The efficacy of low intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED) has received hard criticism and recently published meta-analyses were not able to provide further insights, nor specific recommendations. The aim of this systematic review and meta-analysis is to evaluate the efficacy of LI-ESWT for ED, identify the ideal treatment population and treatment protocol, and provide recommendations for future research in the field. A systematic research for relevant clinical studies published from January 2010 to September 2018 was performed, using the following databases: Medline, Embase, The Cochrane Library, Scopus, and Web of Science. Only clinical studies that investigated the efficacy of LI-ESWT for ED only, and reported primary outcomes using IIEF-EF scores/questionnaires were included. Both, randomised controlled trials (RCTs) and cohort studies were included, but the meta-analysis was performed only for sham-controlled RCTs. Ten RCTs including 873 patients were selected for the meta-analysis. Pooling data of these studies showed that LI-ESWT could significantly improve erectile function in men with ED regarding both patient-subjective outcomes (IIEF-EF: +3.97; 95% CI [2.09–5.84]; p < 0.0001, EHS ≥ 3: OR: 4.35; 95% CI [1.82–10.37]; p = 0.0009) and patient-objective outcomes (peak systolic velocity: +4.12; 95% CI [2.30–5.94]; p < 0.00001). In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.
Subscribe to Journal
Get full journal access for 1 year
only $14.88 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol. 2010;58:243–8.
Fode M, Lowenstein L, Reisman Y. Low-intensity extracorporeal shockwave therapy in sexual medicine: a questionnaire-based assessment of knowledge, clinical practice patterns, and attitudes in sexual medicine practitioners. Sex Med. 2017;5:e94–8.
Fode M, Hatzichristodoulou G, Serefoglu EC, Verze P, Albersen M. Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Nat Rev Urol. 2017;14:593.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
Chitale S, Morsey M, Swift L, Sethia K. Limited shock wave therapy vs sham treatment in men with Peyronie’s disease: results of a prospective randomized controlled double‐blind trial. BJU Int. 2010;106:1352–6.
Hatzichristodoulou G, Meisner C, Gschwend JE, Stenzl A, Lahme S. Extracorporeal shock wave therapy in Peyronie’s disease: results of a placebo-controlled, prospective, randomized, single-blind study. J Sex Med. 2013;10:2815–21.
Rosen RC, Allen KR, Ni X, Araujo AB. Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol. 2011;60:1010–6.
Souper R, Hartmann J, Alvarez M, Fuentes I, Astroza G, Marconi M. Correlation between peak systolic velocity and diameter of cavernosal arteries in flaccid versus dynamic state for the evaluation of erectile dysfunction. Int J Impot Res. 2017;29:132.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Gruenwald I, Appel B, Vardi Y. Low‐intensity extracorporeal shock wave therapy—A novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med. 2012;9:259–64.
Bechara A, Casabé A, De Bonis W, Nazar J. Effectiveness of low-intensity extracorporeal shock wave therapy on patients with erectile dysfunction (ED) who have failed to respond to PDE5i therapy. A pilot study. Arch Esp Urol. 2015;68:152–60.
Chung E, Cartmill R. Evaluation of clinical efficacy, safety and patient satisfaction rate after low‐intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open‐label single‐arm prospective clinical trial. BJU Int. 2015;115:46–9.
Pelayo-Nieto M, Linden-Castro E, Alias-Melgar A, Grovas DE, Carreño-de la Rosa F, Bertrand-Noriega F, et al. Linear shock wave therapy in the treatment of erectile dysfunction. Actas Urol Esp. 2015;39:456–9.
Reisman Y, Hind A, Varaneckas A, Motil I. Initial experience with linear focused shockwave treatment for erectile dysfunction: a 6-month follow-up pilot study. Int J Impot Res. 2015;27:108.
Ruffo A, Capece M, Prezioso D, Romeo G, Illiano E, Romis L, et al. Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction. Int Braz J Urol. 2015;41:967–74.
Bechara A, Casabé A, De Bonis W, Ciciclia PG. Twelve-month efficacy and safety of low-intensity shockwave therapy for erectile dysfunction in patients who do not respond to phosphodiesterase type 5 inhibitors. Sex Med. 2016;4:e225–32.
Frey A, Sønksen J, Fode M. Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction: a pilot study. Scand J Urol. 2016;50:123–7.
Hisasue SI, China T, Horiuchi A, Kimura M, Saito K, Isotani S, et al. Impact of aging and comorbidity on the efficacy of low‐intensity shock wave therapy for erectile dysfunction. Int J Urol. 2016;23:80–4.
Ayala HA, Cuartas JP, Cleves DC. Impact on the quality of erections after completing a low-intensity extracorporeal shock wave treatment cycle on a group of 710 patients. Adv Urol. 2017:1843687. https://doi.org/10.1155/2017/1843687.
Tsai CC, Wang CJ, Lee YC, Kuo YT, Lin HH, Li CC, et al. Low-intensity extracorporeal shockwave therapy can improve erectile function in patients who failed to respond to phosphodiesterase type 5 inhibitors. Am J Mens Health. 2017;11:1781–90.
Chen X, Huang HW, Zhu XB, Chen GX, Li PC, Song F, et al. Focused low-intensity extracorporeal shock wave therapy for erectile dysfunction: preliminary observation of 32 cases. Natl J Androl. 2018;24:529–32.
Kitrey ND, Vardi Y, Appel B, Shechter A, Massarwi O, Abu-Ghanem Y, et al. Low intensity shock wave treatment for erectile dysfunction—how long does the effect last? J Urol. 2018;200:167–170.
Vardi Y, Appel B, Kilchevsky A, Gruenwald I. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study. J Urol. 2012;187:1769–75.
