The expert urologist surgeon in reconstructive penile surgery, Peyronie’s disease and Sexual Medicine, Dr. François Peinado, has stated that shock waves can “produce modest improvements in erectile function, but the available evidence still does not allow its real clinical efficacy to be confirmed with sufficient solidity.”
As he has recalled, “after more than a decade of clinical use, we still do not have solid, consistent, and high-quality evidence that clearly confirms its real clinical efficacy,” referring to a 2025 Cochrane review that analyzed 21 randomized clinical trials with 1,357 men and concluded that the overall quality of the evidence is low in almost all the evaluated parameters.
Regarding the results, he has pointed out that the published studies suggest a certain short-term improvement in erectile function with this therapy. However, he has warned that, “in many cases, the changes are small, barely exceeding the minimum threshold considered clinically relevant, and not always translating into a significant sexual improvement for the patient.” He has also specified that “small improvements in penile rigidity were also observed, although the results were modest and the changes were situated near the minimum threshold considered clinically important.”
With regard to longer-term follow-up, Peinado has commented that “in the long term, the results seem somewhat better, but they are based on fewer studies and show greater heterogeneity, which reduces confidence in the data,” and he added that “the review also does not show clear differences in adverse effects, but it does not provide solid data on quality of life or patient satisfaction.”
They call for more rigorous and higher-quality trials
In his view, “the objective of treatment goes beyond improving a score,” since “it is about achieving a clear functional recovery of the patient’s erections and sexual life.” For this reason, he has insisted that “current results may not be reliable and could change significantly with better designed and higher-quality studies,” despite the fact that “shock waves have an attractive theoretical basis, related to angiogenesis, vascular regeneration, or tissue repair.”
The specialist has emphasized that this technique must be differentiated from already established therapies, such as PDE5 inhibitors, among which include sildenafil and tadalafil. In his view, "shock waves show modest results, high variability, and evidence that is still insufficient," although he has clarified that "this does not mean that no patient can benefit."
Along these lines, he has reiterated that "the point is that it is still not known with sufficient precision in which patients it works best, what the appropriate protocol is, how long the effect lasts, and what results can truly be expected," and he has concluded that, "in rigorous Medicine, that uncertainty is a problem and must be explained to the patient clearly."