https://doi.org/10.4081/aiua.2026.14707
Low-intensity extracorporeal shock wave therapy in vasculogenic erectile dysfunction refractory to PDE5 inhibitors: a prospective study with 12- and 18-month outcomes
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Published: 2 March 2026
Background: Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising treatment for vasculogenic erectile dysfunction (ED), particularly in men who do not respond to phosphodiesterase type-5 inhibitors (PDE5-Is).
Objective: To evaluate the feasibility, safety, and clinical effectiveness of Li-ESWT in men with vasculogenic ED through a prospective 12- and 18-month follow-up.
Methods: A prospective observational study was conducted on 188 patients with vasculogenic ED and inadequate response to PDE5-Is. Patients underwent 6 weekly sessions of Li-ESWT. Erectile function was assessed using the international index of erectile function (IIEF) and erection hardness score (EHS). Responders were defined as those achieving ≥ 3-point improvement on IIEF-EF and/or EHS ≥3.
Results: Mean age was 66.6 years; mean ED duration was 24 months. IIEF-EF improved from 11 at baseline to 21 at 12 months and 18 at 18 months. At 12 months, 71% of patients showed improvement in EHS. Younger age (<45 years), shorter ED duration (<12 months), and moderate baseline severity predicted better response (p<0.05). Sustained improvement was observed in 65% of patients at 12 months and 54% at 18 months. No adverse events were reported.
Conclusions: Li-ESWT is a safe and effective treatment for vasculogenic ED unresponsive to PDE5-Is, with maximum benefit observed within 12 months. Efficacy tends to decline at 18 months. Larger controlled studies are needed to define long-term outcomes.
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