(265) Extended Low-Intensity Shockwave Therapy to the Anterior Urogenital Triangle Enhances Clinical Outcomes in Erectile Dysfunction: A Prospective Comparative Study

Introduction Low-intensity extracorporeal shockwave therapy (Li-ESWT) is an effective treatment for vasculogenic erectile dysfunction (ED), traditionally targeting the penile shaft ad the crura. However, erectile function is also influenced by pelvic floor musculature, nerve networks, and psychological components. Objective This study aimed to evaluate whether extending Li-ESWT to the anterior urogenital triangle improves functional, urinary, and psychometric outcomes compared to standard penile-only treatment. Methods 40 patients with mild-to-moderate vasculogenic erectile dysfunction were enrolled and randomized into two equal groups. Group 1 (n = 20): Li-ESWT applied to the penile shaft and crura (6 sessions; 0.09 mJ/mm2; 3000 pulses per session). Group 2 (n = 20): Same protocol, extended to include the anterior urogenital triangle with an additional 1000 pulses per session. Li-ESWT was performed using the Duolith SD1 T-TOP “ultra” (Storz Medical AG, Tägerwilen, Switzerland), which generates focused shockwaves by an electromagnetic cylindrical coil. Treatments were administered twice weekly for three weeks. Clinical assessments were conducted at baseline (T0) and five weeks (T5) using validated questionnaires: IIEF, IPSS, PHQ-9, EQ-VAS, NIH-CPSI, and VAS for pelvic pain. All procedures followed the Declaration of Helsinki and received ethics approval (protocol code 80/2025). Results At baseline, both groups were comparable in all mean values. After 5 weeks, both showed improvement, but results were more pronounced in the extended treatment group. Mean IIEF scores increased by about 60% in the extended group compared with 37% in the penile-only group (p<0.01). Mean IPSS decreased by 50% versus 31%, while mean EQ-VAS improved by 27% compared with 11%. Mean PHQ-9 scores were reduced by 57% versus 19%, and mean VAS (pelvic pain) decreased by 53% compared with 23%. Mean NIH-CPSI total scores dropped by 54% in the extended group and 29% in controls. Overall, extending Li-ESWT to the anterior urogenital triangle led to broader and faster improvement across erectile, urinary, and psychosomatic domains. Conclusions Extending Li-ESWT to the anterior urogenital triangle resulted in broader and faster clinical improvement compared with the standard penile-only approach. The extended protocol significantly enhanced erectile function, reduced urinary and pain symptoms, and improved psychometric scores. These findings support a more comprehensive concept of erectile rehabilitation, where neuromuscular and pelvic floor stimulation contribute synergistically to vascular recovery. Further studies with larger cohorts and longer follow-up are warranted to confirm these promising results. Disclosure No