Comparative effectiveness radial shockwave therapy versus focused linear shockwave therapy as an erectile dysfunction treatment systematic review and meta-analysis.

Abstract

Low-intensity shockwave therapy (SWT) is a promising non-invasive treatment for vasculogenic erectile dysfunction (ED). Two primary modalities, focused linear shockwave therapy (fSWT) and radial shockwave therapy (rSWT), differ in energy delivery and tissue penetration. While fSWT is well-studied, rSWT remains less explored for ED despite its growing use. This study compares the effectiveness of fSWT and rSWT in improving erectile function. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Relevant studies published between 2009 and 2024 were identified through searches in PubMed, ScienceDirect, and Cochrane Library. Studies assessing erectile function using the International Index of Erectile Function (IIEF-5), Sexual Health Inventory for Men (SHIM), or Erection Hardness Score (EHS) were included. A random-effects model was applied to analyze standardized mean differences (SMD) and address heterogeneity. Fifteen studies met the inclusion criteria. Meta-analysis revealed that fSWT demonstrated superior efficacy compared to rSWT, with an SMD of 0.45 (95% CI: 0.04-0.86; P < 0.005). High heterogeneity was observed (I² = 80% for rSWT; I² = 99% for fSWT). fSWT and rSWT improved erectile function, but fSWT consistently produces better outcomes across IIEF-5, SHIM, and EHS scores.