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Low-intensity extracorporeal shock wave treatment improves erectile function in non-responder PDEi5 patients: a systematic review

Grandez-Urbina, JA1; Pichardo-Rodriguez, R1; Pariona-Vargas, F2; Helguero-Santin, LM1; Torres-Roman, JS1; Saldana-Gallo, J1; Garcia-Perdomo, HA3

1: Clinica de Urologia Avanzada UROZEN, Lima, Peru, Peru; 2: Hospital Nacional Alberto Sabogal Sologuren, Es Salud, Callao, Perú; 3: Universidad del Valle, Cali, Colombia

Objective: To determine the effectiveness and harms of LI-ESWT in patients that are non-responder to PDEi5 in ED.

Material and Methods: A comprehensive search of the OVID MEDLINE, CENTRAL, EMBASE, Lilacs and Google Scholar databases to October 2016 was performed. Randomized Clinical Trials(RCT) and Prospective Cohort studies reporting LIWST in ED were included. The IIEF-5 and EHS were the most commonly used tools to evaluate therapeutic efficacy in ED. The keywords used were ED, LI-ESWT and

ultrasonic therapy. We exclude systematic reviews, editorial commentaries, letter to editor, case series, clinical cases and technical limited researches in the treatment application. The erectile function was evaluated in 1,3,6 and 12 months.

Results: There were 6 studies including 196 patients from 2012 to 2016. Only one study was a RCT; in other studies, the setup parameters of LI-ESWT and the protocol of treatment were variable. The improvement of IIEF-5 and EHS in patients in 1,3,6 and 12 months was statically significant in almost all the studies (Table 1). Non-adverse events were reported. Selection bias was identified in 66% of the studies, there are several limitations in the Open-label single arm studies included.

Conclusions: LI-ESWT is an effective and secure treatment in non-responder to PDEi5 patients to improve the IIEF-5 and EHS. However there is weak evidence and there are several limitations and risk of bias, especially in prospective studies. We encourage researchers to publish more RCTs with longer follow up to provide more evidence for the clinical use of this therapy.


Work supported by industry: no.

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