Yee CH, Chan ES, Hou SS, Ng CF. Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double‐blinded, placebo controlled study. Int J Urol. 2014;21:1041–5.
Olsen AB, Persiani M, Boie S, Hanna M, Lund L. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol. 2015;49:329–33.
Srini VS, Reddy RK, Shultz T, Denes B. Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population. Can J Urol. 2015;22:7614–22.
Kitrey ND, Gruenwald I, Appel B, Shechter A, Massarwa O, Vardi Y. Penile low intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham controlled study. J Urol. 2016;195:1550–5.
Motil I, Kubis I, Sramkova T. Treatment of vasculogenic erectile dysfunction with Piezowave2 device. Application of low intensity shockwaves using novel linear shockwave tissue coverage (LSTC-ED®) technique. A prospective, multicentric, placebo-controlled study. Adv Sex Med. 2016;6:15.
Fojecki GL, Tiessen S, Osther PJ. Effect of low-energy linear shockwave therapy on erectile dysfunction—a double-blinded, sham-controlled, randomized clinical trial. J Sex Med. 2017;14:106–12.
Kalyvianakis D, Hatzichristou D. Low-intensity shockwave therapy improves hemodynamic parameters in patients with vasculogenic erectile dysfunction: a triplex ultrasonography-based sham-controlled trial. J Sex Med. 2017;14:891–7.
Yamaçake KG, Carneiro F, Cury J, Lourenço R, Françolin PC, Piovesan AC, et al. Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography. Int J Impot Res. 2018;14:1.
Zewin TS, El-Assmy A, Harraz AM, Bazeed M, Shokeir AA, Sheir K, et al. Efficacy and safety of low-intensity shock wave therapy in penile rehabilitation post nerve-sparing radical cystoprostatectomy: a randomized controlled trial. Int Urol Nephrol. 2018;19:1–8.
Qi T, Ye L, Wang B, Zhang B, Chen J. Comparison of the effects of extracorporeal shock wave therapy and a vacuum erectile device on penile erectile dysfunction: a randomized clinical trial. Medicine. 2017;96:e8414.
Fojecki GL, Tiessen S, Osther PJ. Effect of linear low-intensity extracorporeal shockwave therapy for erectile dysfunction—12-Month follow-up of a randomized, double-blinded, sham-controlled study. Sex Med. 2018;6:1–7.
Kalyvianakis D, Memmos E, Mykoniatis I, Kapoteli P, Memmos D, Hatzichristou D. Low-intensity shockwave therapy for erectile dysfunction: a randomized clinical trial comparing 2 treatment protocols and the impact of repeating treatment. J Sex Med. 2018;15:334–45.
Katz JE, Molina ML, Clavijo R, Prakash NS, Ramasamy R. A phase 2 randomized trial to evaluate different dose regimens of low-intensity extracorporeal shockwave therapy for erectile dysfunction: clinical trial update. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.07.011.
Lu Z, Lin G, Reed-Maldonado A, Wang C, Lee YC, Lue TF. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. 2017;71:223–33.
Angulo JC, Arance I, de Las Heras MM, Meilán E, Esquinas C, Andrés EM. Efficacy of low-intensity shock wave therapy for erectile dysfunction: a systematic review and meta-analysis. Actas Urol Esp. 2017;41:479–90.
Clavijo RI, Kohn TP, Kohn JR, Ramasamy R. Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis. J Sex Med. 2017;14:27–35.
Zou ZJ, Tang LY, Liu ZH, Liang JY, Zhang RC, Wang YJ, et al. Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis. Int Braz J Urol. 2017;43:805–21.
Man L, Li G. Low-intensity extracorporeal shock wave therapy for erectile dysfunction: a systematic review and meta-analysis. Urology. 2018;119:97–103.
Gao L, Qian S, Tang Z, Li J, Yuan J. A meta-analysis of extracorporeal shock wave therapy for Peyronie’s disease. Int J Impot Res. 2016;28:161.
Feldman R, Denes B, Appel B, et al. The safety and efficacy of Li-ESWT in 604 patients for erectile dysfunction: summary of current and evolving evidence. J Urol. 2015;193:e905–6.
Hatzichristou D. Low-intensity extracorporeal shock waves therapy (LI-ESWT) for the treatment of erectile dysfunction: Where do we stand? Eur Urol. 2017;71:234–6.
Fode M, Albersen M, Østergren PB. Is low-intensity shockwave therapy for erectile dysfunction ready for clinical practice? Int J Impot Res. 2018. https://doi.org/10.1038/s41443-018-0081-z.
Sokolakis I, Dimitriadis F, Psalla D, Karaliulakis G, Kalyvianakis D, Hatzichristou D. Effects of low-intensity shock wave therapy (LiST) on the erectile tissue of naturally aged rats. Int J Impot Res. 2018. https://doi.org/10.1038/s41443-018-0064-0.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sokolakis, I., Hatzichristodoulou, G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res 31, 177–194 (2019). https://doi.org/10.1038/s41443-019-0117-z
Low intensity shockwave therapy in combination with phosphodiesterase-5 inhibitors is an effective and safe treatment option in patients with vasculogenic ED who are PDE5i non-responders: a multicenter single-arm clinical trial
International Journal of Impotence Research (2021)
“Doc, if it were you, what would you do?”: a survey of Men’s Health specialists’ personal preferences regarding treatment modalities
International Journal of Impotence Research (2021)
Li-Eswt improves hemodynamic parameters thus suggesting neoangiogenesis in patients with vascular erectile dysfunction
International Journal of Impotence Research (2021)
Current Urology Reports (2021)
Current Physical Medicine and Rehabilitation Reports (2021)