Effectiveness of Micro-Energy Therapies for Erectile Dysfunction: A Systematic Review and Network Meta-analysis

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A comprehensive systematic review and network meta-analysis were conducted by evaluating the effects of all micro-energy therapies on ED. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.18.0. Twenty-two studies encompassing 618 participants met the inclusion criteria. According to the NMA, significant improvements in the International Index of Erectile Function (IIEF) were observed in LiESWT, hPMSCs with LiESWT, PDE5I with LiESWT, LIPUS, and PDE5I with LIPUS among patients with ED compared to control (P < 0.05). Furthermore, PDE5I with LIPUS was the most effective micro-energy therapy for enhancing IIEF, followed by PDE5I with LiESWT, hPMSCs with LiESWT, LIPUS, and LiESWT based on surface Under the Cumulative Ranking Curve (SUCRA). Additionally, according to the NMA, significant increases were observed in PDE5I with LiESWT, and LiESWT resulted in the Erection Hardness Score (EHS) compared to control (P < 0.05). PDE5I with LiESWT was ranked as the most effective intervention for enhancing EHS, followed by LiESWT based on SUCRA values. The available evidence shows PDE5I with LIPUS appears more effective in enhancing IIEF scores, while PDE5I with LiESWT shows superior outcomes for enhancing EHS scores. Nevertheless, owing to the limited number of studies available for each therapeutic approach and the diversity of micro-energy therapies, this review's scope remains incomplete. Health sciences/Diseases/Reproductive disorders/Sexual dysfunction Health sciences/Health care/Quality of life erectile dysfunction micro-energy therapies meta-analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 INTRODUCTION Erectile dysfunction (ED) represents a worldwide public health issue, profoundly affecting overall health status, with demonstrating a clear upward trend with age [ 1 ]. While phosphodiesterase type 5 inhibitors (PDE5i) represent the recommended first-line drug, limitations including inconsistent efficacy, adverse drug reactions, contraindications, and focused on symptom alleviation create an imperative for alternative treatments [ 2 – 3 ]. Alternative approaches such as vacuum devices, intracavernosal injections, or penile prostheses are fraught with difficulties due to its invasive nature, acceptability, and long-term utility [ 4 – 5 ]. This domain highlights the urgent necessity of effective, durable, and minimally invasive approaches that ameliorate the pathological substrate. Micro-energy therapies (METs) has risen to prominence as an innovative regenerative therapy with great potential for ED. This approach comprises low-intensity extracorporeal shockwave therapy (LiESWT), electromagnetic field (EMF) therapy and low-intensity pulsed ultrasound (LIPUS) [ 6 ]. Such non-invasive methods utilize mechanical or radiative forces to penile tissue, designing to promote tissue repair and regeneration. Potential explanatory frameworks comprise stimulating new blood vessel formation, improving endothelial health and downregulation of nitric oxide synthase, mediating progenitor cell chemotaxis, and promoting axonal regrowth localized to the cavernous tissue [ 7 – 8 ]. The application of micro-energy therapies in this field originated with LiESWT, demonstrating promise in sustained improvement [ 9 ], and has broadened to encompass techniques like LIPUS [ 10 ] and EMF therapy [ 11 ], individually exhibiting therapeutic benefit among stratified patient populations. Notwithstanding the growing body of evidence, critical gaps in understanding pose a barrier to achieving optimal therapeutic results. First, evidence from comparative studies regarding the comparative efficacy of LiESWT, LIPUS, and EMF is limited, given that most clinical studies employ a sham control arm to assess the specific efficacy of modality [ 12 – 13 ]. Furthermore, it is still not well understood whether micro-energy combination therapies demonstrate superior effectiveness in comparison with standalone micro-energy therapies. Conventional pairwise meta-analyses have synthesized evidence against a common control but are constrained in comparing and prioritizing therapeutic options in the absence of direct comparative trials [ 14 ]. Consequently, this systematic review and NMA strives to systematically review and integrate the available evidence to evaluate and hierarchize the efficacy of different METs for ED and evaluate whether micro-energy combination therapies demonstrate superior effectiveness in comparison with standalone micro-energy therapies. METHODS Literature searches The meta-analysis followed PRISMA guidelines [ 15 – 16 ] and was prospectively registered in the PROSPERO database (CRD420261290462). The Web of Science, Embase, and PubMed databases were systematically searched for relevant studies from January 2002 to January 2026. The keywords and MeSH terms used in the searches included "Erectile dysfunction", "low-intensity extracorporeal shockwave therapy", "electromagnetic field therapy", "low-intensity pulsed ultrasound", "IIEF", and "EHS", to maximize retrieval sensitivity and specificity. Study selection The criteria used for study inclusion were that: (1) Micro-energy therapies aimed at ED management; (2) provided sufficient quantitative information to calculate the IIEF or EHS; (3) male participants (more than 18) with regular sexual partners; Exclusion criteria included articles lacking adequate data for analysis and publications that were non-original in nature, such as reviews, clinical case reports, editorial opinions, symposium proceedings, commentary, or not RCT articles. Collection of data and evaluation of studies Two researchers independently collected the data using a standardized protocol. Any discrepancies encountered during this process were resolved by consulting a third researcher. Study methodologies and risk of bias were appraised with the the revised Cochrane risk-of-bias tool (RoB 2, version 2), applied independently by two reviewers. Statistical analysis STATA 18.0 (StataCorp LP, College Station, TX, USA) was used for statistical analyses. As cognitive function was assessed using different instruments across studies, the standardized mean difference‌ (SMD) with 95% confidence interval (CI) was employed as the effect measure. And a random-effects model was employed to pool effect sizes. The Surface Under the Cumulative Ranking Curve (SUCRA) was employed to rank various Micro-energy therapies based on their effectiveness. League tables were generated to present pairwise comparisons between interventions. Possible publication bias was evaluated using funnel plots. RESULTS Study Selection and Quality Evaluation Following a comprehensive screening process, 22 eligible studies involving 618 participants were retained for the final analysis (Fig. 1 , Table 1 , Supplementary Fig. 1, Supplementary Fig. 2). Of these, 16 studies focused exclusively on LiESWT [ 12 , 17 – 31 ], 1 study investigated hPMSCs with LiESWT [ 32 ]. 