Sokolakis I. et al., 2019: Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials
Sokolakis I, Hatzichristodoulou G.
Department of Urology and Paediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
The efficacy of low intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED) has received hard criticism and recently published meta-analyses were not able to provide further insights, nor specific recommendations. The aim of this systematic review and meta-analysis is to evaluate the efficacy of LI-ESWT for ED, identify the ideal treatment population and treatment protocol, and provide recommendations for future research in the field. A systematic research for relevant clinical studies published from January 2010 to September 2018 was performed, using the following databases: Medline, Embase, The Cochrane Library, Scopus, and Web of Science. Only clinical studies that investigated the efficacy of LI-ESWT for ED only, and reported primary outcomes using IIEF-EF scores/questionnaires were included. Both, randomised controlled trials (RCTs) and cohort studies were included, but the meta-analysis was performed only for sham-controlled RCTs. Ten RCTs including 873 patients were selected for the meta-analysis. Pooling data of these studies showed that LI-ESWT could significantly improve erectile function in men with ED regarding both patient-subjective outcomes (IIEF-EF: +3.97; 95% CI [2.09-5.84]; p < 0.0001, EHS ≥ 3: OR: 4.35; 95% CI [1.82-10.37]; p = 0.0009) and patient-objective outcomes (peak systolic velocity: +4.12; 95% CI [2.30-5.94]; p < 0.00001). In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.
Int J Impot Res. 2019 Jan 21. doi: 10.1038/s41443-019-0117-z. [Epub ahead of print] Review.
A positive aspect of this meta-analysis is the detailed analysis of the drawbacks of previous meta-analyses; this is a prerequisite to justify the reading of another meta-anylysis.
Despite the positive conclusion, there still is room for improvement:
“More studies are needed in order to find the response rate of LI-ESWT depending on the baseline severity of ED and the ideal protocol for each category (mild to severe ED).
The first quarter of 2019 offers at least 7 publication on LI-ESWT (1-7)
The LI-ESWT community seems to stand up like one man to defend this therapy, which tries to restore the aging tissue of the aging male, against criticism and skepticism.
1 Faix A, Chevallier D.
Low-intensity extracorporeal shockwave therapy for erectile dysfunctio: a new option ?
Rev Med Suisse. 2019 Mar 13;15(642):590-595.
2 Liu T, Shindel AW, Lin G, Lue TF.
Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy.
Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0113-3.
3 Patel P, Fode M, Lue T, Ramasamy R.
Should Low-intensity Extracorporeal Shockwave Therapy Be the First-line Erectile Dysfunction Treatment for Nonresponders to Phosphodiesterase Type 5 Inhibition?
Eur Urol Focus. 2019 Feb 15. pii: S2405-4569(19)30024-0. doi: 10.1016/j.euf.2019.02.004.
4 Patel P, Huang C, Molina M, Ramasamy R.
Clinical trial update on shockwave therapy and future of erectile function restoration.
Int J Impot Res. 2019 Jan 22. doi: 10.1038/s41443-019-0115-1.
5 Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F.
The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies.
J Sex Med. 2019 Feb;16(2):168-194. doi: 10.1016/j.jsxm.2018.12.016.
6 Sokolakis I, Hatzichristodoulou G.
Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.
Int J Impot Res. 2019 Jan 21. doi: 10.1038/s41443-019-0117-z.
7 Usta MF, Gabrielson AT, Bivalacqua TJ.
Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review. Int J Impot Res. 2019 Feb 1. doi: 10.1038/s41443-019-0121-3.