{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T01:00:53Z","timestamp":1775091653964,"version":"3.50.1"},"reference-count":28,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising treatment for vasculogenic erectile dysfunction (ED), particularly in men who do not respond to phosphodiesterase type-5 inhibitors (PDE5-Is).Objective: To evaluate the feasibility, safety, and clinical effectiveness of Li-ESWT in men with vasculogenic ED through a prospective 12- and 18-month follow-up.Methods: A prospective observational study was conducted on 188 patients with vasculogenic ED and inadequate response to PDE5-Is. Patients underwent 6 weekly sessions of Li-ESWT. Erectile function was assessed using the international index of erectile function (IIEF) and erection hardness score (EHS). Responders were defined as those achieving \u2265 3-point improvement on IIEF-EF and\/or EHS \u22653.Results: Mean age was 66.6 years; mean ED duration was 24 months. IIEF-EF improved from 11 at baseline to 21 at 12 months and 18 at 18 months. At 12 months, 71% of patients showed improvement in EHS. Younger age (&lt;45 years), shorter ED duration (&lt;12 months), and moderate baseline severity predicted better response (p&lt;0.05). Sustained improvement was observed in 65% of patients at 12 months and 54% at 18 months. No adverse events were reported.Conclusions: Li-ESWT is a safe and effective treatment for vasculogenic ED unresponsive to PDE5-Is, with maximum benefit observed within 12 months. Efficacy tends to decline at 18 months. Larger controlled studies are needed to define long-term outcomes.<\/jats:p>","DOI":"10.4081\/aiua.2026.14707","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T13:23:30Z","timestamp":1772457810000},"source":"Crossref","is-referenced-by-count":0,"title":["Low-intensity extracorporeal shock wave therapy in vasculogenic erectile dysfunction refractory to PDE5 inhibitors: a prospective study with 12- and 18-month outcomes"],"prefix":"10.4081","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0587-173X","authenticated-orcid":false,"given":"Giuseppe","family":"Saitta","sequence":"first","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Di Paola","sequence":"additional","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Di Salvatore","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano (MI)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetto","family":"Calabrese","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Simone","family":"Ceresoli","sequence":"additional","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franco","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attilio Luigi","family":"Meazza","sequence":"additional","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Seveso","sequence":"additional","affiliation":[{"name":"Istituto Clinico Citt\u00e0 Studi, Milan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"216745","doi-asserted-by":"crossref","unstructured":"1. 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Lewis RW, Witherington R. External vacuum therapy for erectile dysfunction: use and results. World J Urol. 1997; 15:78-82.","DOI":"10.1007\/BF01275162"},{"key":"216757","doi-asserted-by":"crossref","unstructured":"13. Albaugh J, San Cheng L, Bergman J, et al. Adherence and barriers to penile rehabilitation over 2 years following radical prostatectomy: a pilot study. BJU Int. 2019; 123:853-860.","DOI":"10.1186\/s12894-019-0516-y"},{"key":"216758","doi-asserted-by":"crossref","unstructured":"14. Yao WJ, Dong JT, Jiang TP, et al. Advances in erectile dysfunction treatment research: a narrative review. Transl Androl Urol. 2025; 14:2106-2117. doi:10.21037\/tau-2025-193.","DOI":"10.21037\/tau-2025-193"},{"key":"216759","doi-asserted-by":"crossref","unstructured":"15. Lu Z, Lin G, Reed Maldonado A, et al. Low-intensity extracorporeal shock wave treatment improves erectile function: a systematic review and meta-analysis. Eur Urol. 2017; 71:223-233.","DOI":"10.1016\/j.eururo.2016.05.050"},{"key":"216760","doi-asserted-by":"crossref","unstructured":"16. Chawla ST, Shahan J, Soutipan N, et al. Radial type low-intensity extracorporeal shockwave therapy enhances penile microvascular perfusion in an aging rat model: a novel interventional strategy to treat erectile dysfunction. World J Mens Health. 2025; 43:396-406.","DOI":"10.5534\/wjmh.240032"},{"key":"216761","doi-asserted-by":"crossref","unstructured":"17. Liu J, Zhou F, Li GY, et al. Evaluation of the effect of different doses of low-energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci. 2013;14:10661-10673.","DOI":"10.3390\/ijms140510661"},{"key":"216762","doi-asserted-by":"crossref","unstructured":"18. Assaly-Kaddoum R, Giuliano F, et al. Low-intensity extracorporeal shock wave therapy improves erectile function in a model of type II diabetes independently of NO\/cGMP pathway. 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Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett. 2005;579:6839-6845.","DOI":"10.1016\/j.febslet.2005.11.023"},{"key":"216767","doi-asserted-by":"crossref","unstructured":"23. Sokolakis I, Dimitriadis F, Psalla D, et al. Effects of low-intensity shock wave therapy (LiST) on the erectile tissue of naturally aged rats. Int J Impot Res. 2019; 31:162-169.","DOI":"10.1038\/s41443-018-0064-0"},{"key":"216768","doi-asserted-by":"crossref","unstructured":"24. Musa ZS, El Assmy A, Shokry AM, et al. Long-term effectiveness and predictors of success of low-intensity shockwave therapy in phosphodiesterase type 5 inhibitor non-responders. Arab J Urol. 2020;18:54-58.","DOI":"10.1080\/2090598X.2019.1688072"},{"key":"216769","doi-asserted-by":"crossref","unstructured":"25. Yao RJ, Wang MY, Chen Q, et al. Retrospective analysis of the efficacy of low-intensity extracorporeal shock wave therapy on young and middle-aged patients with erectile dysfunction responsive to PDE5Is. Sex Med. 2024; 12:qfae052.","DOI":"10.1093\/sexmed\/qfae065"},{"key":"216770","unstructured":"26. Mo DS, et al. Efficacy and safety of low-intensity extracorporeal shock wave therapy in the treatment of ED: a meta-analysis of randomized controlled trials. Andrologia. 2019; 61:e13289."},{"key":"216771","doi-asserted-by":"crossref","unstructured":"27. Zou ZJ, Tang LY, Liu ZH, et al. Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis. Int Braz J Urol. 2017;43:805-821.","DOI":"10.1590\/s1677-5538.ibju.2016.0245"},{"key":"216772","doi-asserted-by":"crossref","unstructured":"28. Kim KS, Jeong HC, Choi SW, et al. 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