Efficacy of Low-Intensity Extracorporeal Shock Wave Treatment in Erectile Dysfunction Following Radical Prostatectomy: A Systematic Review and Meta-Analysis

Abstract

Erectile dysfunction (ED) is a well-known complication of radical prostatectomy (RP). Oral 5-phosphodiesterase inhibitors are currently the most widely used penile rehabilitation treatment for ED following RP, but they are less effective than for those with general ED. Low-intensity extracorporeal shock wave treatment (LI-ESWT), causing a biological change that induces neovascularization, has recently been used as a treatment for ED. Therefore, we conducted a systematic review and meta-analysis to investigate the efficiency of LI-ESWT in ED following RP. PubMed, Embase, and the Cochrane Library were searched up until December 2021. The endpoint was the change in IIEF scores after LI-ESWT. Five papers (460 patients) were included in the final analysis. In IIEF scores performed 3–4 months after LI-ESWT, the group receiving LI-ESWT showed statistically significantly better results than the control (WMD = −2.04; 95% CI, −3.72 to −0.35; p = 0.02). However, there were a total of two studies that measured the results after 9–12 months. There was no statistical difference between the two groups (WMD = −5.37; 95% CI, −12.42 to 1.69; p = 0.14). The results of this analysis indicate that LI-ESWT showed a statistically significant effect on early recovery in penile rehabilitation of ED following RP. However, the level of evidence was low. Therefore, careful interpretation of the results is required.

Reviving intimacy: Penile rehabilitation strategies for men after prostate cancer treatment

“…conducted a recent systematic review and meta-analysis of LISWT following RP and reported IIEF scores 3–4 months post-BNSRP were statistically better than the control (weight mean difference = −5.37, p = 0.02). 53 Although, two studies in their analysis found no significant difference at 9–12 months post-LISWT. Despite a low level of evidence among the five studies in their analysis, these data suggest LISWT may have a statistically significant impact on early EF recovery post-BNSRP.…”

Variations in Low Intensity Shockwave Treatment Protocols for Erectile Dysfunction: A Review of the Literature and Guide to Offering Treatment

“…Most randomized control trials (RCTs) have different protocols, patient populations, sham mechanisms, outcome definitions/measurements, and follow up. In an attempt to answer questions about the utility of LiSWT for ED there have been a large number of RCTs published in the last 10 years, as well as approximately 10 meta-analysis studies in about the last 7 years [ 13 14 15 16 17 18 19 20 21 22 ].…”

“…Specific patient populations have been evaluated via a meta-analysis approach, with a 2022 study reporting on the effects of LiSWT on ED for post-prostatectomy patients. The meta-analysis showed that in the 4 studies reporting IIEF scores at 3 months, there was a weighted mean difference of 2.04 (95% CI: –3.72 to –0.35; p=0.02) favoring the treatment group [ 20 ].…”

Regenerative therapies as a potential treatment of erectile dysfunction

“…Therefore, to analyze these conflicting results, meta-analyses of RCTs on Li-ESWT for ED have been published ( Table 4 ) [ 86 87 88 89 90 91 ]. First, a total of 833 patients from 14 studies were included in the meta-analysis published by Lu et al [ 86 ], which showed that patients who underwent Li-ESWT had significantly improved IIEF (weighted mean difference [WMD]: 2.00; 95% confidence interval [CI], 0.99–3.00; p<0.0001) and EHS (risk difference: 0.16; 95% CI, 0.04–0.29; p=0.01) scores compared with the control.…”