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

A Letter to the Editor to this article was published on 22 July 2016

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.

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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.

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Correspondence to Palle Jörn Sloth Osther.

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Fojecki, G.L., Tiessen, S. & Osther, P.J.S. Extracorporeal shock wave therapy (ESWT) in urology: a systematic review of outcome in Peyronie’s disease, erectile dysfunction and chronic pelvic pain. World J Urol 35, 1–9 (2017). https://doi.org/10.1007/s00345-016-1834-2

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Keywords

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