(653) Clinical Outcomes and Treatment Adherence to Low-Intensity Extracorporeal Shockwave Therapy in Erectile Dysfunction: A Multicenter Experience in Latin America

Introduction Erectile dysfunction (ED) represents a significant public health challenge, affecting up to 52% of men between 40 and 70 years of age worldwide. Latin America faces similar burdens: the DENSA study documented a prevalence of 53.4% across Colombia, Ecuador, and Venezuela, while Mexico reports rates around 29.7%. Low-intensity extracorporeal shockwave therapy (Li-ESWT) has emerged as a promising treatment option for men with vasculogenic ED, working through tissue regeneration and improved blood flow mediated by growth factor release. While multiple studies have demonstrated IIEF improvements ranging from 3.4 to 5.3 points compared to controls, its clinical role remains under debate. European guidelines currently consider it an evolving therapy whose efficacy has not been completely established. Despite growing clinical adoption, real-world evidence from Latin American populations remains scarce, particularly regarding how treatment adherence impacts clinical outcomes. Objective To evaluate the clinical outcomes of Li-ESWT in men with erectile dysfunction across five Latin American countries, analyzing how treatment adherence affects final severity and identifying associated factors. Methods This multicenter observational study enrolled 7,893 men with ED who received Li-ESWT treatment between January 2023 and March 2025 across Mexico, Argentina, Colombia, Ecuador, and Peru. All patients received concomitant pharmacological treatment. Baseline and final severity were assessed using the IIEF-5 and Erection Hardness Score (EHS). Adherence was classified as complete (meeting both dose and timing requirements), partial (dose only), or non-adherent. Ordinal logistic regression models were constructed, adjusting for country, age, hypertension, diabetes, coronary artery disease, and baseline severity. A complementary analysis recategorized adherence as high (≥60%) versus low (<60%) to explore dose-response relationships. Results No patients presented with severe ED at baseline; most had moderate or mild dysfunction. Ecuador demonstrated the highest adherence rate (82.5%), while Peru showed the lowest (53.6%); Colombia's median was 60%. Overall, 65.3% of patients decreased at least one level of severity following treatment, with average IIEF-5 scores increasing by 6 points. Among men starting with moderate ED, 68.8% experienced improvement, while 39.8% of those with mild ED achieved normal erectile function. Compared to non-adherent patients, complete adherence showed protective effects (OR=0.81; 95% CI: 0.75-0.88), as did partial adherence, though less pronounced (OR=0.92; 95% CI: 0.85-0.99). Advanced age (>60 years) and diabetes were associated with greater final severity. Colombia, Ecuador, and Peru demonstrated the best clinical outcomes. While the Kruskal-Wallis test reached statistical significance (p=0.0392), differences between adherence levels did not achieve clinical relevance, and the recategorized analysis (≥60% vs <60%) showed no significant differences in final severity. Conclusions In real-world Latin American settings, Li-ESWT proves effective for men with mild to moderate erectile dysfunction. Complete adherence improves clinical outcomes compared to non-adherence. With partial adherence, it also provides benefits, although to a lesser extent. Baseline severity emerged as the strongest predictor of outcomes, followed by age and diabetes. The absence of severe ED patients limits extrapolation to that population. Future research should compare different adherence schedules and session frequencies, evaluate cost-effectiveness in Latin American populations, explore outcomes in severe ED with psychological factors, and develop standardized regional protocols based on accumulated evidence and best practices. Disclosure No