Low-Intensity Extracorporeal Shock Wave Therapy (LI-ESWT) for Erectile Dysfunction in Patients Post-prostatectomy: A Systematic Review
Bibliographic record
Abstract
Erectile dysfunction (ED) is a common and distressing complication following radical prostatectomy, significantly affecting patients' quality of life. Low-intensity extracorporeal shock wave therapy (LI-ESWT) has emerged as a non-invasive modality aimed at enhancing erectile function through tissue regeneration and improved neovascularisation. This review aims to systematically evaluate the safety and efficacy of LI-ESWT in the treatment of ED in men following prostatectomy. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across PubMed, PubMed Central (PMC), MEDLINE, Cochrane Library, and Scopus for studies published between January 2015 and July 2025. Eligible studies included randomised controlled trials (RCTs) and cohort studies evaluating LI-ESWT for post-prostatectomy ED using validated outcome measures such as the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS). Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2.0 and the Newcastle-Ottawa Scale. Ten studies, of which five were RCTs and five were cohort studies, involving a total of 760 patients met the inclusion criteria. LI-ESWT was associated with statistically significant improvements in erectile function across most studies, particularly when combined with phosphodiesterase-5 inhibitors (PDE5is). IIEF-5 scores improved in both three-monthly and 6-12-monthly follow-ups, and EHS ≥3 was commonly achieved in combination therapy cohorts. No serious adverse events were reported. However, variations in treatment protocols, energy settings, and follow-up durations limited comparability and precluded meta-analysis. The overall certainty of evidence was moderate for efficacy and high for safety. LI-ESWT appears to be a safe and potentially effective treatment for ED following radical prostatectomy, particularly when initiated early and used alongside PDE5is. Despite encouraging results, heterogeneity among studies and treatment protocols, alongside methodological limitations, underscores the need for larger, high-quality RCTs to establish standardised protocols and confirm long-term benefits.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.009 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".