What is the latest evidence for using shockwave therapy for erectile dysfunction?

The latest evidence from 2024–2025 strongly supports the use of low-intensity extracorporeal shockwave therapy (Li-ESWT) as a safe and effective non-invasive treatment for men with erectile dysfunction (ED), especially vasculogenic ED. Recent meta-analyses and randomised controlled trials (RCTs) demonstrate significant improvements in standardised erectile function measures compared to sham treatments, with benefits sustained up to 12 months post-treatment.

Key findings from recent research:

• Meta-analyses (2025): Large systematic reviews of RCTs including nearly 900 men show that Li-ESWT leads to a statistically significant improvement in the International Index of Erectile Function (IIEF-EF) and Erection Hardness Score (EHS) compared to sham therapy.

• Prospective trials: Comparative studies of different shockwave protocols found that both approaches were equally effective, showing substantial improvement at 6 and 12 months with minimal or no side effects.

• Safety: Shockwave therapy is consistently reported as well-tolerated, with no adverse sequelae in published trials.

• Treatment protocols: There remains some variability in the number of sessions, devices, and intensity used across studies. Evidence suggests that increased frequency (twice weekly) and higher pulse counts may enhance efficacy, but no universally accepted protocol exists yet.

• Population focus: Most included studies focus on men with vasculogenic ED, and men with post-prostatectomy ED are typically excluded from analyses.

Caveats and limitations:

• Objective measures are limited: Many studies rely primarily on self-reported scores like IIEF rather than objective assessments such as penile Doppler ultrasound.

• Long-term data: While short-to-mid term efficacy (up to 12 months) is well-supported, larger multicentre RCTs with longer follow-up are needed to confirm durability of benefit.

• Patient selection: The greatest benefit is seen in men with vasculogenic ED; efficacy in diabetic men, men with severe or comorbid ED, or after prostate surgery is still being investigated.

In summary, the latest high-level evidence indicates that shockwave therapy is effective and safe for many men with erectile dysfunction, especially those with vascular causes, but standardized treatment protocols and more long-term data are still needed for universal guideline endorsement