(845) Combined Homocysteine-Lowering Therapy and Li-ESWT Lead to Earlier Functional and Hemodynamic Improvement in Erectile Dysfunction: A 6-Month Prospective Pilot Study

Introduction Hyperhomocysteinemia (HHcy) impairs endothelial function and is associated with poor response to erectile dysfunction (ED) treatments. While homocysteine-lowering therapy improves vascular health over time, its isolated effect on erectile function remains limited. Low-intensity extracorporeal shockwave therapy (Li-ESWT) promotes neovascularization and endothelial repair. Objective This study aimed to assess whether the combination of Li-ESWT and homocysteine-lowering therapy enhances and accelerates recovery in HHcy-related ED. Methods Twenty patients with ED and plasma homocysteine >15 μmol/L were enrolled in a prospective pilot study. All received a 12-week course of folic acid (5 mg/day), vitamin B6 and B12. Patients were randomized into two groups: • Group A (n=10): homocysteine-lowering therapy alone • Group B (n=10): same therapy + Li-ESWT (6 sessions, 0.09 mJ/mm2, 3000 pulses, twice weekly). Li-ESWT was performed using the Duolith SD1 T-TOP “ultra” (Storz Medical AG, Tägerwilen, Switzerland) International Index of Erectile Function-5 (IIEF-5), peak systolic velocity (PSV) on penile duplex ultrasound, and plasma homocysteine were assessed at baseline, 3 months, and 6 months. Results At baseline, the two groups showed comparable mean values for IIEF-5 (Group A: 12.0 ± 1.3; Group B: 12.0 ± 1.2), PSV (Group A: 20.0 ± 2.1 cm/s; Group B: 20.0 ± 2.0 cm/s), and plasma homocysteine (Group A: 18.1 ± 2.4 μmol/L; Group B: 18.3 ± 2.5 μmol/L). At 3 months, both groups showed a reduction in homocysteine levels (Group A: 13.9 ± 2.0 μmol/L; Group B: 13.8 ± 1.9 μmol/L; p=ns). However, Group B demonstrated a mayor functional and hemodynamic improvement, with IIEF-5 increasing to 18.1 ± 1.8 versus 14.2 ± 1.6 in Group A (p<0.01), and PSV reaching 25.2 ± 2.0 cm/s versus 20.8 ± 2.3 cm/s in Group A (p<0.01). At 6 months, Group A also showed further improvement (IIEF-5: 17.5 ± 1.5; PSV: 24.3 ± 1.9 cm/s), but Group B maintained superior outcomes (IIEF-5: 19.0 ± 1.3; PSV: 26.5 ± 1.8 cm/s). These findings confirm that the addition of Li-ESWT to homocysteine-lowering therapy results in both earlier and greater recovery of erectile function and penile arterial inflow. Conclusions Li-ESWT enhances the short-term effects of homocysteine-lowering therapy, resulting in earlier functional and vascular improvement in HHcy-related ED. The combination may represent an effective synergistic strategy for patients with endothelial-related erectile dysfunction. Disclosure No