Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis
Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis
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DOI：
10.1016/j.eururo.2016.05.050
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发表时间：
2017-02-01
期刊：
影响因子：
23.4
通讯作者：
Lue, Tom F.
中科院分区：
文献类型：
--
作者：
Lu, Zhihua;Lin, Guiting;Lue, Tom F.
背景：低强度体外冲击波治疗（LI-ESWT）作为一种治疗勃起功能障碍（ED）的新方法，近年来在临床中得到了应用。我们认为，对当前文献进行总结和系统回顾，以评估LI-ESWT治疗ED的疗效，将有助于那些对使用这种治疗方式治疗ED患者感兴趣的医生。目的：对LI-ESWT治疗ED患者的证据进行系统回顾，并进行荟萃分析，以确定治疗方式的疗效。证据获取：对PubMed和Embase数据库进行全面检索，直至2015年11月。纳入了有关LI-ESWT治疗ED患者的研究报告。国际勃起功能指数（IIEF）和勃起硬度评分（EHS）是评价LI-ESWT治疗效果最常用的工具。证据综合：2005 - 2015年共纳入14项研究，833例患者。7项研究为随机对照试验（RCTs）；然而，在这些研究中，LI-ESWT的设置参数和治疗方案是可变的。荟萃分析显示，LI-ESWT可显著改善IIEF（平均差异为2.00,95%可信区间[CI]为0.99-3.00,p < 0.0001）和EHS（风险差异为0.16,95% CI为0.04-0.29,p = 0.01）。治疗效果可持续至少3个月。轻、中度ED患者治疗后的疗效优于重度ED或合并症患者。能量通量密度、每次治疗的冲击波次数、LI-ESWT治疗的持续时间与临床结果密切相关，尤其是在IIEF改善方面。结论：近年来，LI-ESWT治疗ED的研究数量急剧增加。无论LI-ESWT设置参数或治疗方案如何变化，大多数研究都呈现出令人鼓舞的结果。这些研究表明LI-ESWT可以显著改善ED患者的IIEF和EHS。来自其他随机对照试验和长期随访的有力证据的发表将为ED患者使用LI-ESWT提供更多的信心。患者总结：我们回顾了14项接受低强度体外冲击波治疗（LI-ESWT）治疗勃起功能障碍（ED）的研究。有证据表明，这些男性在LI-ESWT后ED有所改善。(C) 2016年欧洲泌尿外科协会。Elsevier B.V.版权所有。
Context: As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED.Objective: A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality. Evidence acquisition: A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT.Evidence synthesis: There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99-3.00; p < 0.0001) and EHS (risk difference: 0.16; 95% CI, 0.04-0.29; p = 0.01). Therapeutic efficacy could last at least 3 mo. The patients with mild-moderate ED had better therapeutic efficacy after treatment than patients with more severe ED or comorbidities. Energy flux density, number of shock waves per treatment, and duration of LI-ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement.Conclusions: The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients.Patient summary: We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED). There was evidence that these men experienced improvements in their ED following LI-ESWT. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.