{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:23:43Z","timestamp":1790742223702,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,2,3]],"date-time":"2018-02-03T00:00:00Z","timestamp":1517616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2018,2,3]],"date-time":"2018-02-03T00:00:00Z","timestamp":1517616000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is lack of evidence-based optimization of the protocol for low-intensity shockwave therapy for erectile dysfunction. Furthermore, the safety and efficacy of repeating shockwave therapy have not been explored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To compare the efficacy and safety of 6 and 12 treatment sessions within a 6-week treatment period and investigate the effect of repeat treatment after a 6-month period in a 2-phase study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with vasculogenic erectile dysfunction that responded to phosphodiesterase type 5 inhibitors were randomized into 2 groups: low-intensity shockwave therapy sessions once (group A, n\u00a0= 21) or twice (group B, n\u00a0= 21) per week for 6 consecutive weeks (phase 1). Patients who completed 6-month follow-up were offered 6 additional sessions (phase 2); group A received 2 sessions per week and group B received 1 session per week. Patients were followed for 6 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>International Index for Erectile Function erectile function domain (IIEF-EF) score, minimally clinical important differences (MCIDs), Sexual Encounter Profile question 3 (SEP3) score, and triplex ultrasonographic parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In phase 1, groups A and B showed improvement in IIEF-EF score, MCID, SEP3 score, and mean peak systolic velocity compared with baseline. MCIDs were achieved in 62% of group A and 71% of group B, and the percentage of yes responses to SEP3 was 47% in group A and 65% in group B (P\u00a0= .02). Mean peak systolic velocity at baseline and at 3-month follow-up were 29.5 and 33.4 cm\/s for group A and 29.6 and 35.4 cm\/s for group B (P\u00a0= .06). In phase 2, group A showed a greater increase in the percentage of yes responses to SEP3 (group A\u00a0=\u00a0+14.9; group B\u00a0=\u00a0+0.3). When the impact of the total number of sessions received was examined, MCIDs in IIEF-EF score from baseline were achieved in 62%, 74%, and 83% of patients after 6, 12, and 18 sessions, respectively. No treatment-related side effects were reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>The total number of low-intensity shockwave therapy sessions affects the efficacy of erectile dysfunction treatment. Retreating patients after 6 months could further improve erectile function without side effects. 12 sessions can be delivered within 6 weeks without a 3-week break period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>This study lacked a sham-controlled arm. However, all patients were randomized to different groups, and baseline characteristics were similar between groups. Also, all patients were confirmed by triplex ultrasonography to have arterial insufficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients can benefit more in sexual performance from 12 sessions twice per week compared with 6 sessions once a week. Shockwave therapy can be repeated up to a total of 18 sessions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2018.01.003","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T21:03:56Z","timestamp":1517519036000},"page":"334-345","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":44,"title":["Low-Intensity Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment"],"prefix":"10.1093","volume":"15","author":[{"given":"Dimitrios","family":"Kalyvianakis","sequence":"first","affiliation":[{"name":"Department of Urology , Heraklion \u00a0 Greece"},{"name":"University of Crete , Heraklion \u00a0 Greece"},{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Memmos","sequence":"additional","affiliation":[{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Mykoniatis","sequence":"additional","affiliation":[{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi","family":"Kapoteli","sequence":"additional","affiliation":[{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Memmos","sequence":"additional","affiliation":[{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Hatzichristou","sequence":"additional","affiliation":[{"name":"1st Department of Urology and Center for Sexual and Reproductive Health , Thessaloniki \u00a0 Greece"},{"name":"Aristotle University of Thessaloniki , Thessaloniki \u00a0 Greece"},{"name":"Institute for the Study of Urological Diseases , Thessaloniki \u00a0 Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,2,3]]},"reference":[{"key":"2023012309224709700_bib1","first-page":"259","article-title":"Low-intensity extracorporeal shock wave therapy\u2014a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy","volume":"9","author":"Gruenwald","year":"2012","journal-title":"J\u00a0Sex Med"},{"key":"2023012309224709700_bib2","first-page":"1550","article-title":"Penile low intensity shock wave treatment is able to shift PDE5i nonresponders to responders: a double-blind, sham controlled study","volume":"195","author":"Kitrey","year":"2016","journal-title":"J\u00a0Urol"},{"key":"2023012309224709700_bib3","first-page":"1769","article-title":"Does low intensity extracorporeal shock wave therapy have a physiological effect\u00a0on erectile function? 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Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}