Advertisement

World Journal of Urology

, Volume 35, Issue 1, pp 1–9 | Cite as

Extracorporeal shock wave therapy (ESWT) in urology: a systematic review of outcome in Peyronie’s disease, erectile dysfunction and chronic pelvic pain

  • Grzegorz Lukasz Fojecki
  • Stefan Tiessen
  • Palle Jörn Sloth Osther
Invited Review

Abstract

Purpose

The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders.

Methods

We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline and PubMed was carried out. The systematic review was performed according to PRISMA guidelines.

Results

We identified 10 trials on 3 urological indications. Two of 3 trials on Peyronie’s disease (PD) involving 238 patients reported improvement in pain; however, no clinical significant changes in penile deviation and plaque size were observed. Four studies on erectile dysfunction (ED) including 337 participants were included. Using International Index of Erectile Function (IIEF-EF) and erectile hardness scale (EHS) data suggested a significant positive effect of ESWT in phosphodiesterase-5 inhibitor (PDE-5i) responders in 2 of 4 trials and 3 of 4 trials, respectively. Three studies on chronic pelvic pain (CPP) engaging 200 men reported positive changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). There was considerable heterogeneity between trials both with regard to treatment techniques and outcome measures, making it difficult to compare results.

Conclusions

ESWT may resolve pain in PD patients, while evidence for reducing curvature and plaques size is poor. Effects of ESWT on IIEF in ED patients are inconsistent; however, data on EHS does imply that the treatment potentially may recover natural erection in PDE-5i responders. ESWT seems to be able to resolve pain in CPP patients in the short term. In all three disease entities, long-term outcome data are still warranted.

Keywords

Extracorporeal shock wave therapy Urology Systematic review Peyronie’s disease Erectile dysfunction Chronic pelvic pain 

