Pelvic fracture urethral injury (PFUI) frequently results in long-term erectile dysfunction (ED), severely impacting quality of life. Low-intensity shockwave therapy (LiSWT) promotes neovascularization and tissue perfusion via VEGF and nitric oxide pathways, offering a potential regenerative treatment for post-traumatic ED. This study aims to evaluate the efficacy and safety of LiSWT for ED secondary to urethral injury from pelvic fractures.
This pilot study included 25 men with ED post-PFUI. Participants received six weekly sessions of LiSWT (24,000 shocks total) using a piezoelectric device. Assessments included the International Index of Erectile Function (IIEF) and Erectile Hardness Scale (EHS) at baseline and at 3, 6, and 12 months' post-treatment, while penile Doppler ultrasound was done at baseline and 12 months' post-treatment.
IIEF scores improved significantly from 14.4 ± 3.2 at baseline to 17.4 ± 3.2 (p = 0.002) post-LiSWT, 16.4 ± 3.2 (p = 0.036) at 3 months, 17.4 ± 3.2 (p = 0.002) at 6 months, and 17.8 ± 3.7 (p < 0.001) at 12 months. EHS increased significantly at all follow-ups (p < 0.001), with a further rise between 3 months 2.35 ± 0.53 and 12 months 2.74 ± 0.58 (p = 0.009). PSV increased from 23.4 ± 6.1 at baseline to 34.1 ± 9.1 (p < 0.001) at 12 months, EDV decreased from 6.68 ± 2.95 at baseline to 3.84 ± 2.70 (p = 0.002) at 12 months, and RI increased from 0.66 ± 0.22 at baseline to 0.86 ± 0.13 (p < 0.001) at 12 months.
LiSWT is safe and effective for ED after PFUI, producing sustained improvements in erectile function, penile rigidity, and hemodynamics, representing a promising noninvasive therapeutic option for post-traumatic ED.
ClinicalTrials.gov NCT07460167, registered 10 March 2026, retrospectively registered.
International urology and nephrology. 2026 Jun 23 [Epub ahead of print]
Atef Fathi, Gamal Alsagheer, Mohammed Talaat, Mostafa AbdelRazek
Department of Urology, Qena University Hospital, South Valley University, Qena, Egypt., Department of Urology, Qena University Hospital, South Valley University, Qena, Egypt. .