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Sokolakis I. et al., 2019: The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies

Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F.
Department of Urology and Paediatric Urology, Julius Maximilian University Medical Centre of Würzburg, Würzburg, Germany; Centre for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece;  Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Department of Global Clinical Research, Dornier MedTech Asia Pte Ltd, Singapore. Poincare Hospital AP-HP, Garches, UMR1179 Inserm-UVSQ-Paris Saclay University, Paris, France.

Abstract

INTRODUCTION: Despite recent promising clinical results, the underlying mechanism of action of low-intensity extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) is mostly unclear and currently under investigation.AIM: To systematically identify and evaluate evidence regarding the basic science behind Li-ESWT for ED, discuss and propose a putative mechanism of action, address the limitations, and imply insights for further investigation in the field. METHODS: Using Cochrane's methodologic recommendations on scoping studies and systematic reviews, we conducted a systematic scoping review of the literature on experimental research regarding Li-ESWT for ED and other pathologic conditions. The initial systematic search was carried between January and November 2017, with 2 additional searches in April and August 2018. All studies that applied shockwave treatment at an energy flux density >0.25 mJ/mm2 were excluded from the final analysis. MAIN OUTCOME MEASURE: We primarily aimed to clarify the biological responses in erectile tissue after Li-ESWT that could lead to improvement in erectile function. RESULTS: 59 publications were selected for inclusion in this study. 15 experimental research articles were identified on Li-ESWT for ED and 44 on Li-ESWT for other pathologic conditions. Li-ESWT for ED seems to improve erectile function possibly through stimulation of mechanosensors, inducing the activation of neoangiogenesis processes, recruitment and activation of progenitor cells, improving microcirculation, nerve regeneration, remodeling of erectile tissue, and reducing inflammatory and cellular stress responses. CLINICAL IMPLICATIONS: Improving our understanding of the mechanism of action of Li-ESWT for ED can help us improve our study designs, as well as suggest new avenues of investigation. STRENGTHS & LIMITATIONS: A common limitation in all these studies is the heterogeneity of the shockwave treatment application and protocol. CONCLUSION: Li-ESWT for ED, based on current experimental studies, seems to improve erectile function by inducing angiogenesis and reversing pathologic processes in erectile tissue. These studies provide preliminary insights, but no definitive answers, and many questions remain unanswered regarding the mechanism of action, as well as the ideal treatment protocol.
J Sex Med. 2019 Feb;16(2):168-194. doi: 10.1016/j.jsxm.2018.12.016. Review.

 

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Comments 1

Peter Alken on Monday, 24 June 2019 08:31

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.

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.
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