Notes

Author contribution

G. Fojecki and S. Tiessen contributed to data collection, data analysis and manuscript writing. P. J. Osther helped with data analysis, manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Eisenberger F, Chaussy C (1978) Contact-free renal stone fragmentation with shock waves. Urol Res 6(3):111CrossRefPubMedGoogle Scholar
  2. 2.
    Rassweiler JJ, Knoll T, Kohrmann KU, McAteer JA, Lingeman JE, Cleveland RO, Bailey MR, Chaussy C (2011) Shock wave technology and application: an update. Eur Urol 59(5):784–796. doi: 10.1016/j.eururo.2011.02.033 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Wang N, Tytell JD, Ingber DE (2009) Mechanotransduction at a distance: mechanically coupling the extracellular matrix with the nucleus. Nat Rev Mol Cell Biol 10(1):75–82. doi: 10.1038/nrm2594 CrossRefPubMedGoogle Scholar
  4. 4.
    Frairia R, Berta L (2011) Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles Ligaments Tendons J 1(4):138–147PubMedGoogle Scholar
  5. 5.
    Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M (1992) Influence of shock waves on fracture healing. Urology 39(6):529–532CrossRefPubMedGoogle Scholar
  6. 6.
    Valchanou VD, Michailov P (1991) High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 15(3):181–184CrossRefPubMedGoogle Scholar
  7. 7.
    Larking AM, Duport S, Clinton M, Hardy M, Andrews K (2010) Randomized control of extracorporeal shock wave therapy versus placebo for chronic decubitus ulceration. Clin Rehabil 24(3):222–229. doi: 10.1177/0269215509346083 CrossRefPubMedGoogle Scholar
  8. 8.
    Saggini R, Figus A, Troccola A, Cocco V, Saggini A, Scuderi N (2008) Extracorporeal shock wave therapy for management of chronic ulcers in the lower extremities. Ultrasound Med Biol 34(8):1261–1271. doi: 10.1016/j.ultrasmedbio.2008.01.010 CrossRefPubMedGoogle Scholar
  9. 9.
    Yang P, Guo T, Wang W, Peng YZ, Wang Y, Zhou P, Luo ZL, Cai HY, Zhao L, Yang HW (2013) Randomized and double-blind controlled clinical trial of extracorporeal cardiac shock wave therapy for coronary heart disease. Heart Vessels 28(3):284–291. doi: 10.1007/s00380-012-0244-7 CrossRefPubMedGoogle Scholar
  10. 10.
    Wang Y, Guo T, Cai HY, Ma TK, Tao SM, Sun S, Chen MQ, Gu Y, Pang JH, Xiao JM, Yang XY, Yang C (2010) Cardiac shock wave therapy reduces angina and improves myocardial function in patients with refractory coronary artery disease. Clin Cardiol 33(11):693–699. doi: 10.1002/clc.20811 CrossRefPubMedGoogle Scholar
  11. 11.
    Hanna M, Pedersen D, Lund M, Marcussen N, Lund L (2012) Low energy ESWT, a novel treatment for diabetic nephropathy (animal study). J Endourol 26:A6CrossRefGoogle Scholar
  12. 12.
    Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M (2001) Guidelines on urolithiasis. Eur Urol 40(4):362–371CrossRefPubMedGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. doi: 10.1016/j.jclinepi.2009.06.005 CrossRefPubMedGoogle Scholar
  14. 14.
    Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U (2001) The prevalence of Peyronie’s disease: results of a large survey. BJU Int 88(7):727–730CrossRefPubMedGoogle Scholar
  15. 15.
    Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, Davis R, Hellstrom W (2004) Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. J Urol 171(6 Pt 1):2350–2353CrossRefPubMedGoogle Scholar
  16. 16.
    Bekos A, Arvaniti M, Hatzimouratidis K, Moysidis K, Tzortzis V, Hatzichristou D (2008) The natural history of Peyronie’s disease: an ultrasonography-based study. Eur Urol 53(3):644–650. doi: 10.1016/j.eururo.2007.07.013 CrossRefPubMedGoogle Scholar
  17. 17.
    Mulhall JP, Schiff J, Guhring P (2006) An analysis of the natural history of Peyronie’s disease. J Urol 175(6):2115–2118. doi: 10.1016/s0022-5347(06)00270-9 (discussion 2118) CrossRefPubMedGoogle Scholar
  18. 18.
    Hatzichristodoulou G, Meisner C, Gschwend JE, Stenzl A, Lahme S (2013) Extracorporeal shock wave therapy in Peyronie’s disease: results of a placebo-controlled, prospective, randomized, single-blind study. J Sex Med 10(11):2815–2821CrossRefPubMedGoogle Scholar
  19. 19.
    Chitale S, Morsey M, Swift L, Sethia K (2010) Limited shock wave therapy vs sham treatment in men with Peyronie’s disease: results of a prospective randomized controlled double-blind trial. BJU Int 106(9):1352–1356CrossRefPubMedGoogle Scholar
  20. 20.
