Abstract Introduction Low-intensity extracorporeal shockwave therapy (LiESWT) has emerged as a restorative option for men with vasculogenic erectile dysfunction (ED) by promoting angiogenesis, tissue remodeling, and neurovascular recovery. Traditional treatment schemes commonly apply two sessions per week for three weeks, limited to the penile shaft. The current study introduces and evaluates a condensed sequential multi-zonal LiESWT protocol, involving consecutive daily sessions targeting the penile root, shaft, and dorsal neurovascular bundle. Objective The objective was to determine whether this intensified anatomical coverage, delivered in a continuous short-course schedule, enhances both erectile function and responsiveness to phosphodiesterase type 5 inhibitors (PDE5i). Methods A prospective open-label study was conducted on 84 men aged 43–69 years (mean 56.8 ± 6.2) with mild-to-moderate vasculogenic ED, confirmed by penile color-Doppler ultrasound and partial PDE5i responsiveness. Treatment was delivered with the Morenova® system, comprising six consecutive daily sessions of 3000 shocks. The first two targeted the penile root, the next two the shaft, and the final two the dorsal surface of the penis. Linear and focal applicators were used at 0.09 mJ/mm2 and 0.15 mJ/mm2, respectively, with frequencie of 2.5 and 2.0 Hz. Dynamic penile color-Doppler ultrasound followed intracavernosal injection of 20 μg alprostadil (PGE₁). Cavernosal peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured 10–15 minutes post-injection. Arterial insufficiency was defined as PSV 25 cm/s, borderline flow 25–30 cm/s, and normal inflow ≥30 cm/s; veno-occlusive dysfunction was suspected when EDV 5 cm/s. Functional assessment included IIEF-EF, Erection Hardness Score (EHS), Doppler parameters, and PDE5i satisfaction at 3 months. Paired t-tests assessed changes (p 0.05). Results All 84 patients completed the treatment protocol and 3-month follow-up. The mean IIEF-EF score increased from 15.6 ± 3.2 to 21.1 ± 3.7 (p 0.001), while the EHS improved from 2.4 ± 0.6 to 3.3 ± 0.7 (p 0.01). Doppler evaluation demonstrated a rise in PSV from 25.8 ± 5.7 cm/s to 34.6 ± 6.1 cm/s (p 0.01) and a reduction in EDV from 5.2 ± 1.8 cm/s to 3.1 ± 1.5 cm/s (p 0.05). A clinically meaningful improvement (≥4-point IIEF-EF gain) was observed in 68% of subjects. Reassessment of PDE5i response revealed a significant increase in overall satisfaction in 86% of patients. No adverse effects, pain, or discontinuation were reported throughout the protocol. Conclusions The condensed sequential multi-zonal LiESWT protocol, incorporating focused treatment at the penile root, shaft, and dorsal neurovascular bundle, achieved significant improvements in erectile function, rigidity, and penile hemodynamics in men with vasculogenic ED. The integration of daily treatment and anatomically targeted energy delivery resulted in enhanced functional recovery and improved PDE5i response. The procedure demonstrated excellent safety, tolerability, and clinical efficiency, supporting its role as an effective alternative to conventional spaced regimens. Further controlled trials are warranted to confirm long-term outcomes and optimize anatomical targeting parameters. Disclosure No
Arian et al. (Mon,) studied this question.
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