Therapeutic Effect of Micro-Energy Treatment for Erectile Dysfunction: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.

Abstract

Purpose: As an emerging therapeutic option for erectile dysfunction (ED), micro-energy treatment (MET) including low-intensity extracorporeal shockwave therapy, low-intensity pulsed ultrasound, and electromagnetic fields, has attracted increasing attention. We summarized the current literature to assess the therapeutic effect and find optimal treatment scheme of MET for ED.

Materials and methods: A comprehensive search of PubMed, Web of Science, and Embase up to April 2025 was performed. Studies reporting on ED treated with various METs were included. The International Index of Erectile Function and the Erection Hardness Score were used to evaluate the therapeutic effect. Subgroup analysis was performed to explore the influence of energy type, treatment course, treatment frequency, patients' characteristics, combination therapy, and setup parameters on efficacy.

Results: A total of 32 randomized controlled trials with 1,986 patients were enrolled. MET group demonstrated better erectile function than control at 1, 3, 6, and 12 months post-treatment (p<0.05). No significant difference was observed among different energy types, treatment courses, or setup parameters. Patients' comorbidities and responsiveness to phosphodiesterase 5 inhibitors did not influence efficacy. Treatment twice weekly was superior to once (p<0.05). Vasculogenic ED responded better than neurogenic ED (p<0.05). Combination with other basic therapies enhanced efficacy of MET (p<0.05).

Conclusions: MET was effective for various types of ED, especially vasculogenic ones, with efficacy lasting up to 1 year and no discrepancy among different energy forms. Twice-weekly treatment with course no more than 4 weeks was an appropriate therapeutic protocol. Moreover, combining MET with other therapies could produce synergistic effect.