Evaluation of cavernosal oxidative biomarkers following radial Li-ESWT in vasculogenic erectile dysfunction

Vasculogenic erectile dysfunction (ED) is associated with endothelial dysfunction and oxidative stress. This study evaluated the clinical efficacy of radial-type low-intensity extracorporeal shockwave therapy (Li-ESWT) and its effects on cavernosal oxidative stress biomarkers.

In this prospective study, 48 men with vasculogenic ED underwent 12 sessions of radial-type Li-ESWT. Erectile function was assessed at baseline, 1 month, and 6 months using the International Index of Erectile Function-Erectile Function domain (IIEF-EF) and Erection Hardness Score (EHS). Cavernosal blood samples were collected before treatment and one week after completion to measure superoxide dismutase (SOD), ischemia-modified albumin (IMA), thiol-disulfide homeostasis, and glutathione redox status.

At 6 months, 43.8% of patients achieved a clinically meaningful improvement in IIEF-EF. Both IIEF-EF and EHS scores improved significantly at 1 and 6 months (p < 0.001). In exploratory multivariable logistic regression analysis, prior PDE5i responsiveness remained independently associated with clinically meaningful improvement (OR 5.59, 95% CI 1.24-25.23; p = 0.025), whereas HbA1c did not retain significance. No significant changes were observed in SOD, IMA, or glutathione redox status. Borderline thiol-disulfide alterations observed in unadjusted analyses did not remain significant after correction for multiple comparisons and were not associated with clinical outcomes.

Radial-type Li-ESWT was associated with clinically meaningful improvements in erectile function in men with vasculogenic ED. However, no robust oxidative biomarker changes were observed in cavernosal blood following treatment.