Effectiveness of Micro-Energy Therapies for Erectile Dysfunction: A Systematic Review and Network Meta-analysis

The efficacy of diverse micro-energy therapies (METs) on erectile dysfunction (ED) were evaluated using a network meta analysis (NMA) to generate evidence-based guidance for selecting appropriate micro-energy therapies. A comprehensive systematic review and network meta-analysis were conducted by evaluating the effects of all micro-energy therapies on ED. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.18.0. Twenty-two studies encompassing 618 participants met the inclusion criteria. According to the NMA, significant improvements in the International Index of Erectile Function (IIEF) were observed in LiESWT, hPMSCs with LiESWT, PDE5I with LiESWT, LIPUS, and PDE5I with LIPUS among patients with ED compared to control (P < 0.05). Furthermore, PDE5I with LIPUS was the most effective micro-energy therapy for enhancing IIEF, followed by PDE5I with LiESWT, hPMSCs with LiESWT, LIPUS, and LiESWT based on surface Under the Cumulative Ranking Curve (SUCRA). Additionally, according to the NMA, significant increases were observed in PDE5I with LiESWT, and LiESWT resulted in the Erection Hardness Score (EHS) compared to control (P < 0.05). PDE5I with LiESWT was ranked as the most effective intervention for enhancing EHS, followed by LiESWT based on SUCRA values. The available evidence shows PDE5I with LIPUS appears more effective in enhancing IIEF scores, while PDE5I with LiESWT shows superior outcomes for enhancing EHS scores. Nevertheless, owing to the limited number of studies available for each therapeutic approach and the diversity of micro-energy therapies, this review's scope remains incomplete.