Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis

Liang Dong, Degui Chang, Xiaojin Zhang, Junjun Li, Fang Yang, Kun Tan, Yali Yang, Shanshan Yong, Xujun Yu, Liang Dong, Degui Chang, Xiaojin Zhang, Junjun Li, Fang Yang, Kun Tan, Yali Yang, Shanshan Yong, Xujun Yu

Abstract

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has been reported as a useful and noninvasive treatment for erectile dysfunction (ED). Systematic review and meta-analysis are utilized to evaluate the efficacy of Li-ESWT by comparing the changes in the International Index of Erectile Function erectile function domain (IIEF-EF) and the Erection Hardness Score (EHS) versus sham therapy in men with ED. A systematic search of the MEDLINE, EMBASE, ClinicalTrials.gov, CBM, CNKI, WANGFANG, and VIP was conducted to obtain randomized controlled trials (RCTs) published in peer-reviewed journals or presented in abstract forms of Li-ESWT for ED treatment from January 2010 to June 2018. If RCTs are published in peer-reviewed literature and IIEF-EF scores and EHS are used to assess erectile function outcomes, they are eligible for inclusion. A meta-analysis was used to summarize the estimates. The meta-analysis included seven RCTs involving 522 participants. The data revealed that men treated with Li-ESWT showed significant improvement in pooled mean IIEF-EF scores from baseline to follow-up compared with sham therapy (MD: 1.99 points; 95% CI [1.35, 2.63]; p < .00001). Changes in the IIEF-EF score increased significantly in the treatment group (MD: 3.62; 95% CI [2.99, 4.25]; p < .00001). The EHS increased significantly in the treatment group in four studies (OR: 16.02; 95% CI [7.93, 32.37]; p < .00001). Patients with moderate and/or severe ED reported better results in mean IIEF scores (MD: 3.95; 95% CI [2.44, 5.46]; p < .00001). In meta-analysis of seven RCTs with men who received Li-ESWT for ED, there was evidence that the IIEF-EF and EHS experienced improvements following Li-ESWT.

Keywords: EHS; Erectile dysfunction; IIEF-EF; low-intensity extracorporeal shock waves; meta-analysis.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram for study selection.
Figure 2.
Figure 2.
How main machines used in the majority of the studies work to exert their effects.
Figure 3.
Figure 3.
Seven randomized controlled trials included in our meta-analysis. Quality of studies was assessed with the Cochrane Collaboration’s tool (A: Risk of bias graph; B: Risk of bias summary).
Figure 4.
Figure 4.
Clinical outcomes of meta-analysis on the IIEF-EF score (A: Mean IIEF-EF score; B: Change of IIEF-EF score.).
Figure 5.
Figure 5.
Clinical outcomes of meta-analysis on the EHS score.
Figure 6.
Figure 6.
Clinical outcomes of meta-analysis on the severity of ED.

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