Low-intensity Extracorporeal Shockwave Therapy for the Management of Postprostatectomy Erectile Dysfunction: A Systematic Review of the Literature

Maria Chiara Sighinolfi; Ahmed Eissa; Carlo Bellorofonte; Alessandro Mofferdin; Mosaab Eldeeb; Simone Assumma; Enrico Panio; Tommaso Calcagnile; Daniele Stroppa; Giorgio Bozzini; Giorgia Gaia; Stefano Terzoni; Mattia Sangalli; Salvatore Micali; Bernardo Rocco

doi:10.1016/j.euros.2022.07.003

Low-intensity Extracorporeal Shockwave Therapy for the Management of Postprostatectomy Erectile Dysfunction: A Systematic Review of the Literature

Eur Urol Open Sci. 2022 Jul 30:43:45-53. doi: 10.1016/j.euros.2022.07.003. eCollection 2022 Sep.

Authors

Maria Chiara Sighinolfi¹, Ahmed Eissa², Carlo Bellorofonte³, Alessandro Mofferdin⁴, Mosaab Eldeeb², Simone Assumma^{1

4}, Enrico Panio^{1

4}, Tommaso Calcagnile^{1

4}, Daniele Stroppa¹, Giorgio Bozzini⁵, Giorgia Gaia⁶, Stefano Terzoni¹, Mattia Sangalli¹, Salvatore Micali⁴, Bernardo Rocco¹

Affiliations

¹ Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
² Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
³ Urology Unit, Columbus Clinic Center, Milan, Italy.
⁴ Urology Department, University of Modena & Reggio Emilia, Modena, Italy.
⁵ Urology Department, ASST Lariana, Como, Italy.
⁶ Gynecology Department, ASST Santi Paolo e Carlo, Milan, Italy.

Abstract

Context: Erectile dysfunction (ED) following radical prostatectomy is a concern for patients and their partners. Low-intensity extracorporeal shockwave therapy (LI-ESWT) can potentially enhance tissue repair and regeneration. The aim of the current study was to systematically review the literature to assess the role of LI-ESWT in the management of patients with postprostatectomy ED.

Evidence acquisition: Two authors independently performed a systematic search of the PubMed and Web of Science databases to identify all relevant articles. Non-English reports, case reports, reviews, letters, and editorials were excluded. Risk of bias was assessed according to the GRADE guidelines.

Evidence synthesis: Nine articles met the inclusion criteria and were included in the qualitative analysis. All the studies included were published between 2015 and 2022 and the majority of them compared phosphodiesterase type 5 inhibitors (PDE5Is) alone versus a combination of LI-ESWT and PDE5Is. Only three studies were randomized controlled trials (RCTs). In general, there is no standardized protocol for LI-ESWT for postprostatectomy ED. In comparisons of LI-ESWT + PDE5Is versus PDE5Is alone, some authors found a statistically significant improvement in erectile function with LI-ESWT + PDE5Is. The starting time for LI-ESWT differed among the studies, ranging from 3 d to 6 mo after surgery. The main limitations of the review are the scarcity of studies, small sample sizes, high risk of bias, and high heterogeneity among studies.

Conclusions: There is currently limited evidence on the use of LI-ESWT either alone or in combination with PDE5Is in penile rehabilitation protocols after prostatectomy. However, small clinical trials with short follow-up show that LI-ESWT could potentially play a role in the management of postprostatectomy ED in the future. Further RCTs with larger sample sizes are needed.

Patient summary: Despite limited reports in the literature, low-intensity shockwave therapy after removal of the prostate is a promising noninvasive treatment for dealing with erectile dysfunction after surgery.

Keywords: Erectile dysfunction; Low-intensity extracorporeal shockwave therapy; Radical prostatectomy.

Publication types

Review