{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:08:58Z","timestamp":1792598938019,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>The Current European Association of Urology guidelines do not provide recommendation for combination of regenerative therapies with standard therapies for erectile dysfunction. The aim of this study was to compare the efficacy of combined regenerative therapy with monotherapy for erectile dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The protocol was registered on PROSPERO (CRD42024522307). Randomized controlled trials and prospective\/retrospective studies comparing combination therapies (low\u2010intensity external shockwave therapy, platelet\u2010rich plasma, stem cell therapy with phosphodiesterase\u20105 inhibitors, or other treatments) with monotherapy were included. Erectile function was assessed using the International Index of Erectile Function\u20105 and Erection Hardness Scale. Groups were compared using standardized mean difference. Subgroup analyses based on treatment type, erectile dysfunction cause, and follow\u2010up duration were also conducted. Risk of bias was assessed using risk of bias 2 and Robins\u2010I tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings and limitations<\/jats:title>\n                    <jats:p>\n                      Of 1416 articles screened, eight studies involving 553 patients met the inclusion criteria. All studies included phosphodiesterase\u20105 inhibitors and low\u2010intensity external shockwave therapy as regenerative treatment, with no studies on stem cell therapy or platelet\u2010rich plasma. After treatment, no significant difference in International Index of Erectile Function scores was found between combination and monotherapy groups. However, subgroup analysis revealed that combination therapy showed a statistically significant improvement compared to low\u2010intensity external shockwave therapy alone (standardized mean difference: 0.61; 95% confidence interval: 0.13\u20121.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.013). A statistically significant improvement was found in vasculogenic (standardized mean difference: 0.65;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and diabetic cases (standardized mean difference: 1.05;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and clinical implications<\/jats:title>\n                    <jats:p>Combination of phosphodiesterase\u20105 inhibitors and intensity external shockwave therapy resulted in significant improvement of International Index of Erectile Function compared to intensity external shockwave therapy alone. However, the risk of bias was high because of the low quality of the studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient summary<\/jats:title>\n                    <jats:p>Combination of phosphodiesterase\u20105 inhibitor with intensity external shockwave therapy significantly improved erectile function, especially in patients with vasculogenic erectile dysfunction or diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/andr.70108","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T04:09:26Z","timestamp":1755058166000},"page":"358-367","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparative efficacy of combination therapy including regenerative therapies versus monotherapy for erectile dysfunction: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7188-2122","authenticated-orcid":false,"given":"Alberto","family":"Quistini","sequence":"first","affiliation":[{"name":"Department of Urology ASST Grande Ospedale Metropolitano Niguarda University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7872-2650","authenticated-orcid":false,"given":"Giuseppe","family":"Fallara","sequence":"additional","affiliation":[{"name":"Department of Urology ASST Santi Paolo e Carlo University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Tozzi","sequence":"additional","affiliation":[{"name":"Department of Urology ASST Santi Paolo e Carlo University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Depalma","sequence":"additional","affiliation":[{"name":"Division of Urology IRCCS European Institute of Oncology University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Damiano","sequence":"additional","affiliation":[{"name":"Urology Unit Magna Graecia University of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences Reproductive Sciences and Odontostomatology Urology Unit University of Naples \u201cFederico II\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Castiglione","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-7165","authenticated-orcid":false,"given":"Andrea","family":"Salonia","sequence":"additional","affiliation":[{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"},{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Urology ASST Santi Paolo e Carlo University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ferro","sequence":"additional","affiliation":[{"name":"Department of Urology ASST Santi Paolo e Carlo University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-1614","authenticated-orcid":false,"given":"Asif","family":"Muneer","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Science University College London  London UK"},{"name":"Department of Urology University College London Hospitals NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6364-0310","authenticated-orcid":false,"given":"Hussain M.","family":"Alnajjar","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Science University College London  London UK"},{"name":"Department of Urology University College London Hospitals NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-2319","authenticated-orcid":false,"given":"Karl H.","family":"Pang","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Science University College London  London UK"},{"name":"Department of Urology University College London Hospitals NHS Trust  London UK"},{"name":"Department of Urology Chelsea and Westminster Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510010089036"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicines8010002"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.440"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.01.012"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12023"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijir.2010.4"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2165\/11641380\u2010000000000\u201000000"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743\u20106109.2009.01626.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/life13020502"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajur.2024.01.001"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2018.12.016"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.2307\/2348250"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2015.12.049"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2022.02.010"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.4111\/icu.20210317"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000525973"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2021.10.007"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.31083\/j.jomh1805118"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.4103\/aja.aja_121_19"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2019.12.024"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743\u20106109.2010.02062.x"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.esxm.2019.06.006"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/andr.12255"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/aja.2011.2"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.36337"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41443\u2010019\u20100117\u2010z"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2022.11.009"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.937958"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sxmr.2018.02.007"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2020.12.019"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.5534\/wjmh.230105"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255\u2010019\u201002127\u2010z"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/and.14421"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41443\u2010021\u201000456\u20101"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.15406\/mojcsr.2015.02.00018"}],"container-title":["Andrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/andr.70108","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/andr.70108","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/andr.70108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:41:21Z","timestamp":1770831681000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/andr.70108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/andr.70108"],"URL":"https:\/\/doi.org\/10.1111\/andr.70108","archive":["Portico"],"relation":{},"ISSN":["2047-2919","2047-2927"],"issn-type":[{"value":"2047-2919","type":"print"},{"value":"2047-2927","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]},"assertion":[{"value":"2025-02-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}