Table 4. Meta-analysis of Li-ESWT clinical data on ED.
| Included studies | Results | Summarized | Reference | |
|---|---|---|---|---|
| Total 14 studies including 833 patients (7 RCTs and 7 non-RCTs) | IIEF (total) | WMD: 2.00; 95% CI, 0.99–3.00; p<0.001 | 1. Most of these studies presented encouraging results, regardless of variation in Li-ESWT setup parameters or treatment protocols. 2. The patients with mild moderate ED had better therapeutic efficacy. 3. Therapeutic efficacy of Li-ESWTs could last at least 3 mo. |
[86] |
| IIEF after 1 mo | WMD: 0.37; 95% CI, -1.45–2.19; p=0.690 | |||
| IIEF after 3 mo | WMD: 2.71; 95% CI, 1.51–3.91; p<0.001 | |||
| EHS after 1 mo | RD: 0.47; 95% CI, 0.38–0.56; p<0.001 | |||
| EHS after 3 mo | RD: 0.16; 95% CI, 0.04–0.29; p=0.010 | |||
| Total 9 RCTs including 637 patients | IIEF (total) | WMD: 2.54; 95% CI, 0.83–4.25; p=0.040 | 1. Li-ESWT could significantly improve the IIEF and EHS of patients with ED. 2. Lower energy density (0.09 mJ/mm2), increased the number of pulses (3,000 pulses), and shorter total treatment courses (<6 wk) was showed better therapeutic efficacy. |
[87] |
| IIEF after 3 mo | WMD: 4.15; 95% CI, 1.40–6.90; p=0.003 | |||
| EHS after 3 mo | RD: 0.16; 95% CI, 0.03–0.28; p=0.010 | |||
| Total 5 studies including 460 patients (3 RCTs and 2 non-RCTs) (Only ED patients after radical prostatectomy) | IIEF (post op baseline) | WMD: 0.02; 95% CI, -0.28–0.32; p=0.900 | Li-ESWT showed a statistically significant effect on early recovery in penile rehabilitation of ED following RP. | [88] |
| IIEF after 3-4 mo | WMD: -3.14; 95% CI, -5.73–0.55; p=0.020 | |||
| IIEF after 9-12 mo | WMD: -5.37; 95% CI, -12.42–1.69; p=0.140 | |||
| Total 10 RCTs including 873 patients | IIEF | WMD: 3.97; 95% CI, 2.09–5.84; p<0.001 | This provided results showing that Li-ESWT significantly improves erectile function in patients with vasculogenic ED. | [89] |
| From EHS ≤2 to EHS ≥3 | OR: 0.16; 95% CI, 0.03–0.28; p=0.010 | |||
| Peak systolic velocity | WMD: 4.12; 95% CI, 2.30–5.94; p≤0.001 | |||
| Total 16 RCTs including 1,064 patients | IIEF after 1 mo | WMD: 3.18; 95% CI, 1.38–4.98; p=0.005 | 1. Li-ESWT could significantly increase IIEF and EHS in ED patients, especially in moderate ED group. 2. This suggest that treatment plans with an energy density of 0.09 mJ/mm2 and pulses number of 1,500 to 2,000 are more beneficial in ED patients. |
[90] |
| IIEF after 3 mo | WMD: 3.01; 95% CI, 2.04–3.98; p<0.001 | |||
| IIEF after 6 mo | WMD: 3.20; 95% CI, 2.49–3.92; p<0.001 | |||
| From EHS ≤2 to EHS ≥3 | OR: 5.07; 95% CI, 1.78–14.44; p=0.002 | |||
| Total 15 studies (4 RCTs and 11 non-RCTs) | IIEF (only RCTs) | RR: 2.50; 95% CI, 0.74–8.45; p=0.140 | 1. Li-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED. 2. Nine-week protocol with energy density of 0.09 mJ/mm2 and 1,500 pluses seemed to have better therapeutic effect |
[91] |
| EHS (only RCTs) | RR: 8.31; 95% CI, 3.88–17.78; p<0.001 | |||
Li-ESWT, low-intensity extracorporeal shock wave therapy; ED, erectile dysfunction; RCT, randomized clinical trial; IIEF, International Index of Erectile Function; EHS, Erectile Hardness Score; WMD, weighted mean difference; CI, confidence interval; RD, risk differences; RR, risk ratio; OR, odds ratio; RP, radical prostatectomy.