Low intensity extracorporeal shockwave therapy on erectile dysfunction—first results from a prospective study

Pedro Costa, Jorge Dias, Ricardo Gouveia, Paulo Espiridião, Daniela Pereira, Raquel Rodrigues, Luís Ferraz


Background: Erectile dysfunction (ED) is a common problem in our society. Its prevalence is higher amongst the elderly and patients with cardiovascular risk. Oral 5-phosphodiesterase inhibitors (PDE5-I) and intracavernous/intra-urethral alprostadil are the main therapeutical options for these patients. Although the good results shown by these approaches, non-responders lack other effective options. In the last years, some innovative options appeared in order to face this problem, and some studies have shown good results with the use of low-intensity extracorporeal shockwave therapy (Li-ESWT) in the corpora cavernosa. This article presents the first results from a prospective study in Centro Hospitalar de V.N. Gaia, Portugal, with the aim to evaluate clinical efficacy of Li-ESWT.
Methods: Eighteen patients with ED were submitted to 4 sessions of Li-ESWT [3,000 pulses/session, distributed in 6 points (4 in the penile shaft + 2 in the crura) once a week]. Every patient has been re-evaluated 1 and 3 months after the last session. Pre- and post-procedure 5-item version of International Index Erectile Function (IIEF-5) scores and Global Assessment Questionnaire-Question 1 (GAQ-Q1) answers were obtained.
Results: The study population was patients were 61.1±7.2 years old, 55.6% diabetic, 61.1% with hypertension and 38.9% smokers. They scored an average 11.6±4.8 points in the IIEF-5. Half of these patients were PDE5-I non-responders, 22% had a medical contraindication for its use and 11% did not respond to alprostadil intracavernous injections. After treatment, IIEF-5 scored 12.3±4.2 points (P=0.36) after 1 month, and 12.3±4.3 after 3 months (P=0.33) with 50% answering positively to GAQ-Q1 at 1 month and 33% at 3 months. No complications have been registered.
Conclusions: The present study failed to show a sustained improvement in erectile function of our patients after treatment with Li-ESWT. Larger studies to confirm Li-EWST efficacy shown by some groups are lacking. In the future, a different protocol with the same technology or a more refined selection of patients might improve the outcomes.