    Palmieri A, Imbimbo C, Longo N, Fusco F, Verze P, Mangiapia F, Creta M, Mirone V (2009) A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie’s disease. Eur Urol 56(2):363–370CrossRefPubMedGoogle Scholar
  21. 21.
    Srirangam SJ, Manikandan R, Hussain J, Collins GN, O’Reilly PH (2006) Long-term results of extracorporeal shockwave therapy for Peyronie’s disease. J Endourol 20(11):880–884. doi: 10.1089/end.2006.20.880 CrossRefPubMedGoogle Scholar
  22. 22.
    Poulakis V, Skriapas K, de Vries R, Dillenburg W, Ferakis N, Witzsch U, Melekos M, Becht E (2006) Extracorporeal shockwave therapy for Peyronie’s disease: an alternative treatment? Asian J Androl 8(3):361–366. doi: 10.1111/j.1745-7262.2006.00138.x CrossRefPubMedGoogle Scholar
  23. 23.
    Skolarikos A, Alargof E, Rigas A, Deliveliotis C, Konstantinidis E (2005) Shockwave therapy as first-line treatment for Peyronie’s disease: a prospective study. J Endourol 19(1):11–14CrossRefPubMedGoogle Scholar
  24. 24.
    Strebel RT, Suter S, Sautter T, Hauri D (2004) Extracorporeal shockwave therapy for Peyronie’s disease does not correct penile deformity. Int J Impot Res 16(5):448–451CrossRefPubMedGoogle Scholar
  25. 25.
    Claro JA, Passerotti CC, Figueiredo Neto AC, Nardozza A Jr, Ortiz V, Srougi M (2004) An alternative non-invasive treatment for Peyronie’s disease. Int Braz J Urol 30(3):199–204CrossRefPubMedGoogle Scholar
  26. 26.
    Michel MS, Ptaschnyk T, Musial A, Braun P, Lenz ST, Alken P, Kohrmann KU (2003) Objective and subjective changes in patients with Peyronie’s disease after management with shockwave therapy. J Endourol 17(1):41–44CrossRefPubMedGoogle Scholar
  27. 27.
    Lebret T, Loison G, Herve JM, Mc Eleny KR, Lugagne PM, Yonneau L, Orsoni JL, Saporta F, Butreau M, Botto H (2002) Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: experience with standard lithotriptor (siemens-multiline). Urology 59(5):657–661CrossRefPubMedGoogle Scholar
  28. 28.
    Kiyota H, Ohishi Y, Asano K, Hasegawa N, Madarame J, Miki K, Kato N, Kimura T, Ishiyama T, Maeda S, Shimomura T, Shiono Y, Miki J (2002) Extracorporeal shock wave treatment for Peyronie’s disease using EDAP LT-02; preliminary results. Int J Urol 9(2):110–113CrossRefPubMedGoogle Scholar
  29. 29.
    Hamm R, McLarty E, Ashdown J, Natale S, Dickinson A (2001) Peyronie’s disease—the plymouth experience of extracorporeal shockwave treatment. BJU Int 87(9):849–852CrossRefPubMedGoogle Scholar
  30. 30.
    Husain J, Lynn NNK, Jones DK, Collins GN, O’Reilly PH (2000) Extracorporeal shock wave therapy in the management of a Peyronie’s disease: initial experience. BJU Int 86(4):466–468CrossRefPubMedGoogle Scholar
  31. 31.
    Hauck EW, Altinkilic BM, Ludwig M, Ludecke G, Schroeder-Printzen I, Arens C, Weidner W (2000) Extracorporal shock wave therapy in the treatment of Peyronie’s disease: first results of a case-controlled approach. Eur Urol 38(6):663–670CrossRefPubMedGoogle Scholar
  32. 32.
    Mirone V, Imbimbo C, Palmieri A, Fusco F (1999) Our experience on the association of a new physical and medical therapy in patients suffering from induratio penis plastica. Eur Urol 36(4):327–330CrossRefPubMedGoogle Scholar
  33. 33.
    Abdel-Salam Y, Budair Z, Renner C, Frede T, Rassweiler J, El-Annany F, El-Magraby H, El-Akkad M (1999) Treatment of Peyronie’s disease by extracorporeal shockwave therapy: evaluation of our preliminary results. J Endourol 13(8):549–552CrossRefPubMedGoogle Scholar
  34. 34.
    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151(1):54–61PubMedGoogle Scholar
  35. 35.
    Porst H, Vardi Y, Akkus E, Melman A, Park NC, Seftel AD, Teloken C, Wyllie M (2010) Standards for clinical trials in male sexual dysfunctions. J Sex Med 7(1 PART 2):414–444CrossRefPubMedGoogle Scholar
  36. 36.
    Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, Montorsi P, Montorsi F, Vlachopoulos C, Kloner R, Sharlip I, Miner M (2010) Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract 64(7):848–857. doi: 10.1111/j.1742-1241.2010.02410.x CrossRefPubMedGoogle Scholar
  37. 37.
    Dong JY, Zhang YH, Qin LQ (2011) Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 58(13):1378–1385. doi: 10.1016/j.jacc.2011.06.024 CrossRefPubMedGoogle Scholar
  38. 38.
    Vardi Y, Appel B, Kilchevsky A, Gruenwald I (2012) Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? short-term results of a randomized, double-blind, sham controlled study. J Urol 187(5):1769–1775. doi: 10.1016/j.juro.2011.12.117 CrossRefPubMedGoogle Scholar
  39. 39.
