A Systematic Review of the Long-Term Efficacy of Low-Intensity Shockwave Therapy for Vasculogenic Erectile Dysfunction

The use of Low-Intensity Shockwave Therapy (LISWT) for erectile dysfunction is becoming increasingly investigated and discussed. Whilst its mechanism of action remains poorly understood and may be multifactorial, it offers a unique treatment modality for patients with vascular erectile dysfunction (ED). Unlike any other treatment available for ED, which are primarily aimed at treating the symptoms of the disease, LISWT could provide men with a natural erection by treating the underlying pathophysiology. However, whilst there is a growing evidence base for its efficacy, its use is still considered experimental by many organizations. Furthermore, there is little consensus on the long-term efficacy data available (beyond six months after intervention) for LISWT, and which patients benefit most from its treatment. We, therefore, aimed to perform a systematic review to assess these factors in men with vasculogenic ED.

Our systematic review of the literature identified eleven studies, with a total of 799 patients. These studies consisted of five randomized trials and six non-randomised studies. When looking at the IIEF-EF improvement post-intervention at six months, nine studies identified a statistically significant improvement in the scores with a range of 2.6 to 10.7 (median of 5.3). However, of the five studies assessing outcomes at twelve months and beyond, non-identified ongoing improvements in IIEF-EF scores. Two demonstrated plateauing of results with the remaining three showing a small gradual decline in scores (-2 to 0.1 IIEF-EF score changes from six months). It is important to note however that scores in all studies remained well above baseline. When looking at predictors of success, specifically for long term outcomes, there is still little consensus on the evidence. There is some data to demonstrate that increasing age negatively impacts results. From this dataset, it is difficult to state if ED severity and duration, co-morbidities and smoking status impact the effectiveness of treatment.

The results of our systematic review demonstrate that LISWT for vasculogenic ED offers a potentially effective treatment modality, with improvement in functional results that are seen beyond the first few months of treatment. This adds to the already exciting evidence base available for its short-term outcomes. However, as seen there may be a gradual decline in erectile function as time goes on. This is important to acknowledge in frank discussions with patients in order to manage ongoing expectations of treatment. It is clear however that further investigation is required into this exciting treatment modality, assessing more real-life treatment conditions such as the impact of concurrent PDE5 inhibitor use and further assessment of outcomes beyond six months duration.

Written by: Oliver Brunckhorst, MBBS, BSc (Hons), MRSC (Eng),¹ Lauren Wells, BSc (Hons),¹ Fiona Teeling, BSc (Hons),¹ Gordon Muir, FRCS Urol, ²Asif Muneer, BSc (Hons), MBChB, FRCS Urol, MD,³ Kamran Ahmed, PhD, FRCS Urol^1,2
1. MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
2. Department of Urology, King’s College Hospital, London, United Kingdom
3. Department of Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom

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