Low-intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review.

Abstract

To assess the efficacy and safety of low-intensity shockwave therapy (LiSWT) for treating erectile dysfunction (ED) compared to sham therapy. This summary is based on the Cochrane systematic review published in the Cochrane Database of Systematic Reviews 2025, Issue 7 (CD013166). We included randomised controlled trials (RCTs) comparing LiSWT to sham therapy. We excluded psychogenic or iatrogenic ED, kidney transplants, or radical prostatectomy. Critical outcomes were erectile function, discontinuation, and adverse events; important outcomes included rigidity, satisfaction, and quality of life. Certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A total of 21 RCTs (1357 men, aged 39-65 years) were analysed. LiSWT may slightly improve short-term erectile function (mean difference [MD] 3.89, 95% confidence interval [CI] 2.89-4.89; I² = 62%; 15 studies; low-certainty), though clinical importance is uncertain. Long-term function may improve (MD 5.25, 95% CI 2.47-8.04; I² = 87%; five studies; low-certainty). LiSWT likely has little effect on discontinuation (risk ratio 0.77, 95% CI 0.47-1.27; I² = 0%) or adverse events (risk difference 0.00, 95% CI -0.01 to 0.02; I² = 0%). It may improve short-term penile rigidity (MD 1.06, 95% CI 0.83-1.28; I² = 53%; low-certainty). Data for satisfaction or quality of life were unavailable. Low-intensity shockwave therapy may improve long-term erectile function and short-term rigidity, with little difference in discontinuation or adverse events. Evidence certainty is low due to methodological limitations and heterogeneity.