Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis

Vol. 43 (x): 2017 March 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0245


REVIEW ARTICLE

Zi-jun Zou 1, Liang-you Tang 1, Zhi-hong Liu 1, Jia-yu Liang 1, Ruo-chen Zhang 1, Yu-jie Wang 1, Yong-quan Tang 1, Rui Gao 2 , Yi-ping Lu 1
1 Department of Urology, Institute of Urology , West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China; 2 Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China

ABSTRACT

Aim: The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erec­tile dysfunction (ED) is not clearly determined. The purpose of this study is to investi­gate the short-term efficacy and safety of LI-ESWT for ED patients.

Materials and Methods: Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databas­es. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment.

Results: Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% con­fidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic ef­fect than five-week protocol. No significant adverse event was reported.

Conclusion: LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis.

Keywords: Erectile Dysfunction; Therapeutics; Meta-Analysis as Topic

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