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Am J Mens Health. 2017 Nov;11(6):1781-1790. doi: 10.1177/1557988317721643. Epub 2017 Sep 8.

Low-Intensity Extracorporeal Shockwave Therapy Can Improve Erectile Function in Patients Who Failed to Respond to Phosphodiesterase Type 5 Inhibitors.

Tsai CC1,2, Wang CJ2,3, Lee YC2,3, Kuo YT4, Lin HH5, Li CC1,2,3, Wu WJ1,2,3, Liu CC2,3,6.

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1 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
3 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
4 Management Offices, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
5 Department of Laboratory Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
6 Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.


Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to improve ED by enhancing perfusion of the penis. The current study was performed to evaluate whether combined treatment with LI-ESWT and PDE5is can restore erectile function in patients who failed to respond to PDE5is alone. This was an open-label single-arm prospective study. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Sociodemographic information and detailed medical history were recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly for 12 weeks. All patients continued their regular PDE5is use. The EHS and the 5-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate the change in erectile function 1 and 3 months after LI-ESWT. A total of 52 patients were enrolled. After LI-ESWT treatment, 35 of the 52 patients (67.3%) could achieve an erection hard enough for intercourse (EHS ≧ 3) under PDE5is use at the 1-month follow-up. Initial severity of ED was the only significant predictor of a successful response (EHS1: 35.7% vs. EHS2: 78.9%, p = .005). Thirty-three of the 35 (94.3%) subjects who responded to LI-ESWT could still maintain their erectile function at the 3-month follow-up. LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of ED was an important predictor of a successful response.


erectile dysfunction; erection hardness score; phosphodiesterase type 5 inhibitor; shockwave therapy

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