LI-ESWT significantly improved erectile function scores at 1 month (MD 3.36; 95% CI 1.58-5.15; p=0.0002) compared to controls, though it provided no additional benefit when combined with PDE-5i.
Meta-Analysis
Does LI-ESWT improve erectile function in patients with vasculogenic ED?
LI-ESWT is an effective standalone treatment for vasculogenic erectile dysfunction, but provides no additional benefit when added to PDE-5 inhibitors.
Mean Difference: 3.36 (95% CI 1.58–5.15)
p-value: p=0.0002
Abstract Introduction Vasculogenic ED, caused by arterial or veno-occlusive issues, is the most common organic ED. LI-ESWT is a non-invasive treatment believed to enhance penile blood flow and endothelial health, promising for this group. Although its effectiveness over placebo (Sham) is confirmed, its use alongside PDE-5 inhibitors (PDE-5i) is still uncertain. Objective This study compares the effectiveness of LI-ESWT in patients with confirmed vasculogenic ED. The goal is to measure the therapeutic benefits of LI-ESWT both as a standalone treatment (compared to Sham) and combined with other therapies (compared to PDE-5i alone) at 1- and 3-month follow-ups. Methods A systematic review and meta-analysis were performed following PRISMA guidelines. PubMed, Web of Science, Scopus, and the Cochrane Library were searched for studies comparing the efficacy of LI-ESWT in patients with vasculogenic ED. The primary outcome was change in the International Index of Erectile Function-5 (IIEF-5) score. We conducted two primary subgroup analyses, the first was LI-ESWT monotherapy vs. Sham treatment, and the second was LI-ESWT + PDE-5i combination therapy vs. PDE-5i monotherapy. Efficacy was assessed at 1-month and 3-month intervals post-treatment. Random-effects models were used to calculate pooled mean differences (MD) with 95% confidence intervals (CI). Results A total of six studies were included. At the 1-month follow-up, the overall pooled analysis demonstrated a significant improvement in IIEF-5 scores favoring the LI-ESWT arms (Total MD: 3.36; 95% CI 1.58, 5.15; p=0.0002). This was primarily driven by the LI-ESWT vs. Sham subgroup, which showed a statistically significant benefit for LI-ESWT (MD: 3.63; 95% CI 1.02, 6.24; p=0.006). In contrast, the addition of LI-ESWT to PDE-5i provided no statistically significant benefit over PDE-5i alone at 1 month (MD: 1.86; 95% CI -1.93, 5.65; p=0.34). At the 3-month follow-up, the overall effect remained robust (Total MD: 4.05; 95% CI 2.98, 5.12; p0.00001). The benefit of LI-ESWT monotherapy over Sham became more pronounced and highly significant, with minimal heterogeneity (MD: 4.35; 95% CI 3.50, 5.20; p0.00001; I2=0%). Conversely, the combination therapy subgroup (LI-ESWT+PDE-5i vs. PDE-5i) continued to show no significant difference between treatments (MD: 0.94; 95% CI -3.12, 5.00; p=0.65). Conclusions This meta-analysis confirms LI-ESWT as an effective standalone treatment for vasculogenic erectile dysfunction, showing significant improvements in erectile function, especially at 3 months post-treatment. However, it does not support using LI-ESWT as an add-on for patients already on PDE-5i, as no extra benefit was found. These results highlight LI-ESWT's potential as a primary therapy for vasculogenic ED. Disclosure No
Abdelshafi et al. (Mon,) conducted a meta-analysis in Vasculogenic Erectile Dysfunction. Low-Intensity Extracorporeal Shock Wave Therapy (LI-ESWT) vs. Sham treatment or PDE-5i monotherapy was evaluated on Change in the International Index of Erectile Function-5 (IIEF-5) score (MD 3.36, 95% CI 1.58-5.15, p=0.0002). LI-ESWT significantly improved erectile function scores at 1 month (MD 3.36; 95% CI 1.58-5.15; p=0.0002) compared to controls, though it provided no additional benefit when combined with PDE-5i.