2 studies evaluated LiESWT with PDE5I [ 33 – 34 ], 1 study assessed EMF [ 11 ], 1 study assessed LIPUS [ 10 ], while 1 study assessed LIPUS with PDE5I [ 35 ]. Table 1 Basic characteristics of the eligible studies included in the meta-analysis. Author (year) Country or City Population Type of ED Intervention Comparison Sessions per week Energy density (mJ/mm2) Frequency (Hz) Pulses per session Time of delivery Follow-up Outcomes Fojecki et al, 2017 [ 17 ] Denmark 118 ED Li-ESWT controls 1 0.09 5 600 5 weeks 2 months IIEF EHS Sexual SQoL-M EDITS Motil et al, 2022 [ 18 ] Czechia 32 ED after RP Li-ESWT controls 1 0.16 8 4000 4 weeks 12 months IIEF Ong et al, 2022 [ 19 ] Malaysia 51 Vasculogenic ED Li-ESWT controls 1 15–20 8 4000 4 weeks 6 months IIEF EHS Ortac et al, 2021 [ 20 ] Turkey 66 Vasculogenic ED Li-ESWT controls 1 0.2 5 3000 4 weeks 12 months IIEF Safty Shendy et al, 2021 [ 21 ] Egypt 42 ED with DM Li-ESWT controls 2 0.09 2 3000 6 weeks 3 months IIEF PSV EDV RI Sramkova et al, 2020 [ 22 ] Czechia 60 ED Li-ESWT controls 2 0.16 8 6000 2 weeks 12 weeks IIEF EHS Global Assess ment Question SEP 2 SEP 3 Kalyvianakis et al, 2017 [ 23 ] Greece 46 Vasculogenic ED Li-ESWT controls 2 0.09 2 1500 9 weeks 12 months PSV RI IIEF Yamaçake et al, 2019 [ 24 ] Brazil 20 ED with renal transplant Li-ESWT controls 2 0.09 2 2000 3 weeks 12 months IIEF EHS Ladegaard et al, 2021 [ 25 ] Denmark 38 ED after RP Li-ESWT controls 1 0.15 5 4000 5 weeks 3 months IIEF EHS Bhondave et al, 2024 [ 26 ] India 40 Vasculogenic ED with DM refractory to PDE5I Li-ESWT controls 1 0.09 2 1500 8 weeks 12 months IIEF SHIM EHS Kalyvianakis et al, 2022 [ 27 ] Greece 68 Vasculogenic ED Li-ESWT controls 2 0.096 5 5000 6 weeks 3 months IIEF MCID SEP 3 Vardi et al, 2012 [ 28 ] Israel 60 ED Li-ESWT controls 2 0.09 2 1500 6 weeks 3 months IIEF EHS Kim et al, 2020 [ 29 ] Korea 81 ED Li-ESWT controls 2 12–20 5 3000 6 weeks 7 weeks IIEF EHS SEP 2 SEP 3 Chung et al, 2023 [ 30 ] Australia 60 Vasculogenic ED refractory to PDE5 Li-ESWT controls 2 0.25 6 3000 6 weeks 6 months IIEF EHS EDITS Yee et al, 2014 [ 31 ] China 58 ED Li-ESWT controls 2 0.09 2 1500 9 weeks 4 weeks IIEF EHS Ji et al, 2025 [ 32 ] China 33 ED with DM hPMSCs and LI-ESWT hPMSCs or LI-ESWT 1 0.09 2 5000 4 weeks 6 months IIEF EHS SEP 2 SEP 3 Gallo et al, 2022 [ 33 ] Italy 83 ED LIESWT+PDE5I + L-arginine LIESWT 1 0.25 4 3000 6 weeks 12 months IIEF EHS MCID Mykoniatis et al, 2022 [ 34 ] Greece 50 Vasculogenic ED LIESWT+PDE5I LIESWT 2 0.096 5 Hz 5000 3 weeks 6 months IIEF MCID SEP 3 Goldstein et al, 2024 [ 12 ] USA 33 ED Li-ESWT controls 1 in 3 wk 0.12 4 5000 9 weeks 3 months IIEF SEP Alzharani et al, 2024 [ 11 ] Saudi Arabia 45 ED with multiple sclerosis EMF controls 5 NA NA NA 5 weeks Post-treatment IIEF SHIM EHS AXES MFIS MSISQ-19 Li et al, 2024 [ 35 ] China 60 ED with chronic prosatitis LIPUS+PDE5I LIPUS 2 1.25 or 2.5 W/cm2 1 or1.7 M NA 4 weeks Post-treatment IIEF-5 EHS NIH-CPSI PHQ-9 GAD-7 Cui et al, 2019 [ 10 ] China 103 ED LIPUS controls 2 0.3 W/cm2 1.7 M NA 4 weeks 3 months IIEF SEP 2/3 GAQ EHS EQS VAS IIEF The diagram of the network geometry of the interactions among the included trials is shown in Fig. 2 . Compared with controls, 5 distinct modalities of micro-energy therapies showed significant improvements in IIEF scores. These micro-energy therapies comprised PDE5I with LIPUS (SMD = 2.28, 95% CI 0.53–4.03), LIPUS (SMD = 1.24, 95% CI 0.06–2.43), PDE5I with LiESWT (SMD = 1.73, 95% CI 0.82–2.65), hPMSCs with LiESWT (SMD = 1.68, 95% CI 0.24–3.13), and LiESWT (SMD = 0.98, 95% CI 0.67–1.30). The comparative effectiveness of the various micro-energy therapies was ranked by employing the SUCRA values, together with the area under the curve and a league chart, as presented in Fig. 3 . The SUCRA plot provides a comparative ranking of the efficacy of all micro-energy therapies, encompassing all rank possibilities and their corresponding uncertainties. With respect to the IIEF outcome, PDE5I with LIPUS yielded the highest SUCRA value (86.0%), indicating that it might be more effective than the other micro-energy therapies evaluated. EHS The diagram of the network geometry of the interactions among the included trials is shown in Fig. 4 . Compared with controls, 2 distinct modalities of micro-energy therapies showed statistically significant improvements in EHS scores. These micro-energy therapies included PDE5I with LiESWT (SMD = 1.55, 95% CI 0.50–2.61), and LiESWT (SMD = 1.05, 95% CI 0.67–1.43). The comparative effectiveness of the various micro-energy therapies was ranked by employing the SUCRA values, together with the area under the curve and a league chart, as presented in Fig. 5 . The SUCRA plot provides a comparative ranking of the efficacy of all micro-energy therapies, encompassing all rank possibilities and their corresponding uncertainties. With respect to the EHS outcome, PDE5I with LiESWT yielded the highest SUCRA value (92.8%), indicating that it might be more effective than the other PDE5I with LiESWT evaluated. Publication bias The funnel plots depicting no significant publication bias was detected for IIEF and EHS are illustrated in Fig. 6 and Fig. 7 , respectively. The studies are arranged symmetrically along the central vertical line (X = 0), with the majority of points located within the anticipated funnel boundaries. DISCUSSION Our systematic review and network meta-analysis adheres to rigorous systematic review methodology to identify and synthesize all relevant evidence to compare the efficacy of various micro-energy therapies for ED. According to the NMA, significant improvements in the IIEF were observed in LiESWT, hPMSCs with LiESWT, PDE5I with LiESWT, LIPUS,and PDE5I with LIPUS among patients with ED compared to control (P < 0.05). Furthermore, PDE5I with LIPUS was the most effective psychological therapy for enhancing IIEF, followed by PDE5I with LiESWT, hPMSCs with LiESWT, LIPUS, and LiESWT based on SUCRA. Additionally, according to the NMA, significant increases were observed in PDE5I with LiESWT, and LiESWT resulted in the EHS compared to control (P < 0.05). PDE5I with LiESWT was ranked as the most effective intervention for enhancing EHS, followed by LiESWT based on SUCRA values. The probability of combination therapy being the optimal choice base on SUCRA, notably PDE5I with LIPUS and PDE5I with LiESWT, are consistent with a strong mechanistic basis suggesting the superiority of combination approaches for ED, especially for patients with complex comorbidities or treatment-refractory disease [ 36 – 37 ]. The synergistic mechanism of action operates on two levels. The pharmacodynamic effect is achieved through downstream enzymatic inhibition of cGMP-specific phosphodiesterase (PDE5), impeding the catabolism of this second messenger, thereby enhancing signal persistence for reduction in intracavernosal smooth muscle tone [ 38 ]. On the contrary, METs are hypothesized to act upstream by ameliorating the tissue milieu. Evidence from both preclinical and clinical studies indicates that LiESWT and LIPUS enhances blood vessel formation, increase endothelial nitric oxide synthase (eNOS) expression, induce the homing of progenitor cells, and regulate inflammatory signaling, thus enhancing nitric oxide (NO) bioavailability, the principal driver of the physiological process of erection, and enhancing the mechanical strength of the penile cavernosal bodies [ 39 – 41 ]. Consequently, the combined action enhances the initial signal (through both MET-mediated NO synthesis and MET-driven tissue remodeling) and maintains its activity within the cell (potentiating the NO-cGMP pathway by preventing cGMP hydrolysis), potentially mitigating the inherent constraints of monotherapy. This has profound clinical implications for PDE5I non-responders, a subset of patients who could potentially gain from this combined methodology [ 37 , 42 ]. Our results confirm both LiESWT and LIPUS proving to be viable standalone options. While LiESWT has been extensively investigated of further clinical research and meta-analytic review [ 43 – 44 ], the efficacy and effectiveness of LIPUS in this NMA is notable. LIPUS operates at substantially lower intensities than the intensities required for thermal ablation, eliciting biological responses through physical forces that regulate cell function, blood flow to the tissue, and repair mediated by mechanisms including acoustic microstreaming and associated shear forces. Comparable measures of treatment effect between these two modalities, an observation replicated in a recent systematic review and meta-analysis on METs [ 14 ], indicate that the predominant biological response - marked by improved blood flow, anti-inflammatory action, and tissue repair and regrowth - could represent a shared mechanism across micro-energy therapies, largely independent of the exact waveform. This lends strong support to the unification of these modalities as part of the MET therapeutic arsenal for ED and demonstrates that clinical decision-making is influenced by multiple factors beyond pure efficacy, including practical considerations like