(P1) effectiveness of low-intensity shockwave therapy for erectile dysfunction: a systematic review of studies from the Middle East and North Africa (MENA) region

Abstract Introduction Low-intensity shockwave therapy (LiSWT) has emerged as a novel, non-invasive treatment modality for erectile dysfunction (ED), believed to promote angiogenesis and improve erectile function through tissue regeneration. This systematic review aims to evaluate the effectiveness of LiSWT in the management of ED by analyzing outcomes from various clinical studies originating from the Middle East and North Africa (MENA) region. Methods A systematic review was performed using PubMed as the primary search engine. Studies were included if they evaluated the effects of LiSWT on patients with ED, had a prospective design, reported outcomes such as the International Index of Erectile Function (IIEF), Erection Hardness Scale (EHS), and other relevant measures, and originated from countries within the MENA region. The review followed the (PRISMA) guidelines for systematic reviews and included randomized controlled trials (RCTs), non-randomized comparative, and observational studies. A total of 10 studies were included in the review, comprising 5 RCTs, 2 non-randomized comparative trials, and 3 observational studies. Sample sizes ranged from 40 to 425 patients, and treatment protocols varied from 4 to 12 sessions. Two RCTs comparing LiSWT to sham treatments reported significant increases in IIEF-5 scores up to 3 months post-intervention, although one study found no significant differences at 6 months. Other RCTs comparing LiSWT to PDE-5 inhibitors or control groups showed significant improvements in all groups, with no significant differences between groups. The combination of LiSWT and a physical exercise regimen outperformed monotherapy with either LiSWT or exercise alone. All observational studies demonstrated improvements in erectile function, with rates of satisfactory sexual intercourse ranging from 51.8% to 76.3% during follow-up periods of up to 30 months. LiSWT was generally well-tolerated across studies, with minimal reported side effects. Conclusion Within the MENA region, LiSWT appears to be an effective and well-tolerated treatment for ED, with reported outcomes that seem to be similar to those observed with PDE-5i treatment. However, additional large-scale RCTs are needed to standardize treatment protocols and assess long-term efficacy.