[50] The efficacy and safety of low-intensity shockwave therapy in erectile dysfunction

Objective: To assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) on patients with erectile dysfunction (ED). Methods: This prospective single-centre study included 21 male patients between January 2015 and October 2017. All patients were aged >18 years and in a stable sexual relationship. They had been diagnosed with ED for ⩾6 months and still not satisfied with oral or intracavernosal injection treatment of their ED. Patients who had penile surgery, coagulopathy abnormalities, unstable or uncontrolled medical or psychiatric disorders, with neurological disorders, post radical pelvic surgery, on hormonal therapy or post pelvic radiation were excluded. The treatment course comprised of two phases using a low-energy shockwave generator, each for 3 weeks with two sessions each week (total 6 sessions) with a 3-week break, and total course duration of 9 weeks. Li-SWT was applied at 19 penile sites, each session delivering 3000 J to the patient’s penis, divided between the 10 points (each 300 J). The energy administered was 0.7–0.25 mJ/mm2 depending on the patient’s tolerability. Patients were in the supine position with no anaesthesia given. The outcome was assessed using the International Index of Erectile Function-Erectile Function (IIEF-EF) score before and after treatment. Results: In all, 21 patients were included in the study, with mean age of 43.9 years. Diabetes mellitus was present in 66.6%. All patients had sexual desire, with 95.25% having orgasmic function. All patients completed the first phase of treatment, and 71.4% felt an improvement and completed the second phase. The mean base IIEF-EF score for all patients was 10.14, which increased to 10.73 after the first phase. The IIEF-EF score rose to 12.8 in 15 of 21 patients who completed the full treatment course. About 66.6% of the patients would repeat the treatment and recommend it to a friend. Only one patient had mild ecchymosis and pain after treatment, which was treated conservatively. Conclusion: Li-SWT is a safe modality for ED and could be an effective treatment with minimal changes that could be beneficial with other non-surgical management strategies such as oral and intracavernosal injection treatments