SynthesisAndrology2026
Comparative efficacy of combination therapy including regenerative therapies versus monotherapy for erectile dysfunction: A systematic review and meta-analysis.
Synthesis in Andrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Beyond symptomatic treatment: PDE5 inhibitors as initiators, enablers, and sustainers of erectile function.International journal of impotence research · 2026Review
- Penile Rehabilitation After Surgery for Prostate Cancer: An Umbrella Review on Traditional Approaches and Novel Perspectives.Journal of clinical medicine · 2026Review
- Erectile Dysfunction: A Comprehensive Review of Pathophysiology, Diagnosis and Contemporary Management.Medicina (Kaunas, Lithuania) · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveThe Current European Association of Urology guidelines do not provide recommendation for combination of regenerative therapies with standard therapies for erectile dysfunction. The aim of this study was to compare the efficacy of combined regenerative therapy with monotherapy for erectile dysfunction.
methodsA systematic review and meta-analysis were conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The protocol was registered on PROSPERO (CRD42024522307). Randomized controlled trials and prospective/retrospective studies comparing combination therapies (low-intensity external shockwave therapy, platelet-rich plasma, stem cell therapy with phosphodiesterase-5 inhibitors, or other treatments) with monotherapy were included. Erectile function was assessed using the International Index of Erectile Function-5 and Erection Hardness Scale. Groups were compared using standardized mean difference. Subgroup analyses based on treatment type, erectile dysfunction cause, and follow-up duration were also conducted. Risk of bias was assessed using risk of bias 2 and Robins-I tools. KEY FINDINGS AND LIMITATIONS: Of 1416 articles screened, eight studies involving 553 patients met the inclusion criteria. All studies included phosphodiesterase-5 inhibitors and low-intensity external shockwave therapy as regenerative treatment, with no studies on stem cell therapy or platelet-rich plasma. After treatment, no significant difference in International Index of Erectile Function scores was found between combination and monotherapy groups. However, subgroup analysis revealed that combination therapy showed a statistically significant improvement compared to low-intensity external shockwave therapy alone (standardized mean difference: 0.61; 95% confidence interval: 0.13‒1.09; p = 0.013). A statistically significant improvement was found in vasculogenic (standardized mean difference: 0.65; p < 0.001) and diabetic cases (standardized mean difference: 1.05; p < 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS: Combination of phosphodiesterase-5 inhibitors and intensity external shockwave therapy resulted in significant improvement of International Index of Erectile Function compared to intensity external shockwave therapy alone. However, the risk of bias was high because of the low quality of the studies. PATIENT SUMMARY: Combination of phosphodiesterase-5 inhibitor with intensity external shockwave therapy significantly improved erectile function, especially in patients with vasculogenic erectile dysfunction or diabetes.
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