Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities

To review the evidence of clinical efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) for the treatment of erectile dysfunction (ED). A search on PubMed using Medical Subject Headings terms [((low intensity extracorporeal shockwave therapy) OR (Li-ESWT)) AND (erectile dysfunction)] was conducted in August 2022, to obtain studies on the use of Li-ESWT for the treatment of ED. Its success rate in terms of International Index of Erectile Function-5 (IIEF-5) score and Erection Hardness Score (EHS) improvement was recorded and analysed. A total of 139 articles were reviewed. Overall, 52 studies were included in the final review. 17 studies were on vasculogenic ED, 5 on post pelvic surgery ED, 4 specifically on ED in diabetic patients, 24 on non -spec-ified origin ED and 2 on mixed pathophysiological origin ED. The mean age of patients was 55.87 +/- 7.91 (standard deviation) years and the duration of ED was 4.36 +/- 2.08 years. The mean IIEF-5 score went from 12.04 +/- 2.67 at baseline to 16.12 +/- 5.72, 16.30 +/- 3.26 and 16.85 +/- 1.63 respectively at 3, 6 and 12 months. The mean EHS went from 2.00 +/- 0.46 at baseline to 2.58 +/- 0.60, 2.75 +/- 0.46 and 2.87 +/- 0.16 respectively at 3, 6 and 12 months. Li-ESWT may be a safe and efficacy option for the treatment and cure of ED. Further studies are needed to assess which patients are more suitable for this procedure and which Li-ESWT protocol can lead to the best outcomes.