Although pharmacological therapy remains the primary treatment for erectile dysfunction, a proportion of patients present unsatisfactory responses or contraindications. (1) In this context, non-invasive therapies have been investigated as alternative approaches. Non-ablative radiofrequency and low-intensity extracorporeal shockwave therapy have shown potential to improve erectile function through mechanisms related to tissue modulation, neovascularization, and improved penile perfusion. (2,3) However, evidence regarding the combined use of these therapies remains limited. This study aimed to describe changes in erectile function, erection quality, and penile hemodynamic parameters in non-prostatectomized patients with erectile dysfunction undergoing combined treatment with non-ablative radiofrequency and low-intensity extracorporeal shockwave therapy.

This was a longitudinal descriptive single-arm study derived from a randomized clinical trial. Seven men diagnosed with erectile dysfunction who were allocated to the combined treatment group in the original trial and who had not undergone prostatectomy were included. Participants underwent a treatment protocol consisting of twelve sessions combining non-ablative radiofrequency and low-intensity extracorporeal shockwave therapy. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5), and erection quality was evaluated using the Quality of Erection Questionnaire (QEQ). Penile hemodynamic assessment was performed using Doppler ultrasound, including peak systolic velocity, end-diastolic velocity, and cavernous artery diameter. Data were analyzed descriptively by comparing pre- and post-intervention measurements. Ethical approval was obtained in the city of origin.

After the therapeutic protocol, a mean increase of 18% in the IIEF-5 score and a mean increase of 19 points in the QEQ score were observed. Three participants showed improvement in both questionnaires simultaneously, suggesting a potential clinical benefit associated with the combined treatment. Penile Doppler evaluation showed variations in peak systolic velocity, end-diastolic velocity, and cavernous artery diameter after the intervention, with a tendency toward reduction in some parameters. No relevant adverse events were reported during the treatment period, and all participants completed the therapeutic protocol.

The findings suggest a trend toward clinical improvement in erectile function and erection quality following combined treatment with non-ablative radiofrequency and low-intensity extracorporeal shockwave therapy. The simultaneous improvement in both questionnaires in some participants may indicate a potential synergistic effect between the two therapeutic modalities. Variations in hemodynamic parameters may also reflect treatment-related changes in penile perfusion. However, these findings should be interpreted cautiously due to the small sample size and the descriptive nature of the analysis.

Combined treatment with non-ablative radiofrequency and low-intensity extracorporeal shockwave therapy showed limited clinical improvement in erectile function and erection quality and demonstrated a satisfactory safety profile. These results suggest that this combination may represent a promising non-invasive therapeutic alternative for the management of erectile dysfunction.

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