 10 years use of Li-ESWT for treating men with ED (men who are not responding to common medical treatment), it is interesting to learn about the summarized impressions of this form of treatment based on observations from several RCTs.
The authors emphasize the lack of objective measurements, something that of course is a major shortcoming. The results accordingly had to be evaluated in terms of IIEF-EF scores (International Index of Erectile Dysfunction, Erectile Function) and EHS ((Erectile Hardness Score).
Unfortunately, IIEF-EF scores were easily compared in only 5 of the RCTs, in one of them only IQR values were reported. On the other hand EHS values were reported in four of the seven studies.
In the Table below I have tried to extract the data that underlie the conclusion that Li-ESWT significantly improved erection:
Although statistically significant differences were recorded, it is of note that the variability was pronounced. Nevertheless the increased mean EHS and change in IIEF-score were superior in treated men compared with controls.
Reflection: These data indicate that there is a need of studies in large groups of patients. The ideal test situation with cross-over studies apparently is not applicable in patients with this specific pathology.