accessibility, affordability, and tolerability. The statistically significant effect associated with the combined use of hPMSCs with LiESWT, though derived from a limited dataset, charts a course toward more advanced regenerative therapies. Stem cell therapy targets the reconstruction of compromised cavernosal tissue through differentiation and paracrine activity [ 45 ], while LiESWT could precondition the tissue through enhancing the vascular microenvironment, diminishing fibrosis and inflammation, and potentially improving the key determinants of stem cell efficacy: homing, survival, and paracrine function [ 46 ]. This combination marks a departure from the sole focus on symptomatic relief aspiring to restore native tissue architecture, addressing the underlying etiology in disorders such as post-prostatectomy neurovascular injury and severe diabetic angiopathy. It demands rigorous investigation in future high-quality trials for the confirmation of efficacy, safety, and assessment of long-term outcomes. Notable improvement in EHS scores, a validated patient-administered questionnaire for erectile function, for PDE5I with LiESWT and LiESWT monotherapy, emphasizes the clinical importance of these interventions beyond standardized instrument scores [ 47 ]. To guide clinical practice, our findings demonstrate that METs constitutes a reasonable alternative for men with vasculogenic erectile dysfunction, patients with an inadequate response to PDE5Is [ 48 ], or patients preferring on-demand use, medical device interventions. The choice between LiESWT and LIPUS hinges initially on the assessment of the availability of medical devices and the proficiency of clinicians, given the comparable effectiveness observed in this study. However, the translation of this evidence is moderated by the ongoing research to define optimal treatment parameters. While our network meta-analysis compared the effectiveness of different treatment modalities, other dedicated analyses have investigated the dose-response relationships in LiESWT. The Bayesian network meta-analysis from Hinojosa-Gonzalez et al indicated that an energy flux density set at 0.15 mJ/mm 2 and a regimen of 1500 pulses per treatment session appears to be one of the most effective parameter sets [ 49 ]. By contrast, the traditional pairwise meta-analysis conducted by Li et al observed no significant difference regardless of energy density or pulse count, though it found that a twice-weekly frequency was superior to a once-weekly one [ 14 ]. This suggests that while a wide range of parameters within treatment within a defined low-intensity window is feasible, more precise optimization might lead to modest further improvements and merits consideration in the design of study protocols. Future efforts to standardize should attempt to resolve these apparent discrepancies to define standardized, efficacious treatment protocols [ 50 ]. Limitations Several limitations of this study require appropriate consideration. Firstly, merely a single suitable trial was obtainable for EMF and LIPUS, potentially compromising the reliability and generalizability of the efficacy determinations. Consequently, these findings demand careful consideration. Second, considering that ED is affecting by multifaceted influences across the lifespan, the study population incorporated diverse patient groups - including malignancy survivors and diabetes mellitus - may modify the relative effectiveness of micro-energy therapies. Finally, restricted participant numbers and variations in treatment strategies and experimental designs among the included studies constrained the practicality of subgroup examinations based on key factors such as particular health disorders or symptom severity. Further investigations should implementation of larger, multi-center, high-quality RCTs to validate and broaden these findings. Despite these considerations, these findings provide an assessment of various micro-energy therapies on ED, as well as a reference for further research aimed at refining clinical decision-making in this setting. CONCLUSIONS In conclusion, this network meta-analysis compared the effectiveness of diverse micro-energy therapies on both the IIEF and the EHS in men with ED. The results indicate that PDE5I with LIPUS was the most effective micro-energy therapy for enhancing IIEF appears more effective in ameliorating IIEF scores, while PDE5I with LiESWT shows superior outcomes for enhancing EHS scores. Nevertheless, owing to the limited number of studies available for each therapeutic approach and the diversity of micro-energy therapies, this review's scope remains incomplete. Further investigations should implementation of larger, multi-center, high-quality RCTs to validate and broaden these findings. Abbreviations ED Erectile dysfunction PDE5i Phosphodiesterase type 5 inhibitors METs Micro-energy therapies LiESWT Low-intensity extracorporeal shockwave therapy EMF Electromagnetic field LIPUS Low-intensity pulsed ultrasound NMA Network meta analysis IIEF International Index of Erectile Function EHS Erection Hardness Score SMD Standardized mean difference‌ eNOS Endothelial nitric oxide synthase NO Nitric oxide CI confidence interval Declarations Ethics approval and consent to participate: Not applicable. Consent to publish: Not applicable. Availability of data and materials: Not applicable. Competing interests: Not applicable. Funding: Not applicable. Authors' Contributions: All authors have read and approved the manuscript. Acknowledgements: Not applicable. References Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. 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A Prospective, Randomized, Double-Blinded, Clinical Trial Using a Second-Generation Duolith SD1 Low-Intensity Shockwave Machine in Males with Vascular Erectile Dysfunction. World J Mens Health, 41(1), 94–100. doi: 10.5534/wjmh.210123 Yee, C. H., Chan, E. S., Hou, S. S., & Ng, C. F. (2014). Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study. Int J Urol, 21(10), 1041–1045. doi: 10.1111/iju.12506 Ji, Y. H., Zhang, Y. F., Tan, X., Hou, H. Z., Yao, Z., & Zhang, B. (2025). High-activity placenta-derived mesenchymal stem cells combined with low-intensity extracorporeal shock wave therapy for diabetic erectile dysfunction: a prospective randomized controlled trial. Stem Cell Res Ther, 16(1), 359. doi: 10.1186/s13287-025-04499-9 Gallo, L., Pecoraro, S., & Sarnacchiaro, P. (2022). Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg increases efficacy and duration of benefits of low-intensity extracorporeal shock wave therapy for erectile dysfunction: A prospective, randomized, single-blinded study with 1-year follow-up. Investig Clin Urol, 63(1), 83–91. doi: 10.4111/icu.20210317 Mykoniatis, I., Pyrgidis, N., Zilotis, F., Kapoteli, P., Fournaraki, A., Kalyvianakis, D., & Hatzichristou, D. (2022). The Effect of Combination Treatment With Low-Intensity Shockwave Therapy and Tadalafil on Mild and Mild-To-Moderate Erectile Dysfunction: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. J Sex Med, 19(1), 106–115. doi: 10.1016/j.jsxm.2021.10.007 Li, Z., Li, D., Zu, X., Xiang, B., Wang, G., & Tang, Z. (2024). Evaluation of efficacy and safety of low-intensity pulsed ultrasound in patients with concurrent erectile dysfunction and chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized controlled study. BMC Urol, 24(1), 232. doi: 10.1186/s12894-024-01630-5 Mykoniatis, I., Pyrgidis, N., Sokolakis, I., Ouranidis, A., Sountoulides, P., Haidich, A. B.,.. . Hatzichristou, D. (2021). Assessment of Combination Therapies vs Monotherapy for Erectile Dysfunction: A Systematic Review and Meta-analysis. JAMA Netw Open, 4(2), e2036337. doi: 10.1001/jamanetworkopen.2020.36337 Palmieri, A., Arcaniolo, D., Palumbo, F., Verze, P., Liguori, G., Mondaini, N.,.. . Cai, T. (2021). Low intensity shockwave therapy in combination with phosphodiesterase-5 inhibitors is an effective and safe treatment option in patients with vasculogenic ED who are PDE5i non-responders: a multicenter single-arm clinical trial. Int J Impot Res, 33(6), 634–640. doi: 10.1038/s41443-020-0332-7 Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. (1998). Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Engl J Med, 338(20), 1397–1404. doi: 10.1056/nejm199805143382001 Qiu, X., Lin, G., Xin, Z., Ferretti, L., Zhang, H., Lue, T. F., & Lin, C. S. (2013). Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med, 10(3), 738–746. doi: 10.1111/jsm.12024 Xin, Z., Lin, G., Lei, H., Lue, T. F., & Guo, Y. (2016). Clinical applications of low-intensity pulsed ultrasound and its potential role in urology. Transl Androl Urol, 5(2), 255–266. doi: 10.21037/tau.2016.02.04 Liu, J., Zhou, F., Li, G. Y., Wang, L., Li, H. X., Bai, G. Y.,.. . Xin, Z. C. (2013). 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, 14(5), 10661–10673. doi: 10.3390/ijms140510661 Dhir, R. R., Lin, H. C., Canfield, S. E., & Wang, R. (2011). Combination therapy for erectile dysfunction: an update review. Asian J Androl, 13(3), 382–390. doi: 10.1038/aja.2011.2 Clavijo, R. I., Kohn, T. P., Kohn, J. R., & Ramasamy, R. (2017). Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med, 14(1), 27–35. doi: 10.1016/j.jsxm.2016.11.001 Sokolakis, I., & Hatzichristodoulou, G. (2019). Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res, 31(3), 177–194. doi: 10.1038/s41443-019-0117-z Albersen, M., Fandel, T. M., Lin, G., Wang, G., Banie, L., Lin, C. S., & Lue, T. F. (2010). Injections of adipose tissue-derived stem cells and stem cell lysate improve recovery of erectile function in a rat model of cavernous nerve injury. J Sex Med, 7(10), 3331–3340. doi: 10.1111/j.1743-6109.2010.01875.x Zhu, G. Q., Jeon, S. H., Bae, W. J., Choi, S. W., Jeong, H. C., Kim, K. S.,.. . Kim, S. W. (2018). Efficient Promotion of Autophagy and Angiogenesis Using Mesenchymal Stem Cell Therapy Enhanced by the Low-Energy Shock Waves in the Treatment of Erectile Dysfunction. Stem Cells Int, 2018, 1302672. doi: 10.1155/2018/1302672 Rosen, R. C., Allen, K. R., Ni, X., & Araujo, A. B. (2011). Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol, 60(5), 1010–1016. doi: 10.1016/j.eururo.2011.07.053 Corona, G., Rastrelli, G., Burri, A., Serra, E., Gianfrilli, D., Mannucci, E.,.. . Maggi, M. (2016). First-generation phosphodiesterase type 5 inhibitors dropout: a comprehensive review and meta-analysis. Andrology, 4(6), 1002–1009. doi: 10.1111/andr.12255 Hinojosa-Gonzalez, D. E., Talamas Mendoza, A., Torres-Martinez, M., Diaz-Garza, K., Hernandez, B. S., Muñoz Hibert, M. I.,.. . Gonzalez-Oyervides, R. (2025). Indirect assessment of low-intensity shockwave therapy's energy density and pulse frequency for erectile dysfunction: a systematic review, bayesian network meta-analysis and meta-regression. Int J Impot Res, 37(4), 278–287. doi: 10.1038/s41443-024-00910-w Chung, E., Lee, J., Liu, C. C., Taniguchi, H., Zhou, H. L., & Park, H. J. (2021). Clinical Practice Guideline Recommendation on the Use of Low Intensity Extracorporeal Shock Wave Therapy and Low Intensity Pulsed Ultrasound Shock Wave Therapy to Treat Erectile Dysfunction: The Asia-Pacific Society for Sexual Medicine Position Statement. World J Mens Health, 39(1), 1–8. doi: 10.5534/wjmh.200077 Additional Declarations There is NO conflict of interest to disclose. Supplementary Files SupplementaryFig.1.pdf Supplementary Fig. 1 SupplementaryFig.2.pdf Supplementary Fig. 2 Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 04 Mar, 2026 Review # 1 received at journal 01 Mar, 2026 Review # 2 received at journal 25 Feb, 2026 Reviewer # 2 agreed at journal 19 Feb, 2026 Reviewer # 1 agreed at journal 19 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 02 Feb, 2026 Unknown event 02 Feb, 2026 Editor assigned by journal 01 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8759236","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":585182130,"identity":"ea926c09-3a59-49b4-b6ba-b5efdc2d7a23","order_by":0,"name":"Hu Zhiyuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIie3Qv0oDMRzA8YSDdAnOkRPvFX7lhlKq6KMkFC6LhU6lo4eQW/oAN/kMmQS3HIG6BGfBwRbh5o4ZCnrXUbg7R8F8phB+X/IHoSD4gwAhgni7GuX5p4erSzIqzC8Tam2Klll6Rh0fTk5YlsXoYMUju4XeZMJkvdsrm0zQHcRLiKRizal+/dSZTEsuQSg7fr53kJZAFirODd649+6LvfEtaxKsqw1wCnShLgyPsOpLhGqTG20pGApMEsZhIJmTNhF6S8QDBeDDiaubmVc51y6yuAQ+Vs0nV71veZH1uV/NrvXHvvCH41eSFEW18+vu5ASTHxumf751HB4JgiD4x74BxtxeZ/Y2ID0AAAAASUVORK5CYII=","orcid":"","institution":"Chinese People's Liberation Army Rocket Force Characteristic Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Hu","middleName":"","lastName":"Zhiyuan","suffix":""},{"id":585182131,"identity":"5c14095e-1c03-4d25-a7c5-35e2b2da2ec3","order_by":1,"name":"Liu Liu Qiangzhao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Liu","middleName":"Liu","lastName":"Qiangzhao","suffix":""},{"id":585182132,"identity":"6ea97b42-42c2-4e81-aab3-cad714b779da","order_by":2,"name":"Lian Qiong","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Lian","middleName":"","lastName":"Qiong","suffix":""},{"id":585182133,"identity":"b80c0e25-5ecd-4f77-b1f0-f66ed9a9a604","order_by":3,"name":"Guo Bohong","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Guo","middleName":"","lastName":"Bohong","suffix":""},{"id":585182134,"identity":"b3b0b8d5-3168-4ee5-abe5-4c920367381c","order_by":4,"name":"Wang Wang Chengbo","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"Wang","lastName":"Chengbo","suffix":""},{"id":585182135,"identity":"4c7986d6-ab18-4fff-9ff9-1764ad32bbda","order_by":5,"name":"Hao Youcheng","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Youcheng","suffix":""}],"badges":[],"createdAt":"2026-02-02 00:25:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8759236/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8759236/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103049894,"identity":"0a7d8423-d69b-4b91-a05f-a49734d57561","added_by":"auto","created_at":"2026-02-20 07:47:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55390,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow chart for the present study.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/1f6c1ceba9cb058ae141bbab.png"},{"id":103049783,"identity":"b9c472d4-90da-4401-8a12-dcdece353a67","added_by":"auto","created_at":"2026-02-20 07:46:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20804,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork geometry for the comparison of individual micro-energy therapies for IIEF.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/c4448943bf177d7ee52bb1cd.png"},{"id":102993828,"identity":"e974d664-a09a-4ecf-8efd-1b1c5d8a1a42","added_by":"auto","created_at":"2026-02-19 11:52:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":88217,"visible":true,"origin":"","legend":"\u003cp\u003eNMA of effectiveness of different micro-energy therapies (SMD and 95 %CI) for IIEF.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/e7a6990540f63e737a53baa6.png"},{"id":103049723,"identity":"3db1efda-0af7-43cf-b9db-84564597fe8c","added_by":"auto","created_at":"2026-02-20 07:45:12","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":19068,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork geometry for the comparison of individual micro-energy therapies for EHS.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/e154c2a90f33c17324bb2e27.png"},{"id":102993824,"identity":"1df7e492-4935-488f-bc97-a4d9722b6361","added_by":"auto","created_at":"2026-02-19 11:52:24","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":62701,"visible":true,"origin":"","legend":"\u003cp\u003eNMA of effectiveness of different micro-energy therapies (SMD and 95 %CI) for EHS.\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/e815dfa84d009118afac8d9e.png"},{"id":102993821,"identity":"c8ec6b65-70f5-4b73-9d71-bdbfc7255868","added_by":"auto","created_at":"2026-02-19 11:52:24","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":30485,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot of IIEF.\u003c/p\u003e","description":"","filename":"Fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/5c4489a9024998881709187e.png"},{"id":102993820,"identity":"39fede4b-acf8-4d5d-b285-bfa0cdbe9ce9","added_by":"auto","created_at":"2026-02-19 11:52:24","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":25578,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot of EHS.