Shock-wave treatment for erectile dysfunction in patients unresponsive to PDE5I therapy

This trial was carried out to assess the effectiveness of low-intensity extracorporeal shockwave therapy (LI-ESWT) for the treatment of patients with erectile dysfunction (ED) who do not respond to vascular medications such as phosphodiesterase type 5 inhibitors (PDE5Is). The authors found that LI-ESWT may improve erectile function in these patients.

Around 52% of men over the age of 40 experience ED. The occurrence of ED increases with age. Several medical treatments for ED exist such as PDE5Is. These drugs increase blood flow to the penis, causing erections. The most common cause of ED can be blood vessel disorders such as high blood pressure or diabetes. Traditional treatments have side effects and can take the spontaneity out of sex. Also, these medications work only they are talked without resolving the cause of ED.

LI-EWST has emerged as a promising treatment ED. LI-ESWT has been used to treat ED worldwide. LI-ESWT involves the use of sound waves to improve blood flow in the penis. The effectiveness of LI-ESWT in patients with ED who no longer respond to PDE5Is is not clear. 

There were 76 men involved in this trial. All participants had ED that no longer responded to PDE5I therapy. 40 patients were randomly assigned to receive LI-ESWT. 36 patients were assigned to receive a placebo procedure. Erectile function was evaluated through standardized questionnaires. Patients were also evaluated using the Erection Hardness Score (EHS). An EHS of higher than 2 indicates the penis is hard enough for penetration. 

At a follow-up of 3 months, there was a significant improvement in erectile function in the LI-ESWT group, while there was a slight reduction in erectile function in the placebo group. At 6 months follow-up 52.5% of patients in the LI-ESWT group had an EHS of higher than 2. This was compared to 27.8% of patients in the placebo group. 40% of the LI-ESWT group had a positive response to LI-ESWT at 6 months compared to 13.9% of the placebo group. 

There were no side effects reported in either group.

The authors concluded that in patients who no longer respond to PDE5Is, LI-ESWT provided improvements in ED symptoms. 

The study had a small number of patients. Penis blood vessel health was not measured to confirm improvement in blood flow to the penis. The trial also had a short follow-up period of 6-months.