The Efficacy of Low-Intensity Shock Wave Therapy based on the Stratification of Erectile Dysfunction Patients: A Long-term Follow-up

Abstract Background Low intensity extracorporeal shockwave therapy (LIESWT) has a considerable positive influence on erectile function (EF) among individuals diagnosed with vasculogenic erectile dysfunction (ED). This research aimed to investigate the impact of LI-ESWT on several subcategories of ED and to determine the duration of the enhancement in erectile function by a comprehensive long-term follow-up. Methods This was a retrospectively collecting data from prospectively kept database. Individuals diagnosed with vasculogenic ED received 6–12 sessions of LI-ESWT with 5000 impulses at a dosage of 0.01 j/mm2. The therapy was administered employing the electromagnetic Dornier Aries® 1 machine. Each patient underwent at least 6 sessions of LI-ESWT. Subsequently, the participants had clinical assessment utilizing the International Index of Erectile Function (IIEF-EF) and the Erection Hardness Scores (EHS) domain score at three months after LI-ESWT, followed by assessments every 6 months. Additionally, the penile blood flow dynamics were assessed three months after LI-ESWT and during the final follow-up examination. Results A total of 42 individuals had been determined, with a mean age of 50 ± 12 years. The mean duration of ED was 31 ± 35 months, and the mean period of follow-up was 10 ± 6 months. The initial IIEF-EF score was 16 ± 6 and increased to 22 ± 6 after 3 months, and then decreased to 21 ± 6 at the final follow-up (p < 0.01). A minimal clinically significant variation was observed in 69% of participants at 3 months and in 60% of the entire study population at the final follow-up. The factors of risk that were shown to be related with a greater likelihood of MICD at 3 months had been age (p = 0.01), uncontrolled diabetes mellitus (DM) ratio (p = 0.04), hypertension (p = 0.24), cardiovascular disease (p = 0.8), smoking (p = 0.63), and ex smoking (p = 0.3). Conclusions Li-ESWT shows promising long-term effectiveness in treating various degrees of ED, as demonstrated by the enhancement in penile blood flow observed during the final follow-up. This effect is particularly notable in individuals with well-managed DM and older age.