\u003c/p\u003e","description":"","filename":"Fig7.png","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/063bf33a750881557053d5cf.png"},{"id":103051134,"identity":"388932c9-18d9-4e45-95d2-d52cdc302883","added_by":"auto","created_at":"2026-02-20 07:58:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1027733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/6083b26a-9148-4eca-bdb4-09b7b826e3bc.pdf"},{"id":102993827,"identity":"ea48f5f4-d0fc-4c3b-95a3-aa7cbbfd6709","added_by":"auto","created_at":"2026-02-19 11:52:24","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":561226,"visible":true,"origin":"","legend":"Supplementary Fig. 1","description":"","filename":"SupplementaryFig.1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/eb3182c5bdf74778e2b2b7a8.pdf"},{"id":103049550,"identity":"0b7b73f8-3e78-4776-bd8b-386f27c12e55","added_by":"auto","created_at":"2026-02-20 07:42:25","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":244548,"visible":true,"origin":"","legend":"Supplementary Fig. 2","description":"","filename":"SupplementaryFig.2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8759236/v1/52d944ffc0a9821a2c5a1f69.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Effectiveness of Micro-Energy Therapies for Erectile Dysfunction: A Systematic Review and Network Meta-analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eErectile dysfunction (ED) represents a worldwide public health issue, profoundly affecting overall health status, with demonstrating a clear upward trend with age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While phosphodiesterase type 5 inhibitors (PDE5i) represent the recommended first-line drug, limitations including inconsistent efficacy, adverse drug reactions, contraindications, and focused on symptom alleviation create an imperative for alternative treatments [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Alternative approaches such as vacuum devices, intracavernosal injections, or penile prostheses are fraught with difficulties due to its invasive nature, acceptability, and long-term utility [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This domain highlights the urgent necessity of effective, durable, and minimally invasive approaches that ameliorate the pathological substrate.\u003c/p\u003e \u003cp\u003eMicro-energy therapies (METs) has risen to prominence as an innovative regenerative therapy with great potential for ED. This approach comprises low-intensity extracorporeal shockwave therapy (LiESWT), electromagnetic field (EMF) therapy and low-intensity pulsed ultrasound (LIPUS) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Such non-invasive methods utilize mechanical or radiative forces to penile tissue, designing to promote tissue repair and regeneration. Potential explanatory frameworks comprise stimulating new blood vessel formation, improving endothelial health and downregulation of nitric oxide synthase, mediating progenitor cell chemotaxis, and promoting axonal regrowth localized to the cavernous tissue [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The application of micro-energy therapies in this field originated with LiESWT, demonstrating promise in sustained improvement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and has broadened to encompass techniques like LIPUS [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and EMF therapy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], individually exhibiting therapeutic benefit among stratified patient populations. Notwithstanding the growing body of evidence, critical gaps in understanding pose a barrier to achieving optimal therapeutic results. First, evidence from comparative studies regarding the comparative efficacy of LiESWT, LIPUS, and EMF is limited, given that most clinical studies employ a sham control arm to assess the specific efficacy of modality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, it is still not well understood whether micro-energy combination therapies demonstrate superior effectiveness in comparison with standalone micro-energy therapies.\u003c/p\u003e \u003cp\u003eConventional pairwise meta-analyses have synthesized evidence against a common control but are constrained in comparing and prioritizing therapeutic options in the absence of direct comparative trials [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Consequently, this systematic review and NMA strives to systematically review and integrate the available evidence to evaluate and hierarchize the efficacy of different METs for ED and evaluate whether micro-energy combination therapies demonstrate superior effectiveness in comparison with standalone micro-energy therapies.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eLiterature searches\u003c/p\u003e \u003cp\u003eThe meta-analysis followed PRISMA guidelines [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and was prospectively registered in the PROSPERO database (CRD420261290462). The Web of Science, Embase, and PubMed databases were systematically searched for relevant studies from January 2002 to January 2026. The keywords and MeSH terms used in the searches included \"Erectile dysfunction\", \"low-intensity extracorporeal shockwave therapy\", \"electromagnetic field therapy\", \"low-intensity pulsed ultrasound\", \"IIEF\", and \"EHS\", to maximize retrieval sensitivity and specificity.\u003c/p\u003e \u003cp\u003eStudy selection\u003c/p\u003e \u003cp\u003eThe criteria used for study inclusion were that: (1) Micro-energy therapies aimed at ED management; (2) provided sufficient quantitative information to calculate the IIEF or EHS; (3) male participants (more than 18) with regular sexual partners;\u003c/p\u003e \u003cp\u003eExclusion criteria included articles lacking adequate data for analysis and publications that were non-original in nature, such as reviews, clinical case reports, editorial opinions, symposium proceedings, commentary, or not RCT articles.\u003c/p\u003e \u003cp\u003eCollection of data and evaluation of studies\u003c/p\u003e \u003cp\u003eTwo researchers independently collected the data using a standardized protocol. Any discrepancies encountered during this process were resolved by consulting a third researcher. Study methodologies and risk of bias were appraised with the the revised Cochrane risk-of-bias tool (RoB 2, version 2), applied independently by two reviewers.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSTATA 18.0 (StataCorp LP, College Station, TX, USA) was used for statistical analyses. As cognitive function was assessed using different instruments across studies, the standardized mean difference\u0026zwnj; (SMD) with 95% confidence interval (CI) was employed as the effect measure. And a random-effects model was employed to pool effect sizes. The Surface Under the Cumulative Ranking Curve (SUCRA) was employed to rank various Micro-energy therapies based on their effectiveness. League tables were generated to present pairwise comparisons between interventions. Possible publication bias was evaluated using funnel plots.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eStudy Selection and Quality Evaluation\u003c/p\u003e \u003cp\u003eFollowing a comprehensive screening process, 22 eligible studies involving 618 participants were retained for the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Supplementary Fig.\u0026nbsp;1, Supplementary Fig.\u0026nbsp;2). Of these, 16 studies focused exclusively on LiESWT [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], 1 study investigated hPMSCs with LiESWT [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. 