Abstract
Introduction
Despite recent promising clinical results, the underlying mechanism of action of low-intensity
extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) is mostly
unclear and currently under investigation.
Aim
To systematically identify and evaluate evidence regarding the basic science behind
Li-ESWT for ED, discuss and propose a putative mechanism of action, address the limitations,
and imply insights for further investigation in the field.
Methods
Using Cochrane’s methodologic recommendations on scoping studies and systematic reviews,
we conducted a systematic scoping review of the literature on experimental research
regarding Li-ESWT for ED and other pathologic conditions. The initial systematic search
was carried between January and November 2017, with 2 additional searches in April
and August 2018. All studies that applied shockwave treatment at an energy flux density
>0.25 mJ/mm2 were excluded from the final analysis.
Main Outcome Measure
We primarily aimed to clarify the biological responses in erectile tissue after Li-ESWT
that could lead to improvement in erectile function.
Results
59 publications were selected for inclusion in this study. 15 experimental research
articles were identified on Li-ESWT for ED and 44 on Li-ESWT for other pathologic
conditions. Li-ESWT for ED seems to improve erectile function possibly through stimulation
of mechanosensors, inducing the activation of neoangiogenesis processes, recruitment
and activation of progenitor cells, improving microcirculation, nerve regeneration,
remodeling of erectile tissue, and reducing inflammatory and cellular stress responses.
Clinical Implications
Improving our understanding of the mechanism of action of Li-ESWT for ED can help
us improve our study designs, as well as suggest new avenues of investigation.
Strengths & Limitations
A common limitation in all these studies is the heterogeneity of the shockwave treatment
application and protocol.
Conclusion
Li-ESWT for ED, based on current experimental studies, seems to improve erectile function
by inducing angiogenesis and reversing pathologic processes in erectile tissue. These
studies provide preliminary insights, but no definitive answers, and many questions
remain unanswered regarding the mechanism of action, as well as the ideal treatment
protocol.
Sokolakis I, Dimitriadis F, Teo P, et al. The Basic Science Behind Low-Intensity Extracorporeal
Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical
Studies. J Sex Med 2019;16:168–194.
Key Words
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Article Info
Publication History
Accepted:
December 19,
2018
Received:
October 11,
2018
Footnotes
Conflict of Interest: Dr. Teo is Global Clinical Research Manager with Dornier MedTech Asia Pte Ltd (Singapore). Dr Hatzichristou received research grants and speaker honoraria from Medispec (Israel), Dornier MedTech (Germany), and Menarini (Italy). Drs Sokolakis, Dimitriadis, Hatzichristodoulou, and Giuliano report no conflicts of interest.
Funding: None.
Identification
Copyright
© 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
