Low-Intensity Shock Wave Therapy in Sexual Medicine—Clinical Recommendations from the European Society of Sexual Medicine (ESSM) |
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| Institution: | 1. Department of Urology; Ospedale San Raffaele, Vita-Salute University, Milano, Italy;2. Department of Urology, University of Southern Denmark, Esbjerg and Odense, Denmark;3. Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark;4. Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy;5. Urology Section–University of Catania, Catania, Italy;6. Hospital Universitari de Bellvitge, Barcelona, Spain;7. Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium;8. Department of Urology, University Hospitals of Leuven, Leuven, Belgium;9. Neuro-urology Unit, Rambam Healthcare Campus, Haifa, Israel;10. Men''s Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands;11. Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy;1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China;2. Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China;1. Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy;2. Università Vita-Salute San Raffaele, Milan, Italy;1. Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California–San Francisco, San Francisco, CA, USA;2. Department of Urology, The Second Hospital, Zhejiang University, Zhejiang, China;3. Department of Urology, Kaohsiung Medical University Hospital, and Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;4. Department of Urology, The Third XiangYa Hospital, Central South University, Changsha, China;5. Department of Urology, The First Hospital of Jilin University, Changchun, China;1. Urology Department, Sheba Medical Center, Tel-Hashomer, Israel;2. Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel;3. Department of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Haifa, Israel;1. Servicio de Urología, Hospital Universitario, Getafe, Madrid, España;2. Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España;3. Análisis Estadísticos PerTICA, S. L., Madrid, España |
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| Abstract: | IntroductionLow-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie’s disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings.AimTo review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine.MethodsMedline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS.OutcomesThe panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations.Results11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time.Clinical ImplicationsLISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice.Strengths and limitationsAll studies have been evaluated by a panel of experts providing recommendations for clinical practice.ConclusionsLISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain.Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine—Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490–1505. |
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| Keywords: | Shockwave Erectile Dysfunction Peyronie's Disease Chronic Prostatitis |
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