2 studies evaluated LiESWT with PDE5I [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], 1 study assessed EMF [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], 1 study assessed LIPUS [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], while 1 study assessed LIPUS with PDE5I [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of the eligible studies included in the meta-analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry or City\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eType of ED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSessions per week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnergy density (mJ/mm2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFrequency (Hz)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePulses per session\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTime of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFojecki et al, 2017 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDenmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eSexual\u003c/p\u003e \u003cp\u003eSQoL-M\u003c/p\u003e \u003cp\u003eEDITS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotil et al, 2022 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCzechia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED after RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOng et al, 2022 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalaysia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrtac et al, 2021 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eSafty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShendy et al, 2021 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED with DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003ePSV\u003c/p\u003e \u003cp\u003eEDV\u003c/p\u003e \u003cp\u003eRI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSramkova et al, 2020 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCzechia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eGlobal Assess ment Question\u003c/p\u003e \u003cp\u003eSEP 2\u003c/p\u003e \u003cp\u003eSEP 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKalyvianakis et al, 2017 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePSV\u003c/p\u003e \u003cp\u003eRI\u003c/p\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYama\u0026ccedil;ake et al, 2019 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED with renal transplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLadegaard et al, 2021 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDenmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED after RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhondave et al, 2024 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED with DM refractory to PDE5I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eSHIM\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKalyvianakis et al, 2022 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eMCID\u003c/p\u003e \u003cp\u003eSEP 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVardi et al, 2012 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIsrael\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKim et al, 2020 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eSEP 2\u003c/p\u003e \u003cp\u003eSEP 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChung et al, 2023 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED refractory to PDE5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eEDITS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYee et al, 2014 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJi et al, 2025 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED with DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ehPMSCs and LI-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ehPMSCs or\u003c/p\u003e \u003cp\u003eLI-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eSEP 2\u003c/p\u003e \u003cp\u003eSEP 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGallo et al, 2022 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLIESWT+PDE5I\u0026thinsp;+\u0026thinsp;L-arginine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLIESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eMCID\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMykoniatis et al, 2022 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVasculogenic ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLIESWT+PDE5I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLIESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 Hz\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eMCID\u003c/p\u003e \u003cp\u003eSEP 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoldstein et al, 2024 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLi-ESWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 in 3 wk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eSEP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlzharani et al, 2024 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED with multiple sclerosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eSHIM\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eAXES\u003c/p\u003e \u003cp\u003eMFIS\u003c/p\u003e \u003cp\u003eMSISQ-19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al, 2024 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED with chronic prosatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLIPUS+PDE5I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLIPUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.25 or 2.5 W/cm2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 or1.7 M\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF-5\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eNIH-CPSI\u003c/p\u003e \u003cp\u003ePHQ-9\u003c/p\u003e \u003cp\u003eGAD-7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCui et al, 2019 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLIPUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtrols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.3 W/cm2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.7 M\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003cp\u003eSEP 2/3\u003c/p\u003e \u003cp\u003eGAQ\u003c/p\u003e \u003cp\u003eEHS\u003c/p\u003e \u003cp\u003eEQS\u003c/p\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eIIEF\u003c/h3\u003e\n\u003cp\u003eThe diagram of the network geometry of the interactions among the included trials is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Compared with controls, 5 distinct modalities of micro-energy therapies showed significant improvements in IIEF scores. These micro-energy therapies comprised PDE5I with LIPUS (SMD\u0026thinsp;=\u0026thinsp;2.28, 95% CI 0.53\u0026ndash;4.03), LIPUS (SMD\u0026thinsp;=\u0026thinsp;1.24, 95% CI 0.06\u0026ndash;2.43), PDE5I with LiESWT (SMD\u0026thinsp;=\u0026thinsp;1.73, 95% CI 0.82\u0026ndash;2.65), hPMSCs with LiESWT (SMD\u0026thinsp;=\u0026thinsp;1.68, 95% CI 0.24\u0026ndash;3.13), and LiESWT (SMD\u0026thinsp;=\u0026thinsp;0.98, 95% CI 0.67\u0026ndash;1.30). The comparative effectiveness of the various micro-energy therapies was ranked by employing the SUCRA values, together with the area under the curve and a league chart, as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The SUCRA plot provides a comparative ranking of the efficacy of all micro-energy therapies, encompassing all rank possibilities and their corresponding uncertainties. With respect to the IIEF outcome, PDE5I with LIPUS yielded the highest SUCRA value (86.0%), indicating that it might be more effective than the other micro-energy therapies evaluated.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eEHS\u003c/h3\u003e\n\u003cp\u003eThe diagram of the network geometry of the interactions among the included trials is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Compared with controls, 2 distinct modalities of micro-energy therapies showed statistically significant improvements in EHS scores. These micro-energy therapies included PDE5I with LiESWT (SMD\u0026thinsp;=\u0026thinsp;1.55, 95% CI 0.50\u0026ndash;2.61), and LiESWT (SMD\u0026thinsp;=\u0026thinsp;1.05, 95% CI 0.67\u0026ndash;1.43). The comparative effectiveness of the various micro-energy therapies was ranked by employing the SUCRA values, together with the area under the curve and a league chart, as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The SUCRA plot provides a comparative ranking of the efficacy of all micro-energy therapies, encompassing all rank possibilities and their corresponding uncertainties. With respect to the EHS outcome, PDE5I with LiESWT yielded the highest SUCRA value (92.8%), indicating that it might be more effective than the other PDE5I with LiESWT evaluated.