Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews

Abstract

Background: Low-intensity extracorporeal shockwave therapy (LI-ESWT) may be a successful complementary treatment approach for erectile dysfunction (ED). In this study, we aimed to review and summarize the research evidence from systematic reviews (SRs)/meta-analyses (MAs) regarding the clinical effectiveness of LI-ESWT for ED.Methods: Studies on LI-ESWT for ED were searched using eight electronic databases from establishment of each database to 31 June 2021 with the language restrictions of Chinese and English. All articles were screened, and qualifying data were recorded based on the inclusion criteria. Methods including: the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2); the Risk of Bias in Systematic Reviews (ROBIS); the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); and Grading of Recommendations, Assessment Development, and the Evaluation (GRADE) were used by two independent raters to assess methodological quality, risk of bias, reporting quality, and SR evidence of quality, respectively.Results: Eight SRs/MAs met all inclusion criteria. Seven reviews were rated as critically low on overall confidence and one review was low on confidence based on the AMSTAR-2 appraisal tool. While most PRISMA criteria were met, the major reporting flaws were in relation the financial statements not being included, along with no protocol registrations. Three SRs/MAs were classed as low risk regarding bias as measured by the ROBIS tool. Based on the GRADE method, only one SRs/MAs of high-quality evidence and seven SRs/MAs of moderate-quality evidence were found. The present research results supported LI-ESWT as a complementary therapy for ED patients, but the evidence should be considered carefully due to the methodological flaws identified. Discussion: Our results showed that LI-ESWT as an adjunctive therapy has benefits for ED patients.There were no obvious side effects, and the number of shockwave treatments and energy flux density (EFD) would affect the IIEF-EF, EHS and PSV scores. However, due to the limited sample size and the quality of reporting evidence, our conclusions may not be fully representative.

Assessing the quality and readability of online content on shock wave therapy for erectile dysfunction

“…LI‐SWT for ED has yet to be approved and applied as standard therapy protocol, as its efficacy is still incompletely defined, leading to some criticism among some experts in the field (Lei et al, 2021; Sokolakis & Hatzichristodoulou, 2019). However, some studies have stated that shock wave therapy for ED is an effective treatment option (Akande et al, 2021; Angulo et al, 2017; Caretta et al, 2021; Clavijo et al, 2017; Lu et al, 2017; Saltzman et al, 2022; Wang et al, 2020; Yao et al, 2022; Yuan et al, 2021). Scientific disagreement of the benefits of shock wave therapy may prompt patients to resort partially or completely to online sources to gain knowledge about LI‐SWT and aid in treatment decision making (Stukus, 2019).…”

Effectiveness and Safety of Type- and Energy-based Extracorporeal Shockwave Therapy in Clinical Practice: Umbrella Review and Evidence Mapping

“…Currently, there was only one overview of SRs on ESWT [67]. Yuan et al used the AMSTAR 2, the Risk of Bias in Systematic Reviews (ROBIS), PRISMA, and GRADE to review 8 SRs on low-intensity ESWT for erectile dysfunction.…”

The Efficacy of Low-Intensity Shock Wave Therapy based on the Stratification of Erectile Dysfunction Patients: A Long-term Follow-up

“…In an over view of eight systematic reviews, Yuan et al stated that Li-ESWT increased the participants' subjective scores mainly the IIEF-EF domain, also the objective EHS and penile hemodynamics were improved in the terms of PSV (11). Similarly, Yao et al analyzed 16 RCTs and reported that both IIEF and EHS in ED patients has increased after Li-ESWT treatment, notably in the moderate ED group.…”