Abstract Background Vasculogenic erectile dysfunction is a condition that significantly impacts the sexual life of many men, especially after the age of 50. Considering that current treatments do not modify the natural course of the disease, studying regenerative therapies such as low-intensity extracorporeal shockwave therapy (Li-ESWT) is crucial to improve the clinical response of these patients. Methods We systematically searched the MEDLINE, COCHRANE and EMBASE databases for studies published between January 2019 and March 2025 using the terms: (vasculogenic erectile dysfunction or arterial erectile dysfunction or arteriogenic erectile dysfunction) and (shockwave). We included only double-blind, placebo-controlled randomized clinical trials. Clinical trials involving patients with erectile dysfunction of non-arteriogenic etiology were excluded. Results Our search yielded six double-blind, placebo-controlled randomized clinical trials. In all studies, patients treated with Li-ESWT showed an increase in the International Index of Erectile Function (IIEF) compared to patients who received sham therapy. Discussion The results of the clinical studies suggest that Li-ESWT is a safe and effective treatment for men with vasculogenic erectile dysfunction. A limitation identified across the studies was the heterogeneity in the diagnostic criteria and methods used to identify erectile dysfunction of vascular origin. A limitation identified across the studies was the heterogeneity in the diagnostic criteria and methods used to identify erectile dysfunction of vascular origin. Conclusion This systematic review confirms that Li-ESWT is an effective intervention for improving erectile function in vasculogenic erectile dysfunction compared to placebo, demonstrating a clinically relevant impact regardless of concomitant tadalafil use. Financing No conflict.
Silva et al. (Sun,) studied this question.