    Olsen AB, Persiani M, Boie S, Hanna M, Lund L (2014) Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study. Scand J Urol 49(4):329–333. doi: 10.3109/21681805.2014.984326 CrossRefPubMedGoogle Scholar
  40. 40.
    Srini VS, Reddy RK, Shultz T, Denes B (2015) Low intensity extracorporeal shockwave therapy for erectile dysfunction: a study in an Indian population. Can J Urol 22(1):7614–7622PubMedGoogle Scholar
  41. 41.
    Yee CH, Chan ES, Hou SS, Ng CF (2014) Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study. Int J Urol 21(10):1041–1045. doi: 10.1111/iju.12506 CrossRefPubMedGoogle Scholar
  42. 42.
    Chung E, Cartmill R (2015) Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial. BJU Int 115(Suppl 5):46–49. doi: 10.1111/bju.13035 CrossRefPubMedGoogle Scholar
  43. 43.
    Gruenwald I, Appel B, Vardi Y (2012) Low-intensity extracorporeal shock wave therapy—a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med 9(1):259–264. doi: 10.1111/j.1743-6109.2011.02498.x CrossRefPubMedGoogle Scholar
  44. 44.
    Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I (2010) Can low-intensity extracorporeal shockwave therapy improve erectile function? a 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol 58(2):243–248CrossRefPubMedGoogle Scholar
  45. 45.
    Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, de C Williams AC (2010) European Association of Urology, EAU guidelines on chronic pelvic pain. Eur Urol 57(1):35–48. doi: 10.1016/j.eururo.2009.08.020 CrossRefPubMedGoogle Scholar
  46. 46.
    Marszalek M, Wehrberger C, Hochreiter W, Temml C, Madersbacher S (2007) Symptoms suggestive of chronic pelvic pain syndrome in an urban population: prevalence and associations with lower urinary tract symptoms and erectile function. J Urol 177(5):1815–1819. doi: 10.1016/j.juro.2007.01.008 CrossRefPubMedGoogle Scholar
  47. 47.
    Turner JA, Hauge S, Von Korff M, Saunders K, Lowe M, Berger R (2002) Primary care and urology patients with the male pelvic pain syndrome: symptoms and quality of life. J Urol 167(4):1768–1773CrossRefPubMedGoogle Scholar
  48. 48.
    Tan JK, Png DJ, Liew LC, Li MK, Wong ML (2002) Prevalence of prostatitis-like symptoms in Singapore: a population-based study. Singapore Med J 43(4):189–193PubMedGoogle Scholar
  49. 49.
    Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B (2014) Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci 19(4):293–296PubMedPubMedCentralGoogle Scholar
  50. 50.
    Vahdatpour B, Alizadeh F, Moayednia A, Emadi M, Khorami MH, Haghdani S (2013) Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial. ISRN Urol 1(1):972601. doi: 10.1155/2013/972601 Google Scholar
  51. 51.
    Zimmermann R, Cumpanas A, Miclea F, Janetschek G (2009) Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol 56(3):418–424CrossRefPubMedGoogle Scholar
  52. 52.
    Zeng XY, Liang C, Ye ZQ (2012) Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study. Chin Med J 125(1):114–118PubMedGoogle Scholar
  53. 53.
    Zimmermann R, Cumpanas A, Hoeltl L, Janetschek G, Stenzl A, Miclea F (2008) Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int 102(8):976–980. doi: 10.1111/j.1464-410X.2008.07742.x CrossRefPubMedGoogle Scholar
  54. 54.
    Khodyreva LA, Dudareva AA, Mudraya IS, Markosyan TG, Revenko SV, Kumachev KV, Logvinov LA (2013) Efficiency assessment of shock wave therapy in patients with pelvic pain employing harmonic analysis of penile bioimpedance. Bull Exp Biol Med 155(2):288–292CrossRefPubMedGoogle Scholar
  55. 55.
    Kahan BC, Rehal S, Cro S (2015) Risk of selection bias in randomised trials. Trials 16:405. doi: 10.1186/s13063-015-0920-x CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Abraham L, Symonds T, Morris MF (2008) Psychometric validation of a sexual quality of life questionnaire for use in men with premature ejaculation or erectile dysfunction. J Sex Med 5(3):595–601. doi: 10.1111/j.1743-6109.2007.00749.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Grzegorz Lukasz Fojecki
    • 1
  • Stefan Tiessen
    • 2
  • Palle Jörn Sloth Osther
    • 3
  1. 1.Department of UrologyHospital of Southern Jutland, University of Southern DenmarkSønderborgDenmark
  2. 2.Department of UrologyOdense University Hospital, University of Southern DenmarkOdenseDenmark
  3. 3.Department of Urology, Urological Research Center, Lillebaelt HospitalUniversity of Southern DenmarkFredericiaDenmark

Personalised recommendations