Low‐Intensity Extracorporeal Shock Wave Therapy—A Novel Effective Treatment for Erectile Dysfunction in Severe ED Patients Who Respond Poorly to PDE5 Inhibitor Therapy

Low‐intensity shock wave therapy (LI‐ESWT) has been reported as an effective treatment in men with mild and moderate erectile dysfunction (ED). The aim of this study is to determine the efficacy of LI‐ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy. This was an open‐label single‐arm prospective study on ED patients with an erection hardness score (EHS) ≤ 2 at baseline. The protocol comprised two treatment sessions per week for 3 weeks, which were repeated after a 3‐week no‐treatment interval. Patients were followed at 1 month (FU1), and only then an active PDE5i medication was provided for an additional month until final follow‐up visit (FU2). At each treatment session, LI‐ESWT was applied on the penile shaft and crus at five different anatomical sites (300 shocks, 0.09 mJ/mm2 intensity at120 shocks/min). Each subject underwent a full baseline assessment of erectile function using validated questionnaires and objective penile hemodynamic testing before and after LI‐ESWT. Outcome measures used are changes in the International Index of Erectile Function‐erectile function domain (IIEF‐ED) scores, the EHS measurement, and the three parameters of penile hemodynamics and endothelial function. Twenty‐nine men (mean age of 61.3) completed the study. Their mean IIEF‐ED scores increased from 8.8 ± 1 (baseline) to 12.3 ± 1 at FU1 (P = 0.035). At FU2 (on active PDE5i treatment), their IIEF‐ED further increased to 18.8 ± 1 (P