Low-intensity shockwave with PDE-5i safe, effective for erectile dysfunction

The combination of low-intensity shockwave therapy (Li-ESWT) with phosphodiesterase 5 inhibitor (PDE-5i) medication safely improves erectile function in vasculogenic erectile dysfunction (ED) patients who had failed first-line oral therapy, a recent study has found.

Researchers conducted a multicentre open-label prospective analysis of 106 nonresponders to first-line PDE-5i treatment. Li-ESWT was delivered as 3,000 shockwaves with an energy of 0.25 mJ/mm2 and a frequency of 4–6 Hz, two times per week for 3 weeks, in an outpatient setting. Outcomes were assessed using the International Index of Erective Function (IIEF), Erection Hardness Score (EHS), and the Sexual Quality of Life-Male (SQOL-M) questionnaires.

Before the combination treatment, the mean IIEF-erectile function (EF) score was 13.47±4.61; two patients had mild ED, 29 had mild-to-moderate ED, 38 had moderate ED, and 37 had severe ED.

After the Li-ESWT regimen, 75 patients (70.7 percent) achieved clinically significant improvement of IIEF-EF, as defined by the minimal clinically important difference (MCID) criterion. Moreover, 30 participants (28.3 percent) achieved normal erectile function (IIEF-EF score ≥26). All other IIEF domains also showed marked improvements after the intervention, and none saw worsening IIEF scores.

Furthermore, 72 patients (67.9 percent) reported EHS score ≥3, sufficient for a full intercourse, while 37 (34.9 percent) reached an EHS score of 4, indicating full rigidity. Mean EHS scores jumped from 2.19±0.52 at baseline to 3.4±0.60 after shockwave treatment (p<0.0001).

Such improvements translated to better SQOL-M scores, which increased significantly from 45.56±8.00 at baseline to 55.31±9.56 (p<0.0001) after treatment. Aside from one patient who complained for dorsal penile curvature and palpable distal plaque, no other adverse events were reported during therapy.