EDITORIAL COMMENT

The therapeutic mechanism of extracorporeal low-intensity shock wave treatment (LIST) is not clear yet, but the acoustic energy of LIST stimulates the penile tissue by causing micromechanical effects and microtrauma. Animal studies have shown that shock wave energy improved nerve stimulated erection in diabetic rats, increased the endothelial content of penile tissue, improved the smooth muscle content, and up-regulated the expression of growth factors (1-2). In this study, the authors investigated the effect of LIST in patients with severe erectile dysfunction who are PDE5i nonresponders and compared with sham controls. The median change in International Index of Erectile Function-Erectile Function score and Erection Hardness Score was significantly high in treatment group compared to sham group. In conclusion, LIST treatment is effective in patients with severe erectile dysfunction. The accumulation of clinical data on LIST may alter the algorithm of erectile dysfunction treatment in near future.