Extracorporeal shock wave therapy (ESWT) in urology: a systematic review of outcome in Peyronie's disease, erectile dysfunction and chronic pelvic pain.
OBJECTIVE
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.
Department of Urology, Hospital of Southern Jutland, University of Southern Denmark, Sønderborg, Denmark.
Grzegorz Lukasz
GL
Fojecki
Department of Urology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Stefan
S
Tiessen
Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark. Palle.Joern.Osther@rsyd.dk.
Palle Jörn Sloth
PJ
Osther
D059350:Chronic Pain / Q000628:therapy*; D007172:Erectile Dysfunction / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017699:Pelvic Pain / Q000628:therapy*; D010411:Penile Induration / Q000628:therapy*; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D058986:Phosphodiesterase 5 Inhibitors
Chronic pelvic pain; Erectile dysfunction; Extracorporeal shock wave therapy; Peyronie’s disease; Systematic review; Urology