In the treatment of mild to moderate erectile dysfunction (ED), low-intensity extracorporeal shockwave therapy (Li-SWT) combined with tadalafil helps improve outcomes, according to the preliminary results of a study from China.

After 1 month of treatment, the mean International Index of Erectile Function-5 (IIEF-5) scores significantly increased from baseline for participants who received Li-SWT plus tadalafil (from 11.57 to 15.34; p<0.001) and those who underwent Li-SWT alone (from 11.03 to 13.96; p=0.021), with the scores being higher in the combination group (p=0.039), reported first author Dr Mujun Lu from the Shanghai Renji Hospital in Shanghai China. [EAU 2025, abstract A0552]

Results for erection hardness followed a similar pattern, Lu added. Erection Hardness Scale (EHS) scores increased from 2.32 at baseline to 2.85 at 1 month with Li-SWT plus tadalafil (p<0.001) and from 2.41 to 2.69 with Li-SWT alone (p=0.036), with the scores being significantly higher in the combination vs Li-SWT alone group (p=0.030).

Lu also noted that the percentage of participants with self-reported efficiency was significantly greater in the combination group than in the Li-SWT alone group (61.2 percent vs 47.6 percent; p=0.013).

In subgroup analyses, the beneficial effects of the combination of Li-SWT plus tadalafil on the examined outcomes among participants with mild or moderate ED were consistent with that seen in the overall population, according to Lu. Compared with the Li-SWT alone, the combination was associated with significantly higher IIEF-5 (14.50 vs 12.87; p=0.040) and EHS (2.85 vs 2.81; p=0.046) scores and greater percentage of participants with self-reported efficiency (64.2 percent vs 54.1 percent; p=0.001).

Overall, the findings demonstrate that while once-weekly Li-SWT alone or in combination with daily tadalafil can improve erectile function in men with mild or moderate ED, the combination has a better therapeutic effect and should be recommended in clinical practice, Lu said.

The EAU guidelines recommend the use of Li-SWT for treating mild vasculogenic ED, and the present work provides evidence supporting its use in moderate ED, he added.

The study included 152 men with ED (IIEF-5 score <22) between 18 and 60 years of age, enrolled from three clinical centres in China. These men were randomly assigned to undergo Li-SWT using a linear low-energy shock waves generator either alone (n=42, mean age 37.43 years) or in combination with the phosphodiesterase type 5 inhibitor tadalafil (n=116, mean age 37.41 years). Li-SWT was conducted with an energy density of 0.09 mJ/mm², once a week for 4 weeks. Tadalafil was administered orally daily at a dose of 5 mg for 4 weeks.  

Lu and his colleague, Dr Yanping Huang also from the Shanghai Renji Hospital, collected demographic data, as well as IIEF-5, EHS, and self-reported symptom measurements at baseline and at 1 month after treatment.