Department of Urology and Paediatric Urology, Julius Maximilian University Medical Centre of Würzburg, Würzburg, Germany; Centre for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece.
Centre for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece; 1(st) Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Sex Med. 2019 Feb;16(2):168-194. doi: 10.1016/j.jsxm.2018.12.016.
Despite recent promising clinical results, the underlying mechanism of action of low-intensity extracorporeal shockwave therapy (Li-ESWT) for erectile dysfunction (ED) is mostly unclear and currently under investigation.
To systematically identify and evaluate evidence regarding the basic science behind Li-ESWT for ED, discuss and propose a putative mechanism of action, address the limitations, and imply insights for further investigation in the field.
Using Cochrane's methodologic recommendations on scoping studies and systematic reviews, we conducted a systematic scoping review of the literature on experimental research regarding Li-ESWT for ED and other pathologic conditions. The initial systematic search was carried between January and November 2017, with 2 additional searches in April and August 2018. All studies that applied shockwave treatment at an energy flux density >0.25 mJ/mm were excluded from the final analysis.
We primarily aimed to clarify the biological responses in erectile tissue after Li-ESWT that could lead to improvement in erectile function.
59 publications were selected for inclusion in this study. 15 experimental research articles were identified on Li-ESWT for ED and 44 on Li-ESWT for other pathologic conditions. Li-ESWT for ED seems to improve erectile function possibly through stimulation of mechanosensors, inducing the activation of neoangiogenesis processes, recruitment and activation of progenitor cells, improving microcirculation, nerve regeneration, remodeling of erectile tissue, and reducing inflammatory and cellular stress responses.
Improving our understanding of the mechanism of action of Li-ESWT for ED can help us improve our study designs, as well as suggest new avenues of investigation.
STRENGTHS & LIMITATIONS: A common limitation in all these studies is the heterogeneity of the shockwave treatment application and protocol.
Li-ESWT for ED, based on current experimental studies, seems to improve erectile function by inducing angiogenesis and reversing pathologic processes in erectile tissue. These studies provide preliminary insights, but no definitive answers, and many questions remain unanswered regarding the mechanism of action, as well as the ideal treatment protocol. Sokolakis I, Dimitriadis F, Teo P, et al. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. J Sex Med 2019;16:168-194.
尽管最近有令人鼓舞的临床结果，但低强度体外冲击波治疗（Li-ESWT）治疗勃起功能障碍（ED）的作用机制在很大程度上仍不清楚，目前正在研究中。
系统地确定和评估有关 Li-ESWT 治疗 ED 的基础科学证据，讨论并提出一种可能的作用机制，解决局限性，并为该领域的进一步研究提供见解。
我们使用 Cochrane 关于范围研究和系统评价的方法建议，对有关 Li-ESWT 治疗 ED 和其他病理状况的实验研究文献进行了系统的范围审查。最初的系统搜索于 2017 年 1 月至 11 月进行，2018 年 4 月和 8 月又进行了两次搜索。所有应用能量通量密度>0.25 mJ/mm 的冲击波治疗的研究均被排除在最终分析之外。
我们主要旨在阐明 Li-ESWT 后对勃起组织的生物学反应，这些反应可能导致勃起功能改善。
共选择了 59 篇文献纳入本研究。确定了 15 篇关于 Li-ESWT 治疗 ED 的实验研究文章和 44 篇关于 Li-ESWT 治疗其他病理状况的实验研究文章。Li-ESWT 治疗 ED 似乎可以通过刺激机械感受器、诱导新生血管过程的激活、募集和激活祖细胞、改善微循环、神经再生、勃起组织重塑以及减少炎症和细胞应激反应来改善勃起功能。
提高我们对 Li-ESWT 治疗 ED 的作用机制的理解，可以帮助我们改进我们的研究设计，并为新的研究方向提供建议。
所有这些研究的一个共同局限性是冲击波治疗应用和方案的异质性。
基于目前的实验研究，Li-ESWT 治疗 ED 似乎通过诱导血管生成和逆转勃起组织中的病理过程来改善勃起功能。这些研究提供了初步的见解，但对于作用机制以及理想的治疗方案，仍有许多问题尚未得到解答。
