Clinical Question

Is shockwave therapy an effective treatment for erectile dysfunction?

Evidence-Based Answer

Shockwave therapy, a noninvasive treatment that applies extracorporeal shock waves to the penile shaft, can provide mild to moderate improvement in patients with erectile dysfunction of varying etiologies, including vascular, neurogenic, and procedural causes. It can also benefit patients for whom previous medical therapies were not effective. (Strength of Recommendation: A, meta-analysis of randomized controlled trials [RCTs] and four RCTs.)

Evidence Summary

A 2019 meta-analysis of 10 RCTs (N = 872) evaluated the effectiveness of shockwave therapy vs. sham treatment for erectile dysfunction in patients with a mean age of 58 years (range = 27 to 81 years).¹ Most participants had vasculogenic erectile dysfunction, and phosphodiesterase inhibitors were effective in most patients. Participants received shockwave therapy or sham treatment once or twice per week for three to six weeks. Erectile function was measured by the International Index of Erectile Function (IIEF), which is self-assessed and scored from 6 to 30, with higher scores indicating better function. In eight trials (n = 519), shockwave therapy resulted in greater improvement (mean difference [MD] = 4.0; 95% CI, 2.1 to 5.8) and higher scores (MD = 3.7; 95% CI, 0.29 to 7.1) at follow-up compared with the control group. More patients receiving shockwave therapy gained a minimal clinically important difference in IIEF score of greater than 4 points (seven trials; n = 556; odds ratio = 8.5; 95% CI, 2.6 to 28). No significant adverse effects were reported. Eight of the 10 studies were considered to have a low risk of bias based on the Cochrane risk of bias assessment, but the two studies with higher risk of bias were among the largest (n = 264).