Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile dysfunction

Abstract

Background: The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LiESWT) for the treatment of erectile dysfunction (ED). Materials and methods: A comprehensive search of PubMed, Medline , and Cochrane databases was performed from November 2005 to July 2018. RCTs evaluating efficacy of LiESWT in the treatment of ED were selected. The primary outcomes were the mean difference between treatment and sham patients in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score 1 month after treatment, and the mean change in IIEF-EF from baseline to 1 month post-treatment. The secondary analysis considered the percentage of men whose erectile hardness score (EHS) changed from <2 at baseline to >3 after treatment. All analyses used a random effects method to pool study-specific results. Results: A total of seven RCTs provided data for 607 patients. The mean IIEF-EF 1 month post-treatment ranged from 12.8 to 22.0 in the treatment group versus 8.17–16.43 in the sham group. The mean difference between the treatment and sham groups at the 1 month follow up was a statistically significant increase in IIEF-EF of 4.23 ( p = 0.012). Overall, five of the seven trials provided data on the proportion of patients with baseline EHS <2 who improved to EHS >3 at 1 month post-treatment. The proportions ranged from 3.5 to 90% in the treatment group versus 0–9% in the sham group and the pooled relative risk of EHS improvement for the treated versus sham group was 6.63 ( p = 0.0095). No significant adverse events were reported. Conclusions: This is the first meta-analysis that evaluates RCTs exploring LiESWT as a treatment modality strictly for ED. This therapeutic strategy appears to be well tolerated with short-term benefits. However further studies exploring specific treatment regimens and long-term outcomes are needed.

Extracorporeal shock wave therapy in the supportive care and rehabilitation of cancer patients

“…Erectile dysfunction is another condition of interest in cancer rehabilitation [9–11]. This indication can also be treated with ESWT, but has to be managed in an interdisciplinary setting [2].…”

Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction

“…11 Men with severe ED with DM, advanced age, and/or hypertension often have less response to drugs and often require additional management strategies. 12 Platelets have an important role in promoting wound healing and coagulation and include several growth factors responsible for regenerative functions (eg, fibroblast growth factor, platelet-derived growth factor, vascular endothelial growth factor [VEGF]). 13 Therefore, owing to these growth factors, it has the potential to support the regenerative matrix and healing in damaged tissues.…”

“… 11 Men with severe ED with DM, advanced age, and/or hypertension often have less response to drugs and often require additional management strategies. 12 …”

Novel Emerging Therapies for Erectile Dysfunction

“…Recent meta-analysis demonstrated that the mean difference of IIEF-EF score between the treatment and sham groups was 4.23 (p=0.012) at the 1-month follow-up. No significant adverse events were reported [ 94 ]. These studies suggest that LI-SWT appears to produce significant improvement of the IIEF and EHS and appears to be well-tolerated.…”