Editorial Comment: Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations

Abstract

In recent times, low-intensity shockwave therapy (LISWT) has become one of the therapeutic modalities for the treatment of andrological disorders with controversial findings, which makes it difficult to recommend them in the guidelines (1-3). In this scenario this interesting paper aimed to evaluate the applicability of the LISWT in the treatment of erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). During their review, the authors analyzed 11 RCTs and 5 meta-analyzes that investigated LISWT for ED, 4 RCTs and 1 meta-analysis for PD and 5 RCTs for CP / CPPS. For erectile dysfunction purposes, although there is a tendency in this direction, the review made clear a heterogeneity among treatment protocols, with controversial findings and indication being restricted to vasculogenic ED. Before starting treatment, patients should be aware that the scientific evidence is controversial and that the expected improvement may not be clinically relevant. In relation to PD, data available from RCTs is poor. Patient inclusion criteria vary from stable disease to non-stable disease and follow-up assessment varies too much (24 weeks to 1 year) using different sources of energy and heterogeneous protocols proposed, making any comparison difficult. Nevertheless, in a large prospective, randomized, double-blind, placebo-controlled study, with four weekly treatment sessions of ESWT, they observed a significant improvement in penile pain and thus