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Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM).
J Sex Med. 2019 10; 16(10):1490-1505.JS

Abstract

INTRODUCTION

Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings.

AIM

To review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine.

METHODS

Medline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS.

OUTCOMES

The panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations.

RESULTS

11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time.

CLINICAL IMPLICATIONS

LISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice.

STRENGTHS AND LIMITATIONS

All studies have been evaluated by a panel of experts providing recommendations for clinical practice.

CONCLUSIONS

LISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain. Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490-1505.

Authors+Show Affiliations

Department of Urology; Ospedale San Raffaele, Vita-Salute University, Milano, Italy. Electronic address: paolo.capogrosso@gmail.com.Department of Urology, University of Southern Denmark, Esbjerg and Odense, Denmark.Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.Urology Section-University of Catania, Catania, Italy.Hospital Universitari de Bellvitge, Barcelona, Spain.Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium; Department of Urology, University Hospitals of Leuven, Leuven, Belgium.Neuro-urology Unit, Rambam Healthcare Campus, Haifa, Israel.Men's Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands.Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31447380

Citation

Capogrosso, Paolo, et al. "Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations From the European Society of Sexual Medicine (ESSM)." The Journal of Sexual Medicine, vol. 16, no. 10, 2019, pp. 1490-1505.
Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med. 2019;16(10):1490-1505.
Capogrosso, P., Frey, A., Jensen, C. F. S., Rastrelli, G., Russo, G. I., Torremade, J., Albersen, M., Gruenwald, I., Reisman, Y., & Corona, G. (2019). Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). The Journal of Sexual Medicine, 16(10), 1490-1505. https://doi.org/10.1016/j.jsxm.2019.07.016
Capogrosso P, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations From the European Society of Sexual Medicine (ESSM). J Sex Med. 2019;16(10):1490-1505. PubMed PMID: 31447380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). AU - Capogrosso,Paolo, AU - Frey,Anders, AU - Jensen,Christian Fuglesang S, AU - Rastrelli,Giulia, AU - Russo,Giorgio I, AU - Torremade,Josep, AU - Albersen,Maarten, AU - Gruenwald,Ilan, AU - Reisman,Yacov, AU - Corona,Giovanni, Y1 - 2019/08/22/ PY - 2019/05/18/received PY - 2019/07/05/revised PY - 2019/07/18/accepted PY - 2019/8/27/pubmed PY - 2020/7/7/medline PY - 2019/8/27/entrez KW - Chronic Prostatitis KW - Erectile Dysfunction KW - Peyronie's Disease KW - Shockwave SP - 1490 EP - 1505 JF - The journal of sexual medicine JO - J Sex Med VL - 16 IS - 10 N2 - INTRODUCTION: Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings. AIM: To review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine. METHODS: Medline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS. OUTCOMES: The panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS: 11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time. CLINICAL IMPLICATIONS: LISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice. STRENGTHS AND LIMITATIONS: All studies have been evaluated by a panel of experts providing recommendations for clinical practice. CONCLUSIONS: LISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain. Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490-1505. SN - 1743-6109 UR - https://wwww.unboundmedicine.com/medline/citation/31447380/Low_Intensity_Shock_Wave_Therapy_in_Sexual_Medicine_Clinical_Recommendations_from_the_European_Society_of_Sexual_Medicine__ESSM__ DB - PRIME DP - Unbound Medicine ER -