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePublication bias\u003c/p\u003e \u003cp\u003eThe funnel plots depicting no significant publication bias was detected for IIEF and EHS are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, respectively. The studies are arranged symmetrically along the central vertical line (X\u0026thinsp;=\u0026thinsp;0), with the majority of points located within the anticipated funnel boundaries.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur systematic review and network meta-analysis adheres to rigorous systematic review methodology to identify and synthesize all relevant evidence to compare the efficacy of various micro-energy therapies for ED. According to the NMA, significant improvements in the IIEF were observed in LiESWT, hPMSCs with LiESWT, PDE5I with LiESWT, LIPUS,and PDE5I with LIPUS among patients with ED compared to control (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, PDE5I with LIPUS was the most effective psychological therapy for enhancing IIEF, followed by PDE5I with LiESWT, hPMSCs with LiESWT, LIPUS, and LiESWT based on SUCRA. Additionally, according to the NMA, significant increases were observed in PDE5I with LiESWT, and LiESWT resulted in the EHS compared to control (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). PDE5I with LiESWT was ranked as the most effective intervention for enhancing EHS, followed by LiESWT based on SUCRA values.\u003c/p\u003e \u003cp\u003eThe probability of combination therapy being the optimal choice base on SUCRA, notably PDE5I with LIPUS and PDE5I with LiESWT, are consistent with a strong mechanistic basis suggesting the superiority of combination approaches for ED, especially for patients with complex comorbidities or treatment-refractory disease [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The synergistic mechanism of action operates on two levels. The pharmacodynamic effect is achieved through downstream enzymatic inhibition of cGMP-specific phosphodiesterase (PDE5), impeding the catabolism of this second messenger, thereby enhancing signal persistence for reduction in intracavernosal smooth muscle tone [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. On the contrary, METs are hypothesized to act upstream by ameliorating the tissue milieu. Evidence from both preclinical and clinical studies indicates that LiESWT and LIPUS enhances blood vessel formation, increase endothelial nitric oxide synthase (eNOS) expression, induce the homing of progenitor cells, and regulate inflammatory signaling, thus enhancing nitric oxide (NO) bioavailability, the principal driver of the physiological process of erection, and enhancing the mechanical strength of the penile cavernosal bodies [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Consequently, the combined action enhances the initial signal (through both MET-mediated NO synthesis and MET-driven tissue remodeling) and maintains its activity within the cell (potentiating the NO-cGMP pathway by preventing cGMP hydrolysis), potentially mitigating the inherent constraints of monotherapy. This has profound clinical implications for PDE5I non-responders, a subset of patients who could potentially gain from this combined methodology [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results confirm both LiESWT and LIPUS proving to be viable standalone options. While LiESWT has been extensively investigated of further clinical research and meta-analytic review [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], the efficacy and effectiveness of LIPUS in this NMA is notable. LIPUS operates at substantially lower intensities than the intensities required for thermal ablation, eliciting biological responses through physical forces that regulate cell function, blood flow to the tissue, and repair mediated by mechanisms including acoustic microstreaming and associated shear forces. Comparable measures of treatment effect between these two modalities, an observation replicated in a recent systematic review and meta-analysis on METs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], indicate that the predominant biological response - marked by improved blood flow, anti-inflammatory action, and tissue repair and regrowth - could represent a shared mechanism across micro-energy therapies, largely independent of the exact waveform. This lends strong support to the unification of these modalities as part of the MET therapeutic arsenal for ED and demonstrates that clinical decision-making is influenced by multiple factors beyond pure efficacy, including practical considerations like accessibility, affordability, and tolerability.\u003c/p\u003e \u003cp\u003eThe statistically significant effect associated with the combined use of hPMSCs with LiESWT, though derived from a limited dataset, charts a course toward more advanced regenerative therapies. Stem cell therapy targets the reconstruction of compromised cavernosal tissue through differentiation and paracrine activity [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], while LiESWT could precondition the tissue through enhancing the vascular microenvironment, diminishing fibrosis and inflammation, and potentially improving the key determinants of stem cell efficacy: homing, survival, and paracrine function [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This combination marks a departure from the sole focus on symptomatic relief aspiring to restore native tissue architecture, addressing the underlying etiology in disorders such as post-prostatectomy neurovascular injury and severe diabetic angiopathy. It demands rigorous investigation in future high-quality trials for the confirmation of efficacy, safety, and assessment of long-term outcomes.\u003c/p\u003e \u003cp\u003eNotable improvement in EHS scores, a validated patient-administered questionnaire for erectile function, for PDE5I with LiESWT and LiESWT monotherapy, emphasizes the clinical importance of these interventions beyond standardized instrument scores [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. To guide clinical practice, our findings demonstrate that METs constitutes a reasonable alternative for men with vasculogenic erectile dysfunction, patients with an inadequate response to PDE5Is [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], or patients preferring on-demand use, medical device interventions. The choice between LiESWT and LIPUS hinges initially on the assessment of the availability of medical devices and the proficiency of clinicians, given the comparable effectiveness observed in this study.\u003c/p\u003e \u003cp\u003eHowever, the translation of this evidence is moderated by the ongoing research to define optimal treatment parameters. While our network meta-analysis compared the effectiveness of different treatment modalities, other dedicated analyses have investigated the dose-response relationships in LiESWT. The Bayesian network meta-analysis from Hinojosa-Gonzalez et al indicated that an energy flux density set at 0.15 mJ/mm\u003csup\u003e2\u003c/sup\u003e and a regimen of 1500 pulses per treatment session appears to be one of the most effective parameter sets [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. By contrast, the traditional pairwise meta-analysis conducted by Li et al observed no significant difference regardless of energy density or pulse count, though it found that a twice-weekly frequency was superior to a once-weekly one [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This suggests that while a wide range of parameters within treatment within a defined low-intensity window is feasible, more precise optimization might lead to modest further improvements and merits consideration in the design of study protocols. Future efforts to standardize should attempt to resolve these apparent discrepancies to define standardized, efficacious treatment protocols [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eSeveral limitations of this study require appropriate consideration. Firstly, merely a single suitable trial was obtainable for EMF and LIPUS, potentially compromising the reliability and generalizability of the efficacy determinations. Consequently, these findings demand careful consideration. Second, considering that ED is affecting by multifaceted influences across the lifespan, the study population incorporated diverse patient groups - including malignancy survivors and diabetes mellitus - may modify the relative effectiveness of micro-energy therapies. Finally, restricted participant numbers and variations in treatment strategies and experimental designs among the included studies constrained the practicality of subgroup examinations based on key factors such as particular health disorders or symptom severity. Further investigations should implementation of larger, multi-center, high-quality RCTs to validate and broaden these findings.\u003c/p\u003e \u003cp\u003eDespite these considerations, these findings provide an assessment of various micro-energy therapies on ED, as well as a reference for further research aimed at refining clinical decision-making in this setting.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, this network meta-analysis compared the effectiveness of diverse micro-energy therapies on both the IIEF and the EHS in men with ED. The results indicate that PDE5I with LIPUS was the most effective micro-energy therapy for enhancing IIEF appears more effective in ameliorating IIEF scores, while PDE5I with LiESWT shows superior outcomes for enhancing EHS scores. Nevertheless, owing to the limited number of studies available for each therapeutic approach and the diversity of micro-energy therapies, this review's scope remains incomplete. Further investigations should implementation of larger, multi-center, high-quality RCTs to validate and broaden these findings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv id=\"AGS1\" class=\"AbbreviationGroupSection\"\u003e \u003cdiv class=\"Heading\"\u003e\u003c/div\u003e \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eErectile dysfunction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePDE5i\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhosphodiesterase type 5 inhibitors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMETs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMicro-energy therapies\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLiESWT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-intensity extracorporeal shockwave therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectromagnetic field\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLIPUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-intensity pulsed ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNetwork meta analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIIEF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Index of Erectile Function\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eErection Hardness Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandardized mean difference\u0026zwnj;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eeNOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndothelial nitric oxide synthase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNitric oxide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeldman, H. 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World J Mens Health, 39(1), 1\u0026ndash;8. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5534/wjmh.200077\u003c/span\u003e\u003cspan address=\"10.5534/wjmh.200077\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-impotence-research","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijir","sideBox":"Learn more about [International Journal of Impotence Research](http://www.nature.com/ijir/)","snPcode":"41443","submissionUrl":"https://mts-ijir.nature.com/cgi-bin/main.plex","title":"International Journal of Impotence Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"erectile dysfunction, micro-energy therapies, meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-8759236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8759236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe efficacy of diverse micro-energy therapies (METs) on erectile dysfunction (ED) were evaluated using a network meta analysis (NMA) to generate evidence-based guidance for selecting appropriate micro-energy therapies. A comprehensive systematic review and network meta-analysis were conducted by evaluating the effects of all micro-energy therapies on ED. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.18.0. Twenty-two studies encompassing 618 participants met the inclusion criteria. According to the NMA, significant improvements in the International Index of Erectile Function (IIEF) were observed in LiESWT, hPMSCs with LiESWT, PDE5I with LiESWT, LIPUS, and PDE5I with LIPUS among patients with ED compared to control (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, PDE5I with LIPUS was the most effective micro-energy therapy for enhancing IIEF, followed by PDE5I with LiESWT, hPMSCs with LiESWT, LIPUS, and LiESWT based on surface Under the Cumulative Ranking Curve (SUCRA). Additionally, according to the NMA, significant increases were observed in PDE5I with LiESWT, and LiESWT resulted in the Erection Hardness Score (EHS) compared to control (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). PDE5I with LiESWT was ranked as the most effective intervention for enhancing EHS, followed by LiESWT based on SUCRA values. The available evidence shows PDE5I with LIPUS appears more effective in enhancing IIEF scores, while PDE5I with LiESWT shows superior outcomes for enhancing EHS scores. Nevertheless, owing to the limited number of studies available for each therapeutic approach and the diversity of micro-energy therapies, this review's scope remains incomplete.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Micro-Energy Therapies for Erectile Dysfunction: A Systematic Review and Network Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 11:52:16","doi":"10.21203/rs.3.rs-8759236/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-03-04T14:00:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-03-01T13:28:55+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-02-25T14:57:44+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-19T16:00:47+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-19T08:41:52+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2026-02-17T09:52:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T16:20:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Impotence Research","date":"2026-02-02T15:24:35+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2026-02-02T14:43:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T00:21:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-impotence-research","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijir","sideBox":"Learn more about [International Journal of Impotence Research](http://www.nature.com/ijir/)","snPcode":"41443","submissionUrl":"https://mts-ijir.nature.com/cgi-bin/main.plex","title":"International Journal of Impotence Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a708758f-a8c9-4673-855e-418af418d23a","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":62255119,"name":"Health sciences/Diseases/Reproductive disorders/Sexual dysfunction"},{"id":62255120,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2026-03-12T10:07:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 11:52:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8759236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8759236","identity":"rs-8759236","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}